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.