Hair disorders in cancer survivors

Freites-Martínez, Azael; Shapiro, Jerry; Hurk, Corina van den; Goldfarb, Shari; Jiménez, Joaquín J.; Rossi, Anthony; Paus, Ralf; Lacouture, Mario E.

doi:10.1016/j.jaad.2018.03.056

Cited by 75 publications

(77 citation statements)

References 100 publications

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“…Conventional chemotherapy drugs, such as cyclophosphamide (CYP), 5‐fluorouracil (5‐FU), doxorubicin, cisplatin and taxol, exert their cytotoxic effect by perturbing various aspects of cellular physiology including DNA replication, RNA synthesis, metabolism and cellular structures . Some of these drugs induce more severe hair loss while others cause only mild or hardly any hair loss . How they differ in pilotoxicity is not well understood, and even less understood is why the pilotoxicity of the same drug can vary so much among different individuals (from absent, mild to massive alopecia), despite a comparable dose and application regime …”

Section: Cia: Basic Conceptsmentioning

confidence: 99%

“…Some of these drugs induce more severe hair loss while others cause only mild or hardly any hair loss . How they differ in pilotoxicity is not well understood, and even less understood is why the pilotoxicity of the same drug can vary so much among different individuals (from absent, mild to massive alopecia), despite a comparable dose and application regime …”

Section: Cia: Basic Conceptsmentioning

confidence: 99%

“…As one of the most proliferative organs in adult life, hair follicles are highly vulnerable to the damage from both chemotherapy and radiotherapy and hair loss, presented clinically as chemotherapy‐induced alopecia (CIA) or radiotherapy‐induced alopecia (RIA), is a common adverse effect . This makes hair follicles a widely employed model to dissect the mechanisms underlying the damage responses of rapidly growing tissues to both chemotherapy and radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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How chemotherapy and radiotherapy damage the tissue: Comparative biology lessons from feather and hair models

Gao

Zhou

Lin

et al. 2018

Experimental Dermatology

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Chemotherapy and radiotherapy are common modalities for cancer treatment. While targeting rapidly growing cancer cells, they also damage normal tissues and cause adverse effects. From the initial insult such as DNA double‐strand break, production of reactive oxygen species (ROS) and a general stress response, there are complex regulatory mechanisms that control the actual tissue damage process. Besides apoptosis, a range of outcomes for the damaged cells are possible including cell cycle arrest, senescence, mitotic catastrophe, and inflammatory responses and fibrosis at the tissue level. Feather and hair are among the most actively proliferating (mini‐)organs and are highly susceptible to both chemotherapy and radiotherapy damage, thus provide excellent, experimentally tractable model systems for dissecting how normal tissues respond to such injuries. Taking a comparative biology approach to investigate this has turned out to be particularly productive. Started in chicken feather and then extended to murine hair follicles, it was revealed that in addition to p53‐mediated apoptosis, several other previously overlooked mechanisms are involved. Specifically, Shh, Wnt, mTOR, cytokine signalling and ROS‐mediated degradation of adherens junctions have been implicated in the damage and/or reparative regeneration process. Moreover, we show here that inflammatory responses, which can be prominent upon histological examination of chemo‐ or radiotherapy‐damaged hair follicle, may not be essential for the hair loss phenotype. These studies point to fundamental, evolutionarily conserved mechanisms in controlling tissue responses in vivo, and suggest novel strategies for the prevention and management of adverse effects that arise from chemo‐ or radiotherapy.

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Section: Cia: Basic Conceptsmentioning

confidence: 99%

Section: Cia: Basic Conceptsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How chemotherapy and radiotherapy damage the tissue: Comparative biology lessons from feather and hair models

Gao

Zhou

Lin

et al. 2018

Experimental Dermatology

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“…Ve fázích zkoušek a studií jsou snahy na příklad o ovlivnění výpadku vlasu ochra nou folikulu nebo zastavením vlasového cyklu, v případě radioterapií indukované alopecie byl zkoušen i botulotoxin [8]. Nejčastěji se doporučuje minoxidil jako přípravek používaný u androgenní alo pecie, který prodlužuje anagenní fázi vlasového cyklu a zabraňuje miniatu rizaci folikulu.…”

Section: Farmakologická Terapieunclassified

“…Individuálně je možno uvažovat i o trans plantaci vlasů či plastické rekonstrukci především při poškození v souvislosti s radioterapií [8].…”

Section: Chirurgická Terapieunclassified

Alopecia and Hair Damage Induced by Oncological Therapy

Jedličková¹,

Vokurka²,

Vojtíšek³

et al. 2019

Klin Onkol

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Poškození a ztráta vlasů (alopecie) jsou předvídatelným nežádoucím účinkem onkologické léčby. Mohou být způsobeny chemoterapií či radioterapií v oblasti hlavy a krku, příp. i cílenou a hormonální léčbou. Ztráta vlasů patří k nejobávanějším nežádoucím účinkům léčby z pohledu pacientů, kteří se současně vyrovnávají s realitou onkologického onemocnění. Ztráta vlasů může být difuzní, kompletní, částečná nebo ložisková, dochází též ke zhoršení kvality vlasů, příp. zá nětu a jizvení pokožky. Výpadek postihuje i řasy, obočí i ochlupení těla. Alopecie je většinou reverzibilní, může ale dojít i k trvalému poškození v závislosti na typu, celkové délce, dávce on kologické léčby a řadě dalších individuálních faktorů. Zvýšené riziko alopecie mají vysoké dávky docetaxelu, doxorubicinu, cyklofosfamidu, nízké riziko je spojeno s preparáty platiny, melfala nem, kapecitabinem. U cílené terapie a imunoterapie pozorujeme imunitně podmíněné alope cie, jako je alopecie areátní a jizvící, ale paradoxně i hypertrichózu a trichomegalii. Existují mož nosti fyzikální i farmakologické prevence a léčby alopecie, jejich účinnost a dostupnost je však limitována. Výpadek vlasů se daří redukovat u moderních metod radioterapie, které šetří oblast kštice. Dobré výsledky má chlazení kštice během krátkých infuzních režimů, které omezuje to xický účinek cytostatika na vlasový folikul. K dispozici je několik chladicích systémů s ochlazením pokožky pod 22 °C. V lokální terapii se používá minoxidil, který urychluje zarůstání kštice. Velmi důležitá je psychologická podpora a dostupnost kosmeticky přijatelných náhrad. Klíčová slova alopecie-chemoterapie-radioterapie-hormonální léčba-cílená léčba-nežádoucí účinky-kvalita života-hirsutizmus

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Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer

et al. 2020

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IMPORTANCE Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described.OBJECTIVE To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. MAIN OUTCOMES AND MEASURESThe clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. RESULTSOf the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, −0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (−0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction.CONCLUSIONS AND RELEVANCE Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.

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Hair disorders in cancer survivors

Cited by 75 publications

References 100 publications

How chemotherapy and radiotherapy damage the tissue: Comparative biology lessons from feather and hair models

How chemotherapy and radiotherapy damage the tissue: Comparative biology lessons from feather and hair models

Alopecia and Hair Damage Induced by Oncological Therapy

Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer

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