Arrow Sign: A Rapid Microscopic Diagnosis of Hair Change Associated with Epidermal Growth Factor Receptor Inhibitors

August 2013 in “ Journal of the American Academy of Dermatology ”

Pai‐Shan Cheng, Feng‐Jie Lai

epidermal growth factor receptor inhibitors EGFR inhibitors microscopic examination plucked hairs hair root sheaths gefitinib erlotinib hair changes degeneration fragility fungal infections

TLDR A new method quickly detects hair changes from EGFR inhibitors using a microscope.

The study reported a new rapid diagnostic method for detecting hair changes associated with epidermal growth factor receptor (EGFR) inhibitors, which are used to treat advanced malignancies. In a study of 13 patients with stage IV lung cancer undergoing treatment with gefitinib or erlotinib, a characteristic "arrow" appearance was observed microscopically in plucked anagen hairs. This appearance was due to degeneration and splitting of the root sheaths and was present even in patients without visible hair loss or scalp changes. The arrow sign provided a quick diagnostic tool for EGFR inhibitor-related hair changes and helped differentiate these changes from fungal infections. The study highlighted the impact of EGFR inhibitors on hair follicle epithelium, leading to root sheath degeneration.

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