Hair and nail abnormalities may commonly occur in patients with chronic lymphocyctic leukemia (CLL) who have been treated with ibrutinib, and they may appear several months after initiating therapy, according to a study published in JAMA Dermatology.1

Researchers led by Carole Bitar, MD, of Tulane University in New Orleans, LA, conducted a prospective study of 66 patients with CLL who were enrolled in a single-arm phase 2 clinical trial of ibrutinib from March 2014 to October 2015 at the National Institutes of Health. Primary outcome was nail and hair changes associated with ibrutinib therapy and assessed by a survey.

Among the patients, 44 were found to have brittle fingernails at a median of 6.5 months after initiating ibrutinib therapy, while 15 developed brittle toenails after a median of 9 months of therapy.

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In addition, textural hair changes were reported in 17 patients with a median of 9 months of ibrutinib treatment.

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“Ibrutinib inhibits Bruton tyrosine kinase by covalently binding to cysteine 481,” the authors wrote. “Whether ibrutinib affects the hair and nails by binding and altering cysteine-rich proteins of hair and nails or by means of another mechanism remains unknown.”


  1. Bitar C, Farooqui MZH, Valdez J, et al. Hair and nail changes during long-term therapy with ibrutinib for chronic lymphocytic leukemia. [published online ahead of print March 16, 2016]. JAMA Dermatol. doi: 10.1001/jamadermatol.2016.0225.