Clinical aspect, pathogenesis and therapy options of alopecia induced by hormonal therapy for breast cancer

Abstract

Adjuvant hormonal therapy is one of the most important treatments of hormone-receptor-positive breast cancer and includes selective estrogen receptor modulators, aromatase inhibitors, and luteinizing hormone-releasing hormone analogs. In patients receiving these drugs, a progressive recession of frontal-temporal hairlines is often observed, such as a certain grade of hair miniaturization in the same areas and the central scalp area, producing a pseudo-female androgenic alopecia, which has to be considered oncotherapy-induced alopecia. The aim of this work, is to describe the clinical aspects and pathogenesis of this type of alopecia and to analyze the different drugs which have been proposed until now. The authors concude that topical hormones should not be considered as a therapeutic approach because of their direct or indirect oncogenic potential. A therapeutic approach that could be both safe and effective is proposed.

A case of aromatase inhibitor‐induced alopecia successfully treated with low‐dose oral minoxidil

“…The treatment options for endocrine therapyinduced alopecia (EIA) are limited and described in few studies. [1][2][3] Most of these studies have analyzed the safety and efficacy of topical minoxidil treatment. 2,3 As alopecia affects the quality of life (QoL) in females, topical minoxidil has been used for EIA.…”

“…Adjuvant HT has been the emerging cornerstone in managing hormone receptor-positive breast cancer, including selective estrogen modulators, and aromatase inhibitors (AI). [1][2][3] Aromatase inhibitors, including anastrozole, letrozole, and exemestane, suppress the plasma estrogen levels by inhibiting aromatase. 2,3 Blocking the conversion of testosterone to estradiol, AI increases the activity of 5α-reductase, leading to a higher production of dihydrotestosterone around hair follicles.…”

“…2,3 Blocking the conversion of testosterone to estradiol, AI increases the activity of 5α-reductase, leading to a higher production of dihydrotestosterone around hair follicles. 1,3 Additionally, AI shortens the anagen phase, contributing to the induction of male-pattern hair loss in susceptible women undergoing HT. 1,2 In patients treated with HT, a progressive recession of the frontaltemporal hairline has often been reported with hair miniaturization in the frontal-temporal and central areas of the scalp.…”

“…1,3 Additionally, AI shortens the anagen phase, contributing to the induction of male-pattern hair loss in susceptible women undergoing HT. 1,2 In patients treated with HT, a progressive recession of the frontaltemporal hairline has often been reported with hair miniaturization in the frontal-temporal and central areas of the scalp. [1][2][3] Among 236 patients treated with AI, 8% discontinued treatment owing to EIA.…”

“…1,2 In patients treated with HT, a progressive recession of the frontaltemporal hairline has often been reported with hair miniaturization in the frontal-temporal and central areas of the scalp. [1][2][3] Among 236 patients treated with AI, 8% discontinued treatment owing to EIA. 4 Nevertheless, there have been few case reports and review articles on treating EIA.…”