Minoxidil and antiandrogen therapy can improve hair density in chemotherapy-induced alopecia: JAMA
Australia: A recent case series published in the journal JAMA Dermatology has outlined previously unreported features of persistent chemotherapy-induced alopecia (pCIA) in breast cancer patients, including a trichoscopic description. For a significant proportion of patients with topical or systemic treatments, cosmetically significant regrowth was achieved. This suggests that pCIA may be at least partly reversible.
According to the study, hair follicle miniaturization which is the hallmark of androgenetic alopecia is a prominent feature in pCIA; recognized androgenetic alopecia treatments, including minoxidil and antiandrogen therapy, can also improve hair density for patients with pCIA.
Many people with breast cancer temporarily lose their hair after treatment with chemotherapy, but persistent hair loss is more common in patients who undergo taxane- and cyclophosphamide-based chemotherapy. However, persistent chemotherapy-induced alopecia (pCIA) tends to be underacknowledged by oncologists.
About 65% of the patients are affected by alopecia induced by classic chemotherapy which is usually reversible. However, there are increasing reports of pCIA, especially for patients treated with taxane-containing chemotherapy regimens. Bevin Bhoyrul, Sinclair Dermatology, Melbourne, Australia, and colleagues aimed to analyze the clinicopathologic characteristics and response to treatment of patients with pCIA after chemotherapy for breast cancer.
The researchers performed a retrospective evaluation 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.
The researchers analyzed clinical, trichoscopic, and histopathologic characteristics and treatment outcomes. 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.
One hundred patients (99 women [99%]; mean age at presentation, 54.0 years) were included.
Key findings include:
- 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 vs 2).
- 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 before treatment vs 3 after treatment).
"This case series outlines previously unreported features of pCIA in patients with breast cancer, including a trichoscopic description," wrote the authors. "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."
Reference:
Bhoyrul B, Asfour L, Lutz G, et al. Clinicopathologic Characteristics and Response to Treatment of Persistent Chemotherapy-Induced Alopecia in Breast Cancer Survivors. JAMA Dermatol. Published online September 29, 2021. doi:10.1001/jamadermatol.2021.3676
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