Dermoscopy and confocal microscopy for different chemotherapy‐induced alopecia (CIA) phases characterization: Preliminary study

Abstract

Background Chemotherapy‐induced alopecia (CIA) affects 65% of patients receiving chemotherapy regimens and is often identified with the massive hair loss stage. Reflectance confocal microscopy (RCM) is a noninvasive technique used in alopecia assessment for disease characterization and state of activity. Objective To describe RCM features of CIA in different timing and identify specific phases of alopecia development. Methods A total of 16 patients treated with chemotherapy underwent dermoscopy and RCM evaluations four times during the observation: 2 and 4‐6 weeks after starting and 3 and 6 months after the end of chemotherapy. Ten examinations for each stage were performed. Results Four phases of CIA have been identified. Initial hair loss showed specific dots not previously described, named CIA dots. massive hair loss phase was characterized by black dots (10/10 pt), CIA dots (8/10 pt) and hair shaft abnormalities. Three months after the end of chemotherapy, during the partial regrowth phase, 10/10 patients showed thin hair in regrowth and 8/10 presented black and yellow dots. At 6 months, normal hair in regrowth appears in all patients (total regrowth phase). Conclusions Chemotherapy‐induced alopecia has to be considered as a dynamic process with specific phases characterized by distinctive dermoscopic and confocal features.

Evaluation of Videodermoscopic Features of Chemotherapy Induced Alopecias

“…KİA'da dilate folikül ostiyum içinde normal veya fragmante saç içeren homojen olmayan materyal saptanır iken; klasik sarı noktada ise boş folikül lümeninin yüksek oranda reaktif materyal ile dolu olduğu saptanmıştır. 13,15 Çalışmamızda ise sarı noktaların AA'da izlenenlere benzer şekilde klasik formda olduğu saptandı.…”

Vismodegib-Induced Alopecia: Trichoscopic and Confocal Microscopy Evaluation

“…It is gradual and has a longer time to onset than that with cytotoxic chemotherapy, developing after at least 2 months [8]. According to our experience, vismodegib-induced alopecia has the same trichoscopic and RCM characteristics in both patients and resembles an AA and CIA [4]. Thanks to dermoscopy and RCM, we are also able to define the phase in which the patient is in the massive hair loss or regrowth phase [9].…”

“…RCM in the acute hair loss phase showed dilated follicular ostia with mashed, malted, nonhomogeneous material, often containing normal or fragmented hair resembling CIA dots found in CIA. As in CIA, they may represent the earliest microscopic signs of direct toxicity of chemotherapy on hair follicle [4, 10] that persist during the whole period of chemotherapy treatment and disappear after the interruption of vismodegib.…”

“…It can be caused by chemotherapy, radiotherapy, or targeted and hormonal therapy. Targeted therapy and immunotherapy can cause immune-mediated alopecia such as alopecia areata (AA) and permanent alopecia, as well as paradoxically hypertrichosis and trichomegaly [4]. We report 2 cases of patients receiving vismodegib for the treatment of locally advanced BCCs that developed alopecia during treatment and describe clinical, dermoscopic, and reflectance confocal microscopy (RCM) features of this adverse event.…”

“…1a). Confocal microscopy showed yellow dots and dilated follicular infundibula containing yellowish, amorphous material, surrounded by a thin, white collaret resembling those found in chemotherapy-induced alopecia (CIA) called CIA dots [4] (Fig. 1b, c).…”