Discussion:
Advancements in hemodialysis have contributed to prolonged life expectancy among CRF patients, affording opportunities for various cutaneous manifestations to emerge.[2,4] A prospective study involving 363 hemodialysis patients documented six cases wherein skin and hair lightening occurred, observed between 10 months to 8 years post-initiation of hemodialysis[5]. Similarly, Udayakuma et al. identified hair abnormalities in 30% of 100 hemodialysis patients, characterized by sparse body hair and diffuse alopecia with dry, lusterless hair, though no instances of hair hypopigmentation were observed[2].Hair color alterations can arise from changes not only in melanin production but also in the hair structure itself, influencing its optical properties. Typically, when the underlying cause is rectified, hair color tends to normalize[6].Drug-induced hair color changes are infrequent adverse effects. While various drugs have been linked to such alterations, robust evidence supporting a causal relationship is often lacking. Chloroquine and certain cancer chemotherapeutic agents exhibit stronger associations with hair color changes. Other implicated drugs include p-aminobenzoic acid, calcium pantothenate, anthralin, mephenesin, minoxidil, propofol, valproic acid, and verapamil, yet further data are required for confirmation. Most drug-induced hair color changes lead to lightening, although exceptions such as PABA and select chemotherapy regimens may darken hair[7,8]. The mechanisms by which drugs enter or modify hair remain uncertain. While the precise mechanism underlying hair hypopigmentation remains elusive, some cases have been linked to disturbances in phenylalanine metabolism resulting in tyrosinase-inhibiting metabolites[4]. Studies administering oral zinc sulfate, a tyrosinase inhibitor, to mice have demonstrated significant hair shaft hypopigmentation[9].
Four cases of lightening of hair in a dialysis patient under heptaminol were reported [6,10] In our case, the temporal correlation between hair lightening and subsequent normalization aligns closely with the introduction and cessation of heptaminol, suggesting a plausible association.