Clinical and histological study of permanent alopecia after bone marrow transplantation

Abstract

BACKGROUNDPermanent alopecia after bone marrow transplantation is rare, but more and more cases have been described, typically involving high doses of chemotherapeutic agents used in the conditioning regimen for the transplant. Busulfan, classically described in cases of irreversible alopecia, remains associated in recent cases. The pathogenesis involved in hair loss is not clear and there are few studies available. In addition to chemotherapeutic agents, another factor that has been implicated as a cause is chronic graft-versus-host disease. However, there are no histopathological criteria for defining this diagnosis yet.OBJECTIVEthe study aims to evaluate clinical and histological aspects in cases of permanent alopecia after bone marrow transplantation, identifying features of permanent alopecia induced by myeloablative chemotherapy and alopecia as a manifestation of chronic graft-versus-host disease.METHODSdata were collected from medical records of 7 patients, with description of the clinical features and review of slides and paraffin blocks of biopsies.RESULTSTwo distinct histological patterns were found: one similar to androgenetic alopecia, non-scarring pattern, and other similar to lichen planopilaris, scarring alopecia.CONCLUSIONThe first pattern corroborates the literature cases of permanent alopecia induced by chemotherapeutic agents, and the second is compatible with manifestation of chronic graft-versus-host disease on scalp, that has never been described yet. The results contribute to the elucidation of the factors involved in these cases, including the development of therapeutic methods

Hair disorders in cancer survivors

“…However, a non-scarring pattern is usually described in pCIA, with an increased number of miniaturized and telogen hair follicles. 30 Other reported histopathologic features of pCIA include scarring alopecia, with concentric fibrosis and a discrete perifollicular lymphoid cell infiltrate 24,30 (Figure 2). In pRIA the predominant features are compatible with a scarring alopecia, 72 and likely similar histopathologic features are present in permanent surgery-induced alopecia (including fibrosis along with decreased numbers or absence of hair follicles).…”

“…pCIA has been mostly reported in breast cancer survivors treated with taxane-based chemotherapy 11,15,19,24,25 (paclitaxel and docetaxel), and cyclophosphamide-based chemotherapy, 15,26,27 with an incidence of 30% 36 months after completion of chemotherapy. 28 In addition, pCIA have been reported in children who have undergone a conditioning therapy with busulfan [29][30][31][32][33][34][35] (with a cumulative incidence of 19%), 36 and with other chemotherapies used for stem cell transplantation (e.g. thiotepa and carboplatin) 37 (Table I).…”

Graft versus host disease presenting as fibrosing alopecia in a pattern distribution: A model for pathophysiological understanding of cicatricial pattern hair loss

“…Specifically, the presentation of chronic GvHD on the scalp may be that of FAPD with features of both AGA and of LPP, as originally proposed by Basilio et al . [ 26 ] in their earlier observations on permanent alopecia after bone marrow transplantation.…”

Permanent alopecia as a manifestation of chronic graft-versus-host disease of the scalp: clinical, dermoscopic and histopathological observations

“…In a previous study, we demonstrated that permanent alopecia after HSCT, although clinically similar, might present two different histological patterns: ‘inflammatory’ and ‘noninflammatory’ types of permanent alopecia …”

“…In conclusion, dermoscopy and scalp biopsy are essential to evaluate cases of permanent alopecia after HSCT, not only to detect early changes of the permanent course of the hair loss and guiding scalp biopsy, but also to distinguish cGVHD of scalp from AA or permanent chemotherapy‐induced alopecia …”