Based on PubMed | Can melanoma treatments, such as immunotherapy or targeted therapy, cause hair loss, and how is this side effect managed?

Hair loss with melanoma treatments: what to expect and how to manage it

Yes melanoma therapies can be associated with hair changes and hair loss, but the likelihood and pattern vary by treatment type. Targeted therapies (such as BRAF and MEK inhibitors) more commonly cause hair thinning or texture changes, while immune checkpoint inhibitors rarely cause hair loss directly but can indirectly lead to hair shedding when they trigger thyroid problems. Understanding which drugs are involved helps set expectations and guides management. ^{[1] [2]}

How often does hair loss happen?

• Targeted therapy (BRAF/MEK inhibitors: vemurafenib, dabrafenib, encorafenib; cobimetinib, trametinib, binimetinib): Hair changes are relatively common and can include thinning, breakage, curl or color change, and sometimes partial alopecia. In routine practice, many people do not lose all their hair, but mild to moderate thinning is reported. ^{[1] [3]}
• Immunotherapy (checkpoint inhibitors: nivolumab, pembrolizumab, ipilimumab): Direct treatment‑related alopecia is uncommon (roughly 1–2% overall across cancers), but hair loss can occur if the therapy causes underactive thyroid (hypothyroidism), which lists hair loss among typical symptoms. ^{[2] [4]}
• Across modern “precision” or targeted agents, pooled analyses suggest alopecia risk is increased compared with placebo but generally less severe than with classic chemotherapy. ^[5]

Drug‑specific examples

• Dabrafenib + trametinib: Reported changes include dry, brittle or curly hair; growth of darker/thicker body hair; hair that breaks easily; and possible hair fall. ^[6]
• Encorafenib + binimetinib: Patient materials note dry, easily broken hair and possible hair loss (thinning). ^[7]
• Vemurafenib: Hair thinning and some hair loss, with recommendations for gentle care and scalp protection. ^[8]
• Cobimetinib + vemurafenib: Clinical guidance lists partial alopecia (patchy thinning or hair loss) among cutaneous effects. ^[9]
• Ipilimumab + nivolumab and nivolumab alone: Thyroid dysfunction can occur; with hypothyroidism, symptoms can include fatigue, dry skin, and hair loss. ^{[10] [4]}

Why it happens

• Targeted therapy: BRAF/MEK pathway inhibition affects the skin and hair follicles, leading to changes in hair structure, color, and growth cycles; partial alopecia and folliculitis are documented class effects. ^{[11] [3]}
• Immunotherapy: Immune‑related endocrine effects especially thyroiditis progressing to hypothyroidism can cause hair shedding; correcting the thyroid imbalance typically improves hair over time. ^{[10] [4]}

What hair loss looks like

• Thinning or partial shedding rather than complete baldness, more common with targeted therapy. ^{[12] [9]}
• Texture and color changes (straight to curly, graying) and increased breakage. ^{[6] [3]}
• Rarely, patchy alopecia or follicular scalp discomfort. ^{[12] [9]}

Management strategies

General hair care

• Use gentle shampoo and a soft brush; avoid harsh treatments like dyes, bleaches, perms, tight hairstyles, and high‑heat styling. ^{[6] [8]}
• Protect the scalp from sun and cold with hats or sunscreen (SPF 50 on exposed scalp). ^{[7] [8]}
• Choose wide‑tooth combs and minimize traction on hair to reduce breakage. ^[13]

Treat underlying causes (immunotherapy)

• Screen and treat thyroid dysfunction if symptoms like fatigue, cold intolerance, or hair loss appear; thyroid hormone replacement can gradually improve hair loss. ^{[10] [4]}

Dermatology support

• Report new or worsening hair or scalp changes early; dermatology input can help distinguish between inflammatory scalp issues (e.g., folliculitis) and treatment‑related hair cycle changes, and guide topical treatments if needed. ^[3]

Scalp cooling

• Scalp cooling is an established method to reduce chemotherapy‑induced alopecia; while evidence primarily concerns chemotherapy, it is occasionally discussed in broader hair‑loss counseling. Effectiveness rates around 50% have been reported in chemo settings, but data for targeted or immunotherapy‑induced hair loss are limited. ^[14]

Cosmetic and psychosocial support

• Consider temporary options like wigs, scarves, or styling changes; many people report good satisfaction with head coverings during regrowth. ^[14]
• Programs focused on appearance‑related side effects (e.g., “Look Good Feel Better”) can be helpful for confidence and coping during treatment. ^[6]

When to call your care team

• New or rapid hair shedding, scalp pain, or signs of folliculitis (tender bumps) during targeted therapy. Early assessment allows dose adjustments or topical treatments if appropriate. ^{[12] [3]}
• Symptoms suggestive of thyroid problems on immunotherapy (fatigue, weight change, cold sensitivity, dry skin, hair loss, constipation, palpitations or heat intolerance). Prompt testing can identify a treatable cause of hair loss. ^{[10] [4]}

Outlook and regrowth

• With targeted therapy, hair changes are often mild and may improve after dose modification or completion of therapy; complete hair loss is uncommon. ^{[1] [3]}
• With immunotherapy‑related hypothyroidism, hair typically improves after the thyroid levels are corrected, though regrowth can take several months. ^{[10] [4]}
• Overall, targeted and immune therapies tend to cause less severe alopecia than traditional chemotherapy, and supportive measures make a meaningful difference in comfort and confidence. ^{[1] [5]}

Quick comparison table

Treatment type	Likelihood of hair loss	Typical pattern	Key actions
Targeted therapy (BRAF/MEK inhibitors)	Moderate; usually partial	Thinning, breakage, texture/color changes; occasional patchy loss	Gentle hair care, scalp protection, report scalp symptoms, dermatology support
Immunotherapy (checkpoint inhibitors)	Low; often indirect	Hair loss mainly if hypothyroidism develops	Monitor/replace thyroid hormone, symptom reporting, supportive hair care
Classic chemotherapy (for context)	High for many regimens	Often complete, temporary alopecia	Scalp cooling (evidence‑based), wigs/head covers, supportive care

Sources indicate many people on targeted therapies will not lose all their hair and are less likely to have chemo‑like side effects; immunotherapy‑related alopecia is uncommon but recognized mainly via endocrine effects such as hypothyroidism. ^{[1] [2]}