Trichoscopy and LC-OCT findings in sonidegib-induced alopecia in patients with advanced basal cell carcinoma

Sonidegib, a Hedgehog pathway inhibitor used for advanced basal cell carcinoma, frequently causes alopecia, affecting 49% of patients. In a study of 45 patients treated with sonidegib, 11 developed alopecia. Trichoscopic examination revealed features such as yellow dots, black dots, exclamation mark hairs, and broken hairs. LC-OCT findings showed yellow dots as dilated follicular spaces with nonhomogeneous material, black dots as follicular ostia with bright material and cadaverized hair, exclamation mark hairs as short, dark dysmorphic hairs, and broken hairs as short dysmorphic hairs. LC-OCT can offer additional insights into the early signs and progression of sonidegib-induced alopecia.