JAAD onlineChemotherapy-induced alopecia
Section snippets
Hair biology
The hair follicle is a highly organized structure within the skin. At the base of every hair follicle there is a structure called the papilla that consists of a collection of rapidly dividing matrix cells that forms an outward moving hair shaft from the dermis. In human beings, all hair follicle formation is complete at birth and the total number of terminal hair follicles on the scalp is approximately 100,000.2 After birth, hair growth involves lifelong continuous cycling through 4 stages as
Pathogenesis of CIA
Cytotoxic chemotherapy agents target dividing cells and as a result the highly proliferative hair matrix cells are an unintended target.4 Because affected hairs are those that are in the proliferative anagen phase, CIA is referred to as anagen effluvium.5
Studies of cyclophosphamide-induced alopecia in human beings and in mice have formed the basis for our current understanding of the pathogenesis of CIA. Early work in human beings demonstrated that cyclophosphamide administration leads to two
Clinical features of CIA
Alopecia from the cytotoxic effects of chemotherapy depends on the specific agent, the dose and duration of therapy, the route by which it is administered, and the response of the individual. Certain classes of chemotherapy agents are known to cause alopecia more readily. The typical agents include alkylating agents, anthracyclines, antibiotics, antimetabolites, vinca alkaloids, and taxanes (Table I). Although several studies have classified or tabulated chemotherapeutic agents based on
The experience of hair loss in patients with cancer
Across the literature, hair loss consistently ranks among the most troublesome and traumatic aspects of chemotherapy (Fig 2).36, 37 Almost 90% of patients with early-stage breast cancer considered perioperative chemotherapy to be the most burdensome aspect of their treatment course because of the alopecia.38 Some women have found hair loss to be more difficult to cope with than the loss of a breast.39, 40 Others have considered refusing treatment because of anticipated alopecia.40, 41 These
Physical interventions
Scalp cooling methods, in the form of ice packs, cooling caps, and caps connected to cooling devices (Penguin Cold Caps, Medical Specialties of California, London, UK), were introduced in the 1970s as a treatment for CIA.45 Scalp hypothermia is postulated to work by several mechanisms. It stimulates local vasoconstriction, thus decreasing the amount of chemotherapeutic agent reaching the follicle. The colder temperature also slows cellular uptake and reduces the overall intrafollicular
Practical applications to patient care
Given our current understanding of the human hair cycle and the state of experimental interventions, clinicians treating CIA must be proactive and supportive toward patients. An overall multidisciplinary approach is recommended. We have summarized our recommendations in Table IV and provided a patient education handout (Table V) with related Internet sites. Our institution offers several other factors to ameliorate patient distress. In particular, easy access to social workers and psychiatrists
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2023, Journal of Investigative Dermatology[Translated article] Chemotherapy, Alopecia, and Scalp Cooling Systems
2022, Actas Dermo-SifiliograficasPermanent chemotherapy-induced alopecia presenting with erosive pustular dermatosis-like retention hyperkeratosis
2022, JAAD Case ReportsCitation Excerpt :Chemotherapy could trigger EPD or retention hyperkeratosis, but this does not explain the patient’s single episode, which usually follows a chronic recurrent course. pCIA can be distressing, with negative impact on quality of life and self-esteem.4,7,8 Prevention with scalp cooling,9 prompt diagnosis, and early treatment may help reduce morbidity.4
The physical, psychological and social experiences of alopecia among women receiving chemotherapy: An integrative literature review
2020, European Journal of Oncology Nursing
Funding sources: None.
Conflicts of interest: None declared.