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


https://doi.org/10.4081/dr.2024.10113
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Authors

  • Irina Ciobotariu Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy. https://orcid.org/0009-0002-7198-4273
  • Gerardo Palmisano
    palmisanogerardo@gmail.com
    Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
  • Giacomo Caldarola Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy. https://orcid.org/0000-0002-8837-9232
  • Alfredo Piccerillo Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
  • Francesco Tassone Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Simone Cappilli Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy. https://orcid.org/0000-0001-9813-2391
  • Alessandro Di Stefani Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
  • Ketty Peris Dermatology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome; Dermatology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.

Sonidegib is a Hedgehog pathway inhibitor (HHI) used as a first-line systemic treatment for patients with advanced basal cell carcinoma (aBCC). Alopecia is reported as a frequent adverse event (AE), occurring in 49% of patients. Forty-five patients with aBCC were treated with sonidegib between December 2022 and December 2023; among them, 11/45 patients developed alopecia. Trichoscopic features included yellow dots, black dots, exclamation mark hairs, and broken hairs. Upon LC-OCT examination, yellow dots were seen as dilated follicular dark spaces containing malted, nonhomogeneous material and outlined by bright collarets. Black dots corresponded to normal-sized follicular ostia filled with bright, homogeneous material and cadaverized hair. Exclamation mark hairs were short, dark dysmorphic hairs with different sizes of proximal and distal ends, and broken hairs were short dysmorphic hairs. LC-OCT may provide additional insights into early signs and clinical evolution of sonidegib-induced alopecia in patients with aBCC.