Encyclopedia · drug with hair side effects
Immune checkpoint inhibitors (nivolumab, pembrolizumab)
Anti-PD-1 cancer immunotherapy darkened white hair in 13 of 14 lung cancer patients in one series, and in a single case left a persistent curly-hair look.
What it is
Antibody drugs that release the brakes on T cells. They are prescription-only, given by infusion for many cancers.
How it works
Hypotheses only: immune modulation could change the pigment environment of the follicle. The authors of one series proposed that repigmentation might mark a good response to treatment.
What the studies show
- In 14 lung cancer patients on anti-PD-1/PD-L1 drugs (13 men), 13 had diffuse darkening of hair, and 13 had at least stable disease. Rivera 2017
- One patient developed persistently curly hair after nivolumab; the authors noted alopecia had been the only hair effect previously tied to the class. Dasanu 2017
- A systematic review of 27 low-quality studies lists inflammatory-pathway drugs among those reported to repigment gray hair. Yale 2020
Caveats: 14 selected, uncontrolled patients. The response-marker idea is a hypothesis, and survivorship bias is likely, since people who respond live long enough to notice.
How it's used in studies
Standard oncology dosing only.
Side effects and safety
Serious immune-related effects are possible (colitis, hepatitis, hormone-gland problems and others). The hair colour change is incidental.
Bottom line
Interesting but not actionable. Do not treat repigmentation as a diagnostic sign. Discuss with a doctor.
Fun facts
- In a 14-patient lung-cancer series, white hair darkened during anti-PD-1 therapy, and 13 of the 14 were doing at least stably. Rivera 2017
Studies 3
Rivera N et al. Hair repigmentation during immunotherapy treatment with an anti-programmed cell death 1 and anti-programmed cell death ligand 1 agent for lung cancer. JAMA Dermatol. 2017
Result: Diffuse darkening of hair in 13 of 14; 13 had at least stable disease.
Read the study ↗Dasanu CA et al. Persistently curly hair phenotype with the use of nivolumab for squamous cell lung cancer. J Oncol Pharm Pract. 2017 (case)
Result: A case report of persistently curly hair after the cancer drug nivolumab.
Read the study ↗Yale K et al. Medication-induced repigmentation of gray hair: a systematic review. Skin Appendage Disord. 2020
Result: Many drugs and some B vitamins were reported to repigment gray hair, mostly as incidental, low-quality reports.
Read the study ↗Related
- Drug-induced hair changesMedicines can thin hair, regrow it curly, darken or whiten it, or lengthen lashes; this table sorts the best-known links by how strong the evidence is.
- Gray hair and premature grayingGraying is mostly genetic, but single-hair mapping shows some gray hairs can regain colour, and the famous stress-causes-gray mechanism has only been proven in mice.
- ImatinibA leukaemia drug that blocks the receptor pigment cells depend on can lighten or whiten hair reversibly, and oddly has also been listed among drugs that darkened gray hair.
- EGFR inhibitors (erlotinib, cetuximab)Cancer drugs that block the EGF receptor can make eyelashes grow abnormally long and curly, and scalp hair curly or brittle, all reversing after the drug stops.