Chapter 30: Chemotherapy-Induced Hair Changes and Alopecia

SUMMARY

• Alopecia due to chemotherapy is usually an acute anagen effluvium that occurs after a few weeks and is reversible after withdrawal of the drug/s.

• Hair loss is the most common cutaneous side effect of antineoplastics and it’s more frequent and severe in combination chemotherapy.

• The absence or incomplete hair regrowth at 6 months after chemotherapy is defined as permanent alopecia.

TIPS FOR DIAGNOSIS

• The evaluation includes a clinical history and patient examination and is followed by invasive and noninvasive tests.

• Trichoscopy represents a valuable, noninvasive technique, used routinely, for the evaluation of patients with hair loss that allows for magnified visualization of the hair and scalp skin.

• Scalp biopsy is fundamental for diagnosis of permanent alopecia due to chemotherapy.

TIPS FOR TREATMENT

• No drugs are actually approved to prevent hair loss.

• Treatment options are still limited.

• After chemotherapy, the goal is to accelerate hair regrowth.

DON’T FORGET

• Hair loss continues to be one of the most distressing and troublesome side effects of chemotherapy for patients.

• The fear of chemotherapy-induced alopecia may be so severe as to lead to refusing or delaying this essential treatment.

• Often, only clinical examination permits correct diagnosis of the hair disease and evaluation of its severity and progression. For this reason, time should be spent getting all of the necessary anamnestic data and to carefully examine the patient.

PITFALLS AND CAUTIONS

• At the beginning, the hair shedding starts as a diffuse or patchy alopecia to became a total alopecia over time, which is the most common clinical manifestation.

• Due to the great insult to the follicles in anagen, hair shedding is characterized by dystrophic anagen hairs.

• In most cases, hair loss due to chemicals is reversible with the chemical’s withdrawal, with a good prognosis.

EXPERT PEARLS

• Anagen effluvium is the most common type of diffuse hair shedding due to chemotherapy, but dermatologists should remember that these drugs may be responsible also of changes in hair texture and color.

• The knowledge of side effects of the drugs prescribed is crucial for better patient management.

• Cases of permanent alopecia after chemotherapy are not so rare as in the past.

PATIENT EDUCATION POINTS

• Hair regrowth after chemotherapy is often characterized by changes in the hair color, texture, shape, with darker and curler hair compared to their original form.

• Hair loss has psychologically negative effects on life, with loss of self-esteem and confidence, loss of virility for men, and of beauty for women.

• Cutting hairs before having a complete and devasting hair loss can be useful for the patients to better managing personal approach.