Case and Research Letters
Probable Iatrogenic Xanthotrichia
Xantotriquia probablemente iatrogénica
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Martí Fajardo, P. García Llopis, R. Ibáñez Ramón, C. Ortega Monzó" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Martí Fajardo" "email" => array:1 [ 0 => "nuriamarfa@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "García Llopis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Ibáñez Ramón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Ortega Monzó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de La Ribera, Alzira Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Farmacología, Hospital Universitario de La Ribera, Alzira Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Xantotriquia probablemente iatrogénica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1026 "Ancho" => 879 "Tamanyo" => 110424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Yellow-orange discoloration of the patient's hair.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of an 82-year-old man who came to our clinic because his hair had acquired a yellowish hue over the previous 10 months. Relevant medical history included chronic ischemic heart disease and dyslipidemia, which had been treated for over 10 years with acetylsalicylic acid (Adiro 1 × 100<span class="elsevierStyleHsp" style=""></span>mg tablet daily) and simvastatin (Pantok 1 × 20<span class="elsevierStyleHsp" style=""></span>mg tablet daily). One year before the consultation, he had been diagnosed with benign prostatic hyperplasia, which was being treated with once daily tamsulosin hydrochloride 0.4<span class="elsevierStyleHsp" style=""></span>mg (Omnic Ocas).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed scalp hair with a yellow-orange hue, especially in the frontal and parietal regions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient's natural hair color is gray and he denied using dyes and other hair treatments or making any change in his normal shampoo. His body hair retained its natural whitish color and the physical examination was otherwise normal. However, the patient also reported that for a few months his sweat had an orange hue while his tears and urine were normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Blood tests carried out included direct and total bilirubin, transaminases, alkaline phosphatase, albumin, prothrombin time, complete blood cell count, lactate dehydrogenase, haptoglobin, thyroid hormones, protein electrophoresis, glucose, lipids, and beta-carotene levels. The results of all blood tests and urinalysis were normal. In view of the bright yellow color of the tamsulosin hydrochloride tablet (Omnic Ocas, Astella Pharma), a color produced by yellow iron oxide (E172), and the fact that the onset of the symptom coincided with the introduction of this treatment, we decided to discontinue the drug after consultation with the urology and pharmacy departments. The yellow hair coloring gradually disappeared on follow-up and was undetectable at 10 months (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We have reported the reaction to the Valencian Regional Pharmacovigilance Centre by way of a yellow card. We have also reported it to the pharmaceutical company who manufacture the drug (Astellas Pharma). The company said it was unaware of any association between tamsulosin and this adverse effect and went on to say that the symptom could be caused by an adverse reaction to an excipient.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Hair color changes have been described in association with the consumption of certain drugs and other exogenous chemicals and can also be caused by some diseases. Hair color may darken in Addison disease and may become lighter in patients with hyperthyroidism or genetic disorders.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Professional or accidental exposure to arsenic, cobalt, lead, mercury, or silver can lead to hair discoloration ranging from blue to green tones and even black.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Greenish hair has also been reported in association with high levels of copper in the water supply.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A variety of drugs have also been implicated in hair color alterations, with different drugs producing lightening or darkening of the original color or even giving rise to a completely new color.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, except in a few cases, the data are insufficient to establish a true causal relationship. The cases in which more evidence is available involve chloroquine and chemotherapeutic agents, but other products clearly related to xantotriquia are p-aminobenzoic acid, calcium pantothenate, anthralin, mephenesin, minoxidil, propofol, valproic acid, and verapamil.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the literature, xantotriquia or yellowing hair is considered to be caused mainly by exogenous chemical substances, such as those found in 2.5% selenium sulphide shampoo and dihydroxyacetone,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but the symptom has also been associated with certain drugs, including some chemotherapeutic agents (bleomycin, doxorubicin, and vincristine), p-aminobenzoic acid, topical anthralin, and minoxidil.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6,7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Hair color in humans is due to the presence of melanin pigment in the keratinocytes of the hair cortex and medulla. Melanocytes present in the bulb can produce two types of melanin: eumelanin, which gives rise to brown and black hair, and pheomelanin, which gives rise to red or blond hair. Pheomelanin, which is found exclusively in the hair and not in the epidermis, is produced through a modification of eumelanin synthesis involving the interaction between dopaquinone and cysteine. Melanocytes are genetically conditioned to produce 1 type of melanin, but can produce both types under certain circumstances.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In the present case, xantotriquia may have been caused by the coloring agent used in the drug that was apparently responsible for the symptom or to the drug itself (or its metabolites) through the stimulation of pheomelanin production and/or the inhibition of eumelanin production. In conclusion, we present an interesting case of xantotriquia which was probably of iatrogenic origin according to the algorithm devised by Naranjo et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Unfortunately we were unable to confirm this origin with the reintroduction of the drug.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martí Fajardo N, García Llopis P, Ibáñez Ramón R, Ortega Monzó C. Xantotriquia probablemente iatrogénica. Actas Dermosifiliogr. 2014;105:722–723.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1026 "Ancho" => 879 "Tamanyo" => 110424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Yellow-orange discoloration of the patient's hair.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 847 "Ancho" => 878 "Tamanyo" => 95896 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Return to normal gray hair 10 months later.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postinflammatory hair darkening" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 4 | 3 | 7 |
| 2024 Octubre | 101 | 44 | 145 |
| 2024 Septiembre | 93 | 27 | 120 |
| 2024 Agosto | 133 | 57 | 190 |
| 2024 Julio | 110 | 44 | 154 |
| 2024 Junio | 96 | 52 | 148 |
| 2024 Mayo | 81 | 50 | 131 |
| 2024 Abril | 75 | 37 | 112 |
| 2024 Marzo | 74 | 52 | 126 |
| 2024 Febrero | 74 | 36 | 110 |
| 2024 Enero | 66 | 31 | 97 |
| 2023 Diciembre | 78 | 28 | 106 |
| 2023 Noviembre | 57 | 32 | 89 |
| 2023 Octubre | 64 | 18 | 82 |
| 2023 Septiembre | 68 | 21 | 89 |
| 2023 Agosto | 72 | 27 | 99 |
| 2023 Julio | 65 | 39 | 104 |
| 2023 Junio | 63 | 26 | 89 |
| 2023 Mayo | 72 | 34 | 106 |
| 2023 Abril | 62 | 22 | 84 |
| 2023 Marzo | 61 | 32 | 93 |
| 2023 Febrero | 51 | 20 | 71 |
| 2023 Enero | 63 | 36 | 99 |
| 2022 Diciembre | 73 | 46 | 119 |
| 2022 Noviembre | 33 | 34 | 67 |
| 2022 Octubre | 36 | 16 | 52 |
| 2022 Septiembre | 21 | 36 | 57 |
| 2022 Agosto | 23 | 36 | 59 |
| 2022 Julio | 23 | 34 | 57 |
| 2022 Junio | 19 | 24 | 43 |
| 2022 Mayo | 38 | 39 | 77 |
| 2022 Abril | 37 | 29 | 66 |
| 2022 Marzo | 49 | 36 | 85 |
| 2022 Febrero | 20 | 21 | 41 |
| 2022 Enero | 71 | 46 | 117 |
| 2021 Diciembre | 23 | 38 | 61 |
| 2021 Noviembre | 24 | 39 | 63 |
| 2021 Octubre | 27 | 44 | 71 |
| 2021 Septiembre | 37 | 38 | 75 |
| 2021 Agosto | 46 | 25 | 71 |
| 2021 Julio | 30 | 28 | 58 |
| 2021 Junio | 25 | 34 | 59 |
| 2021 Mayo | 28 | 53 | 81 |
| 2021 Abril | 80 | 71 | 151 |
| 2021 Marzo | 48 | 29 | 77 |
| 2021 Febrero | 36 | 16 | 52 |
| 2021 Enero | 22 | 9 | 31 |
| 2020 Diciembre | 32 | 4 | 36 |
| 2020 Noviembre | 31 | 18 | 49 |
| 2020 Octubre | 25 | 4 | 29 |
| 2020 Septiembre | 21 | 14 | 35 |
| 2020 Agosto | 23 | 18 | 41 |
| 2020 Julio | 25 | 8 | 33 |
| 2020 Junio | 25 | 20 | 45 |
| 2020 Mayo | 22 | 18 | 40 |
| 2020 Abril | 26 | 13 | 39 |
| 2020 Marzo | 31 | 20 | 51 |
| 2020 Febrero | 4 | 1 | 5 |
| 2020 Enero | 0 | 3 | 3 |
| 2019 Diciembre | 4 | 3 | 7 |
| 2019 Noviembre | 0 | 2 | 2 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 3 | 3 |
| 2019 Junio | 2 | 6 | 8 |
| 2019 Mayo | 0 | 10 | 10 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Agosto | 0 | 4 | 4 |
| 2018 Julio | 0 | 1 | 1 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 10 | 10 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 2 | 5 | 7 |
| 2018 Febrero | 41 | 6 | 47 |
| 2018 Enero | 64 | 9 | 73 |
| 2017 Diciembre | 85 | 12 | 97 |
| 2017 Noviembre | 24 | 12 | 36 |
| 2017 Octubre | 20 | 4 | 24 |
| 2017 Septiembre | 32 | 13 | 45 |
| 2017 Agosto | 50 | 13 | 63 |
| 2017 Julio | 54 | 21 | 75 |
| 2017 Junio | 51 | 38 | 89 |
| 2017 Mayo | 45 | 23 | 68 |
| 2017 Abril | 24 | 17 | 41 |
| 2017 Marzo | 31 | 26 | 57 |
| 2017 Febrero | 30 | 12 | 42 |
| 2017 Enero | 19 | 10 | 29 |
| 2016 Diciembre | 19 | 4 | 23 |
| 2016 Noviembre | 57 | 13 | 70 |
| 2016 Octubre | 36 | 9 | 45 |
| 2016 Septiembre | 43 | 12 | 55 |
| 2016 Agosto | 5 | 10 | 15 |
| 2016 Julio | 5 | 4 | 9 |
| 2016 Junio | 9 | 4 | 13 |
| 2016 Mayo | 4 | 17 | 21 |
| 2016 Abril | 6 | 7 | 13 |
| 2016 Marzo | 1 | 1 | 2 |
| 2016 Febrero | 7 | 14 | 21 |
| 2016 Enero | 6 | 17 | 23 |
| 2015 Diciembre | 7 | 1 | 8 |
| 2015 Noviembre | 8 | 10 | 18 |
| 2015 Octubre | 6 | 11 | 17 |
| 2015 Septiembre | 5 | 9 | 14 |
| 2015 Agosto | 11 | 4 | 15 |
| 2015 Julio | 40 | 7 | 47 |
| 2015 Junio | 34 | 7 | 41 |
| 2015 Mayo | 32 | 16 | 48 |
| 2015 Abril | 21 | 18 | 39 |
| 2015 Marzo | 27 | 23 | 50 |
| 2015 Febrero | 19 | 6 | 25 |
| 2015 Enero | 13 | 12 | 25 |
| 2014 Diciembre | 15 | 6 | 21 |
| 2014 Noviembre | 16 | 5 | 21 |
| 2014 Octubre | 14 | 4 | 18 |
| 2014 Septiembre | 14 | 3 | 17 |
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