Topical, systemic treatments may partly reverse persistent chemotherapy-induced alopecia

A novel trichoscopic description of persistent chemotherapy-induced alopecia was reported in a cohort of mostly women with breast cancer, according to a study.

“Alopecia induced by classic chemotherapy affects up to 65% of patients and is usually reversible,” Bevin Bhoyrul, MBBS, of Sinclair Dermatology in Melbourne, Australia, and colleagues wrote. “However, there are increasing reports of persistent chemotherapy-induced alopecia (pCIA), especially for patients treated with taxane-containing chemotherapy regimens.”

In the retrospective case series, Bhoyrul and colleagues assessed the clinical, trichoscopic and histopathologic characteristics and response to therapy in 100 patients (99% women; mean age at presentation, 54 years) with pCIA after breast cancer treatment. Eligible participants were accrued at four hair clinics between Nov. 1, 2011, and Feb. 29, 2020.

The researchers graded patients using the Sinclair Scale, which rates patients from 1-5 based on hair density. This parameter was used for those 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,” according to the findings.

Non-scarring alopecia was observed in 39 patients, while 55 had female pattern hair loss and six had male pattern hair loss. Cicatricial alopecia occurred in six patients.

Treatment data showed that 92% of patients were treated using taxane-containing regimens. Patients treated with these regimens experienced a median Sinclair score of 4 (interquartile range, 3-5), while those treated with non-taxane-based regimens had a median Sinclair score of 2 (IQR, 2-2.5; P < .001).

Further data showed that 88% of 86 patients demonstrated trichoscopic signs that could not be distinguished from androgenetic alopecia.

The analysis also included 18 patients with available biopsy data. Fourteen of those patients demonstrated androgenetic alopecia-like features, while two showed cicatricial alopecia and two exhibited features of both conditions.

An improvement in hair density from Sinclair grade 4 (IQR, 3-5) to grade 3 (IQR, 2-4) was reported among patients treated with both topical and oral minoxidil, or combined with antiandrogen therapy (P < .001).

“This case series outlines previously unreported features of pCIA in patients with breast cancer, including a trichoscopic description,” the researchers wrote. “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.”