Alopecia Areata in a Patient Receiving Cemiplimab for Metastatic Cutaneous Squamous Cell Carcinoma

A 77-year-old woman with metastatic cutaneous squamous cell carcinoma (cSCC) was treated with cemiplimab, an immune checkpoint inhibitor, and achieved a complete clinical and radiological response after eight infusions and local radiation therapy. Following the discontinuation of cemiplimab, she developed alopecia areata (AA) and fingernail dystrophy, which were successfully treated with prednisone and topical corticosteroids, resulting in complete hair regrowth and nail improvement. This case highlights AA as a rare immune-related adverse event associated with cemiplimab, likely due to the breakdown of the hair follicle's immune privilege triggered by the enhanced immune response from the treatment. At a 2-year follow-up, the patient maintained a complete oncologic response.