Hair disorders in patients with cancer

Freites-Martínez, Azael; Shapiro, Jerry; Goldfarb, Shari; Nangia, Julie R.; Jiménez, Joaquín J.; Paus, Ralf; Lacouture, Mario E.

doi:10.1016/j.jaad.2018.03.055

Cited by 80 publications

(83 citation statements)

References 166 publications

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“…Hair loss, either temporary or permanent, is one of the most stressful side effects for patients undergoing oncologic treatment (1)(2)(3)(4)(5). Radiation-induced alopecia may permanently alter the self-perception of the neurooncological patients and have a significant impact on their quality of life (2,5).…”

Section: Discussionmentioning

confidence: 99%

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Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

et al. 2020

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Purpose: To determine dose constraints that correlate with alopecia in patients treated with photon-based Volumetric Modulated Arc Therapy (VMAT) for primary brain tumors.Methods: During the treatment planning process, the scalp was drawn as a region of interest. Dose received by 0.1 cc (D 0.1cc ), mean dose (D mean ), absolute volumes receiving different doses (V 16Gy , V 20Gy , V 25Gy , V 30Gy , V 35Gy , V 40Gy , and V 43Gy ) were registered for the scalp. Alopecia was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Receiver operating characteristics (ROC) curve analysis was used to identify parameters associated with hair-loss.Results: One-hundred and one patients were included in this observational study. At the end of radiotherapy (RT), 5 patients did not develop alopecia (D mean scalp 3.1 Gy). The scalp of the patients with G1 (n = 11) and G2 (n = 85) alopecia received D mean of 10.6 Gy and 11.8 Gy, respectively. At ROC analysis, V 16Gy20Gy ≥ 5.2 cc were the strongest predictors of acute alopecia risk. Chronic hair-loss assessment was available for 74 patients: median time to recovery from G2 alopecia was 5, 9 months. The actuarial rate of hair regrowth was 98.1% at 18 months after the end of RT. At ROC analysis, V 40Gy43Gy ≥2.2 cc were the strongest predictors of chronic G2-alopecia risk. V 20Gy, V 40Gy , and D 0,1cc were shown to be independent variables according to correlation coefficient r.Conclusions: V 20Gy and V 40Gy were the strongest predictors for acute and chronic G2 hair-loss, respectively. The low-dose bath typical of VMAT corresponds to large areas of acute but transient alopecia. However, the steep dose gradient of VMAT allows to reduce the areas of the scalp that receive higher doses, minimizing the risk of permanent alopecia. Scoccianti et al. Predictors of Radiotherapy-Induced AlopeciaThe application of our dosimetric findings for the scalp may help in reducing the alopecia risk and also in estimating the probability of hair-loss during patient counseling before starting radiotherapy.

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Section: Discussionmentioning

confidence: 99%

“…Due to the high radiosensitivity of hair follicles, radiotherapy (RT) may induce hair-loss with a huge psychological impact and, thus, negative effects on patient's quality of life, also in case of limited life expectancy (1)(2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

et al. 2020

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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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Clinicopathologic Characteristics and Response to Treatment of Persistent Chemotherapy-Induced Alopecia in Breast Cancer Survivors

Bhoyrul

Asfour

Lutz³

et al. 2021

JAMA Dermatol

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IMPORTANCE Alopecia induced by classic chemotherapy affects up to 65% of patients and is usually reversible. However, there are increasing reports of persistent chemotherapy-induced alopecia (pCIA), especially for patients treated with taxane-containing chemotherapy regimens.OBJECTIVE To analyze the clinicopathologic characteristics and response to treatment of patients with pCIA after chemotherapy for breast cancer.DESIGN, SETTING, AND PARTICIPANTS In this case series, a retrospective evaluation was performed of patients with a diagnosis of pCIA after chemotherapy for breast cancer in 4 specialist hair clinics from November 1, 2011, to February 29, 2020.MAIN OUTCOMES AND MEASURES Clinical, trichoscopic, and histopathologic characteristics and treatment outcomes were analyzed. For patients who presented with diffuse alopecia or diffuse rarefaction of hair over the midfrontal scalp with widening of the central part line and preservation of the frontal hairline, the Sinclair scale (grades 1-5, where 1 indicates normal hair density and 5 indicates the most severe stage of hair loss, with little or no hair in the centroparietal region) was used to assess severity. RESULTSOne hundred patients (99 women [99%]; mean age at presentation, 54.0 years [range, 29.0-74.1 years]) were included. Most patients had diffuse nonscarring alopecia (n = 39), female pattern hair loss (n = 55), or male pattern hair loss (n = 6). Six patients developed cicatricial alopecia. Taxane-containing regimens were used for most patients (92 [92%]) and were associated with more severe alopecia than regimens that did not contain taxanes (median Sinclair grade, 4 [IQR, 3-5] vs 2 [IQR, 2-2.5]; P < .001). A total of 76 of 86 patients (88%) had trichoscopic signs indistinguishable from those of androgenetic alopecia. Of 18 patients who had biopsies, 14 had androgenetic alopecia-like features, 2 had cicatricial alopecia, and 2 had features of both. Both topical and oral minoxidil, sometimes combined with antiandrogen therapy, were associated with an improvement in hair density (median Sinclair grade, 4 [IQR, 3-5] before treatment vs 3 [IQR, 2-4] after treatment; P < .001).CONCLUSIONS AND RELEVANCE This case series outlines previously unreported features of pCIA in patients with breast cancer, including a trichoscopic description. Cosmetically significant regrowth was achieved for a significant proportion of patients with topical or systemic treatments, suggesting that pCIA may be at least partly reversible.

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Hair disorders in patients with cancer

Cited by 80 publications

References 166 publications

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

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

Clinicopathologic Characteristics and Response to Treatment of Persistent Chemotherapy-Induced Alopecia in Breast Cancer Survivors

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