Drug-induced hair pigmentation: Clinical perspectives and updates

Many commonly used drug therapies have the ability to modulate hair follicle growth and function.Although the most common drug-induced hair change is mild to moderate alopecia, rarely, drugs may also alter hair pigmentation.Drug-induced hair pigmentation changes include hypopigmentation, a lightening or graying/whitening that may occur with antiepileptics, oral retinoids, tyrosine kinase inhibitors, antimalarials, or anticancer drugs; and hyperpigmentation, a darkening or repigmentation of original hair color that may occur with targeted immunotherapies, oral retinoids, hormonal therapies, minoxidil, or immunomodulatory drugs.Because pigmentation changes can be a distressing side effect for many patients and often challenging to attribute to 1 specific drug, a thorough and up-to-date understanding of previously reported drugs associated with hair color changes greatly aids in making this clinical diagnosis and guiding the management course.In this review, we aimed to provide an updated report of systemic drugs associated with changes in hair pigmentation and describe their prevalence, clinical characteristics, and proposed mechanisms.( JAAD Reviews 2025;3:6-17.)