Sintilimab-induced Alopecia Universalis in a Patient With the Anti-tumor Effect of Complete Remission After Hepatectomy

This case report describes a 65-year-old male patient with hepatocellular carcinoma who developed alopecia universalis after receiving Sintilimab, a PD-1 inhibitor, as part of his cancer treatment. The patient experienced extensive hair loss across his body 4 weeks into the treatment, which progressed to alopecia universalis over 21 months without dermatologic intervention. Pathological examination showed increased lymphocyte infiltration, predominantly CD8 positive T cells, around hair follicles. Despite the alopecia, the patient achieved complete tumor remission, with serum alpha-fetoprotein levels normalizing and significant tumor regression observed. The study suggests that while alopecia areata is a rare side effect of immune checkpoint blockades, the continuation of PD-1 inhibitor treatment is recommended due to its effective anti-tumor response.