We report the first case of progressive hair repigmentation associated with the use of lenalidomide in an elderly patient with multiple myeloma. The influence of lenalidomide on follicular melanogenesis may involve removing the inhibitory influences of some cytokines such as IL-1, IL-6 and TNF-α. In addition, certain endocrine effects of lenalidomide on the hypophyseal-adrenal axis could explain its action on hair pigmentation. We further hypothesize that lenalidomide may be capable of stimulating migration and/or differentiation of melanocytes to promote repigmentation of gray hair follicles. Pending the clarification of how hair repigmentation occurs with lenalidomide, our observation materializes the concept that hair graying may not be an irreversible process, which opens avenues for targeted therapeutics in the fields of cosmetics and anti-aging medicine.
RajkumarSVHaymanSRLacyMQ. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood2005; 106: 4050–4053.
2.
HallVCEl-AzharyRABouwhuisA. Dermatologic side effects of thalidomide in patients with multiple myeloma. J Am Acad Dermatol2003; 48: 548–552.
3.
SviggumHPDavisMDPRajkumarSV. Dermatologic adverse effects of lenalidomide therapy for amyloidosis and multiple myeloma. Arch Dermatol2006; 142: 1298–1302.
4.
PersonaEPMesaMGSanchezPJG. Lenalidomide treatment for patients with multiple myeloma: Diagnosis and management of most frequent adverse events. Adv Ther2011; 28(Suppl 1): 11–16.
5.
Galimont-CollenAFSVosLELavrijsenAPM. Classification and management of skin, hair, nail and mucosal side-effects of epidermal growth factor receptor (EGFR) inhibitors. Eur J Cancer2007; 43: 845–851.
6.
LacoutureME. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev2006; 6: 803–813.
7.
MakKKChanSY. Epidermal growth factor as a bioplogic switch in hair growth cycle. J Biol Chem2003; 278: 26120–26126.
8.
Santmyire-RosenbergerBRAlbertM. Acquired trichomegaly with topiramate. J Am Acad Dermatol2005; 53: 262–263.
9.
SaifMWGnanarajJ. Erlotinib-induced trichomegaly in a male patient with pancreatic cancer. Cutan Ocul Toxicol2010; 29: 62–66.
10.
AlexandrescuDTKauffmanCLDasanuCA. Persistent hair growth during treatment with the EGFR inhibitor erlotinib. Derm Online J2009; 15: 4–4.
11.
CohenPREscudierSMKurzrockR. Cetuximab-associated elongation of the eyelashes: Case report and review of eyelash trichomegaly secondary to epidermal growth factor inhibitors. Am J Clin Dermatol2011; 12: 63–67.
12.
PascualJCBanulsJBelinchonI. Trichomegaly following treatment with gefitinib (ZD1839). Br J Dermatol2004; 151: 1111–1112.
13.
PausRCotsarelisG. The biology of hair follicles. N Engl J Med1999; 341: 491–497.
14.
SlominskiAPausR. Melanogenesis is coupled to murine anagen: Toward new concepts for the role of melanocytes and the regulation of melanogenesis in hair growth. J Invest Dermatol1993; 101: 90S–97S.
15.
SugiyamaS. Mode of redifferentiation and melanogenesis of melanocytes in mouse hair follicles. An ultrastructural and cytochemical study. J Ultrastruct Res1979; 67: 40–54.
16.
LindnerGBotchkarevVABotchkarevaNV. Analysis of apoptosis during hair follicle regression (catagen). Am J Pathol1997; 151: 1601–1617.
17.
TobinDJHagenEBotchkarevVA. Do hair bulb melanocytes undergo apoptosis during hair follicle regression (catagen)?J Invest Dermatol1998; 111: 941–947.
18.
HearingVJ. Biochemical control of melanogenesis and melanosomal organization. J Investig Dermatol Symp Proc1999; 4: 24–28.
19.
SlominskiAWortsmanJLugerT. Corticotropin releasing hormone and proopiomelanocortin involvement in the cutaneous response to stress. Physiol Rev2000; 80: 979–1020.
20.
SlominskiAPausR. Towards defining receptors for l-tyrosine and l-dopa. Mol Cell Endocrinol1994; 99: C7–C11.
21.
SlominskiATobinDJShibaharaS. Melanin pigmentation in mammalian skin and its hormonal regulation. Physiol Rev2004; 84: 1122–1155.
22.
De SanctisJBMijaresMSuárezA. Pharmacological properties of thalidomide and its analogues. Recent Pat Inflamm Allergy Drug Discov2010; 4: 144–148.
23.
LockerDSuperstineESulmanFG. The mechanism of the push and pull principle. 8. Endocrine effects of thalidomide and its analogues. Arch Int Pharmacodyn Ther1971; 194: 39–55.
24.
BrodeE. Experimental studies with cyclic imides. I. Modification of hypophyseal-adrenal axis by thalidomide. Arzneimittelforschung1968; 18: 661–665.
25.
RedondoPGuzmanMMarquinaM. Repigmentation of gray hair after thyroid hormone treatment. J Actas Dermosifiliogr2007; 98: 603–610.
26.
FaivreADelbaldoCVeraK. SU11248, a novel oral multitarget tyrosine kinase inhibitor, in patients with cancer. J Clin Oncol2006; 24: 25–35.
27.
AlexandrescuDTDasanuCAFarzanmehrH. Persistent cutaneous hyperpigmentation after tyrosine kinase inhibition with imatinib for GIST. Dermatol Online J2008; 14: 7–7.
28.
Etienne G, Cony-Makhoul P and Mahon FX. Imatinib mesylate and gray hair. N Engl J Med 2002; 347:446.
