Alopecia due to chemotherapy
Last Updated: 2023-10-12
Author(s): Anzengruber F., Navarini A.
Rapid onset non-scarring alopecia under chemotherapy caused by telogenic or anagen-dystrophic felluvium. The hair coat usually regenerates completely within 120 days after the end of the therapy.
The hair can react in two ways under chemotherapy:
- telogenic effluvium
- anagen-dystrophic effluvium
- Only the growing anagen hairs are affected
- Telogenous hairs are not affected, they normally fall out after 2-4 months
- The follicle usually remains intact so that the hair can grow back after the end of the therapy.
- Drugs that can trigger anagen effluvium are: Vincristine, Vinblastine, Methotrexate, Doxorubicin, Fluorouracil, CKD4/6 inhibitors
- Intense precipitating damage attacks the hair-forming epithelium in the follicle. This results in quantitatively inferior hair shafts that break off before they can reach the telogen phase. As early as 2 weeks after the start of chemotherapy, anagen-dystrophic effluvium may occur, whereby all aanagen hairs (>80%) may fall out.
- If the damage is only slight, the hair reacts with a telogen effluvium. Part of the anagen hair passes prematurely into the tellogen stage and falls out after completion of the same.
Rapid loss of most of the hair on the head up to complete baldness.
Detachment of the anagen hairs is already possible with a light pull. Anagen hairs can be recognised by their broom-shaped, pigmented shaft.
To distinguish it from any DDs, the back of the head affected here is crucial.
- Inquire about the duration and extent of the hair loss
- Determine medication/chemotherapy
- When regrowth occurs after the end of therapy, the texture may be altered with certain medications. After treatment with Adriamycin, for example, previously straight hair may suddenly show waves or curls.
- In therapy with multiple agents or taxanes, incomplete recovery of the hair may occur. Irreversible alopecia is said to occur 6 months after cessation of therapy. Alopecia areata-like areas or a female pattern hair loss are found.
I.d.R. regrowth of hair within 120 days after completion of chemotherapy.
- Fonia A1, Cota C2, Setterfield JF3, Goldberg LJ4, Fenton DA1, Stefanato CM5.,J Am Acad Dermatol. 2017 May;76(5):948-957. doi: 10.1016/j.jaad.2016.12.027. Epub 2017 Mar 8.,Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: clinicopathologic findings in a cohort of 10 patients.