Repigmentation of the white hair after systemic corticosteroids for bullous pemphigoid

Abstract

stopped ART long back. Investigations revealed CD4 + counts 12 cells/mL, reactive Toxoplasma-IgM ELISA, haemoglobulin 8 g% and ESR 95 mm in first hour. He could not afford viral load studies. With reinstitution of triple ART and prophylaxis for opportunistic infections, he was free of all skin/scrotal lesions within a week. DiscussionHIV-associated psoriasis usually develops in non-terminal stages of AIDS and is frequently severe, recalcitrant to therapy and has associated arthritis six times more often. 4 The clinical appearance is rather uniform with facial seborrhea, scalp, flexural and acral involvement, palmoplantar pustulosis and asymptomatic arthritis. 5 A considerable clinical overlap occurs between psoriasis, psoriatic arthropathy and Reiter's syndrome that correlates with the presence of HLA-B27, suggesting that HIV-associated psoriasis and Reiter's syndrome perhaps constitutes a continuum of similarly expressed cutaneous disease in genetically predisposed individuals manifesting with a psoriatic spectrum having Reiter's dsyndrome as its severest manifestation. 2,4 Although his past immune status was uncertain, he had similar manifestations at that time and a diagnostic/therapeutic dilemma of Reiter's syndrome for years.HIV infection shares many immunologic features with psoriasis including increased production of cytokines relevant to pathogenesis of psoriasis. 6,7 There is evidence that HIV plays a direct role in the pathogenesis of HIV-related psoriasis in genetically predisposed patients. 3,8,9 However, degree of immunosuppression and the type or severity of HIV-related psoriasis show no correlation. Paradoxically, it worsens with immunosuppression unlike classical psoriasis. Falling CD4 + cell counts (as observed in our patient) or ART resistance precipitates psoriasis relapses while clinical improvement occurs in the absence of viral replication implying that efficacy of ART in HIV-related psoriasis is attributable to improved cytokine imbalance/ immunosuppression following reduction of HIV load rather than to CD4 + cells. 3,10 Excellent response to triple ART in our patient substantiates foregoing observations. As the therapeutic effect seems only suppressive, ART irrespective of CD4 + cell counts would greatly improve survival and quality of life in these patients. VK Mahajan, NL References1 Buccheri L, Katchen BR, Karte AJ, Cohen SR. Acitretin therapy is effective for psoriasis associated with Human Immunodeficiency virus infection. Arch Dermatol 1997; 133: 711-715. 2 Breuer-McHam J, Marshall G, Adu-Oppong A et al. Alterations in HIV expression with psoriasis or pruritus treated with phototherapy. J Am Acad Dermatol 1999; 40: 48 -60. 3 Duvic M, Crane MM, Conant M, Mahoney SE, Reveille JD, Lehrman SN. Zidovudine improves psoriasis in human immunodeficiency virus-positive males. Arch Dermatol 1994; 130: 447-451. 4 Reveille JD, Conant MA, Duvic M. Human immunodeficiency virus-associated psoriasis, psoriatic arthritis and Reiter's syndrome: a disease continuum. Arthritis Rheum 1990; 33: 1574-157...

Repigmentation and curling of hair after acitretin therapy

“…Acitretin, a widely used drug in dermatology, can be listed among those drugs that may induce changes in hair colour and texture. 3 Defibrotide Deep venous thrombosis Darkening 7 months Rebora et al 4 Cyclosporine Erythroderma Darkening 1 month Khaled et al 5 Corticosteroid Bullous pemphigoid Darkening 4 months Nanda et al 6 Etretinate Psoriasis Lightening 3 months Vesper et al 7 Etretinate Pityriasis rubra pilaris Darkening 9 months Fleming et al 10 a-Interferon Melanoma Lightening 5 months Redondo et al 11 L-thyroxine Hypothyroidism Darkening 1 month Read 12 Verapamil Hypertension Darkening 1 year Hampson et al 13 Tamoxifen Breast cancer Darkening 2.5 years Reynolds et al 14 Levodopa Parkinson's disease Darkening 8 months Robinson et al 15 Cisplatin Cancer treatment Darkening or lightening Not recorded Noppakun et al 16 Cyanocobalamine Pernicious anaemia Darkening 2 months 9 Acitretin 50 mg/day Psoriasis 53-year-old woman, hair kinking 3 months Present case Acitretin 25 mg/day Psoriasis 70-year-old woman, hair curling 6 months Figure 1 Repigmentation of white hair is most prominent in the occipital region; however, black hairs interspersed between white hairs are also seen in the rest of the scalp. The hair also has a curly texture.…”

“…1 Drug-induced changes in the colour and texture of hair have been reported for a variety of drugs, including tamoxifen, valproic acid, defibrotide, cyclosporine, corticosteroids, verapamil, levodopa, a-interferon, L-thyroxine, cisplatin, cyanocobalamine and etretinate. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Drug-induced changes in hair colour can be either as lightening or darkening, usually occurring after 3-12 months of treatment (Table 1).…”

Topical RT1640 treatment effectively reverses gray hair and stem cell loss in a mouse model of radiation‐induced canities

“…We and others have shown that complete loss of McSCs or a reduction in their function results in the generation of hair shafts that lack pigment, otherwise known as gray hairs (Harris et al, 2013(Harris et al, , 2018Nishimura et al, 2005). However, in humans, a small but notable number of case reports demonstrate that gray hair can be drastically reversed in response to various systemic medications suggesting that either non-functional McSCs retained in the stem cell niches of gray hairs can be induced to resume their normal function or that functional McSCs can be recruited from neighboring hairs to repopulate niches of gray hairs (Khaled, Trojjets, Zeglaoui, Fazaa, & Kamoun, 2008;Manson, Marabelle, & Houot, 2018;Nagase, Inoue, & Narisawa, 2017;Rivera et al, 2017;Yale, Juhasz, & Atanaskova Mesinkovska, 2020). Regardless of the source of McSCs, the observation that repigmentation of gray hair can occur indicates that the follicular pigment system is physiologically capable for and responsive to pharmacologically induced rejuvenation.…”

Permanent Localized Hair Repigmentation Following Herpes Zoster Infection

“…3,4 It is unclear if viral reactivation due to immunosuppression may have played a role in those cases. Hair repigmentation as a consequence of postinflammatory process has been suggested, which is also a potential mechanism in our patient.…”