Hair Repigmentation from the Drug Acitretin in an 80 Year old Man

50 mg Acitretin Caused Hair Repigmentation after 20 months of Treatment

I read with great interest a nice report by Dr Eunice Chow and Dr Thomas Salopek from the University of Alberta regarding an 80-year-old man who had remarkable hair repigmentation after using the vitamin A derivative acitretin.

The man was diagnosed with a skin condition known as pityriasis rubra pilaris (PRP) and was started on acitretin 40 mg daily and then increased to 50 mg once daily. His medical history included hypertension and diabetes. His medication list also included aspirin, betamethasone valerate 0.1% cream, hydrocortisone valerate 0.2% cream, indapamide, lisinopril, and metformin. After 18 months of treatment with acitretin and topical steroids, he resolved all cutaneous and nail changes completely. What was so interesting about this report was that by the 20th month, he started noticing that his previously white hair started to darken ! A photo from this nice report is shown below:

Hair repigmentation in a patient using acitretin. FROM: Chow  EY and Salopek TG. Acitretin-Induced Repigmentation of Gray Hair: A Case Report. Cureus. 2024 Apr 14;16(4):e58261. doi: 10.7759/cureus.58261. eCollection 2024 Apr.

Other Reports of Acitretin-Induced Repigmentation

The authors point out that this is not the first report of acitretin causing repigmentation. There are, in fact, a few other reports in the medical literature (see reference below). However, most other reports describe patients who not only experienced hair repigmentation but also experienced curling of the hair. What was unique about this report is that the patient experienced repigmentation but not hair curling.

Hair repigmentation has also been reported with etretinate therapy (another retinoid) and I’ve put this reference in the reference list too

Why would acitretin darken hair?

The authors point out that the exact mechanism by which acitretin darkens hair is not known. The authors propose that several mechanisms could be important. One such mechanism is the ability of acitretin to lower IL-6 levels. IL-6 normally functions to inhibit melanogenesis so lowering IL-6 could favor pigmentation. Another possible mechanism is through acitretin’s ability to increase retinoic acid and, in turn, upregulate the C KIT receptor (which would sensitive melanocyte stem cells to the KIT ligand).

Summary and Conclusion

This was a nice report that reminds us all to keep acitretin on our list of drugs that cause hair repigmentation.

The authors remind us in their report that several classes of drugs can induce hair repigmentation. These include:

a) monoclonal antibodies (adalimumab, dupilumab, checkpoint inhibitors, secukinumab, Ustekinumab

b) tyrosine kinase inhibitors (imatinib, sorafenib, erlotinib, dasatinib_

c) immunosuppressants (thalidomide, cyclosporine and prednisone)

d) others (retinoids, interferons, latanoprost, tamoxifen, levodopa, L-thyroxine, others)

REFERENCE

Chow  EY and Salopek TG. Acitretin-Induced Repigmentation of Gray Hair: A Case Report. Cureus. 2024 Apr 14;16(4):e58261. doi: 10.7759/cureus.58261. eCollection 2024 Apr.

Seckin D, Yildiz A. Repigmentation and curling of hair after acitretin therapy. . Australas J Dermatol. 2009;50:214–216.

Ward PD, Miller HL, Shipman AR. A case of repigmentation and curling of hair on acitretin therapy. . Clin Exp Dermatol. 2014;39:91–92.

Nagase K, Inoue T, Narisawa Y. Manifest hair repigmentation associated with etretinate therapy. J Dermatol. 2017;44:0–5.