Immune-related alopecia (areata and universalis) in cancer patients receiving immune checkpoint inhibitors Journal Article


Authors: Zarbo, A.; Belum, V. R.; Sibaud, V.; Oudard, S.; Postow, M. A.; Hsieh, J. J.; Motzer, R. J.; Busam, K. J.; Lacouture, M. E.
Article Title: Immune-related alopecia (areata and universalis) in cancer patients receiving immune checkpoint inhibitors
Abstract: Cytotoxic T-lymphocyte-associated protein-4, programmed cell death protein and programmed cell death protein ligand 1 monoclonal antibodies (immune checkpoint inhibitors), are used to treat various malignancies. Their mechanism of action involves the inhibition of negative regulators of immune activation, resulting in immune-related adverse events (irAEs) including endocrinopathies, pneumonitis, colitis, hepatitis and dermatological events. Dermatological irAEs include maculopapular rash, pruritus, vitiligo, blistering disorders, mucocutaneous lichenoid eruptions, rosacea and the exacerbation of psoriasis. Alopecia secondary to immune checkpoint inhibitors has been reported in 1·0–2·0% of treated patients. Our objective is to characterize for the first time the clinicopathology of patients with alopecia areata (AA) secondary to immune checkpoint inhibitors, including the first report of anti-PD-L1 therapy-induced AA, and review of the literature. Four cases of patients who developed partial or complete alopecia during treatment with immune checkpoint inhibitors for underlying cancer were identified from our clinics. Methods include the review of the history and clinicopathologic features. Three patients (75%) had AA and one had universalis. Two patients had a resolution after topical, oral or intralesional therapies and one had a resolution after immunotherapy was discontinued; all regrown hair exhibited poliosis. One of the four patients had coincident onychodystrophy. This report describes a series of four patients who developed partial or complete alopecia (i.e. areata and universalis) during treatment with immune checkpoint inhibitor therapies for cancer. The recognition and management of hair-related irAEs are important for pretherapy counselling and interventions that contribute to maintaining optimal health-related quality of life in patients. © 2016 British Association of Dermatologists
Journal Title: British Journal of Dermatology
Volume: 176
Issue: 6
ISSN: 0007-0963
Publisher: Blackwell Publishing  
Date Published: 2017-06-01
Start Page: 1649
End Page: 1652
Language: English
DOI: 10.1111/bjd.15237
PROVIDER: scopus
PMCID: PMC5459625
PUBMED: 27943234
DOI/URL:
Notes: Article -- Export Date: 3 July 2017 -- Source: Scopus
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  1. Mario E Lacouture
    457 Lacouture
  2. Robert Motzer
    1243 Motzer
  3. James J Hsieh
    125 Hsieh
  4. Klaus J Busam
    688 Busam
  5. Viswanath Reddy Belum
    38 Belum