Can vemurafenib (960 mg orally twice daily) cause a change from straight to curly hair in a 68‑year‑old woman treated for Langerhans cell histiocytosis?

Hair Changes with Vemurafenib: Straight to Curly Hair Transformation

Yes, vemurafenib commonly causes hair texture changes, including transformation from straight to curly hair (hair kinking), which occurs in a substantial proportion of treated patients and is a well-documented adverse effect of this BRAF inhibitor. 1

Incidence and Characteristics

• Hair kinking (straight-to-curly transformation) is a frequent adverse event occurring in patients treated with vemurafenib, documented in multiple dermatologic evaluations of melanoma patients receiving this agent 1

• The hair changes often present in association with other hair-related adverse events, including acute hair loss and hair color changes, forming a constellation of adnexal side effects 1

• In melanoma cohorts, hair kinking and related changes were classified as Grade 2 (moderate) in approximately 21% of patients and Grade 1 (mild) in approximately 57% of vemurafenib-treated patients, indicating this is not a rare occurrence 1

Clinical Pattern in Langerhans Cell Histiocytosis

• For the 68-year-old woman with LCH receiving vemurafenib 960 mg twice daily, hair texture changes are an expected adverse effect that should be monitored alongside other cutaneous complications 2

• Cutaneous complications occur in 47-62% of vemurafenib-treated patients, making dermatologic adverse events the most common category of side effects with this agent 2

Management Approach

• Hair texture changes (kinking) do not typically require dose modification or drug discontinuation, as they are generally classified as Grade 1-2 adverse events 1

• Dose reductions should be reserved for intolerable Grade 2 or higher non-cutaneous adverse reactions, not for cosmetic hair changes 2

• Early recognition and documentation of hair changes by dermatologists is beneficial to distinguish these benign cosmetic effects from more serious adverse events that might necessitate intervention 1

Important Caveats

• More serious cutaneous complications requiring intervention include cutaneous squamous cell carcinoma and keratoacanthomas (occurring in 18% of patients), which should be excised promptly without interrupting vemurafenib therapy 3

• Extreme photosensitivity reactions (Grade 2-3 in 12% of patients) require sun protection counseling and may necessitate dose adjustment 3

• Regular dermatologic evaluation is essential while on vemurafenib treatment to monitor for both benign cosmetic changes and potentially serious cutaneous malignancies 3