Alopecia and Hair Repigmentation Associated with Anti-Programmed Death-Ligand 1 (PD-L1) Immunotherapy

This document reports a case of a woman in her sixties with metastatic squamous cell carcinoma who experienced alopecia areata (AA) and global hair repigmentation as immune-related adverse events (irAEs) during anti-PD-L1 immunotherapy. The patient developed AA 15 months after starting combination immunotherapy, which is later than the typical onset. She was treated with intralesional triamcinolone, resulting in full hair regrowth and unexpected generalized hair repigmentation, returning to her original hair color without external dyes. This case highlights the rare occurrence of simultaneous AA and hair repigmentation as irAEs, suggesting a disruption of hair follicle immune privilege due to PD-L1 blockade. The study emphasizes the importance of recognizing and managing irAEs to maintain patients on immunotherapy, noting that intralesional steroids can effectively restore hair growth and improve quality of life.