‘Hair is identity’: Low-dose oral minoxidil treats hair loss in breast cancer survivors
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Key takeaways:
- The study included breast cancer survivors that underwent chemotherapy or surgery and radiation alone.
- All women taking minoxidil saw improved hair growth or stabilized hair loss within 3 to 6 months.
One in eight women will suffer from breast cancer in their lifetime. Eight percent will decline treatment due to the fear of alopecia.
These statistics from the American Cancer Society and a 2021 study by Bhoyrul and colleagues, respectively, show the immense need of women with breast cancer to find a solution for their chemotherapy-induced alopecia.
“Women should have options to treat one of the most devastating side effects of chemotherapy,” Kristen Lo Sicco, MD, associate professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, told Healio. “Alopecia is an outward reminder of their vulnerability, suffering and lack of control. Alopecia is a visible reminder of their battle with cancer.”
Since chemotherapy for breast cancer often includes cardiotoxic therapies, clinicians have been hesitant to prescribe oral minoxidil, a medication known to cause potential cardiovascular adverse events. However, the implications of hair loss for some patients with breast cancer can be the difference between life or death.
This realization prompted Lo Sicco and colleagues to investigate the efficacy and safety of low-dose oral minoxidil (LDOM), defined as less than or equal to 5 mg per day, for the treatment of alopecia in women with breast cancer.
The researchers assessed data from NYU Langone Health’s electronic health record system from 2012 to 2023 and found detailed records on 51 women (median age, 67 years) with breast cancer who had taken LDOM of 1.25 mg per day for longer than 1 month. Twenty-five of these women were treated with chemotherapy, whereas the remainder underwent surgery or radiation alone.
These records showed that all women taking LDOM either experienced improvement in their hair growth or stabilization of their hair loss within 3 to 6 months of starting LDOM. In fact, LDOM was equally effective among those treated with chemotherapy as it was among those not treated with chemotherapy.
A total of 29 patients experienced 44 adverse events, with the most common being hypertrichosis (61.4%). No cardiovascular or life-threatening adverse events were reported.
The researchers saw no difference in adverse event rates between those receiving chemotherapy and those that underwent surgery or radiation alone except in the timing of when those adverse events were experienced.
“Unexpectedly, patients taking minoxidil who did not undergo chemotherapy reported side effects a median of 3 months later than those that had a history of chemotherapy use,” Devyn Zaminski, BA, a medical student at the NYU Grossman School of Medicine and co-lead author of the study, told Healio. “While the reasons for this delay are not yet clear, it underscores the importance of ongoing monitoring, as the timing and nature of side effects can vary depending on the treatment context.”
The authors emphasized that this study supports the safety of LDOM for the treatment of hair loss in breast cancer survivors, including those who used cardiotoxic drugs, and clinicians should feel comfortable prescribing LDOM to these patients.
“Hair is identity, hair is personal, hair often defines our sense of self, and its loss can rob someone of their identity,” Lo Sicco said. “Dermatologists are uniquely equipped with the skillset to treat this patient population and, in doing so, helping to restore their identities.”
References:
- Key statistics for breast cancer. https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html. Updated Jan. 17, 2024. Accessed Jan. 6, 2025.
- Bhoyrul B, et al. JAMA Dermatol. 2021;doi:10.1001/jamadermatol.2021.3676.