Abstract
Simple SummaryAlthough it does not represent a condition that threatens the life of patients, alopecia nevertheless has an essential impact on the quality of life of patients, particularly in terms of the psychological and social aspects. Indeed, while it has long been considered an acceptable side effect in the management of patients, the progressive emergence of a patient-centered approach coupled with a better knowledge of the pathophysiological processes involved has led to a better consideration of alopecia, both on the preventive and palliative sides. Thus, cancerous alopecia can be multifactorial: iatrogenic (in particular via conventional chemotherapy), induced by a vitamin/nutritional deficiency, or even caused by the disease itself. In this state-of-the-art review, we therefore cover alopecia in an exhaustive manner by considering the different mechanisms involved and their frequency as well as the various therapies offered. Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance.
Highlights
Alopecia, which is defined as a decrease in hair density, exhibits a wide range of features
The scope of this review is to provide physicians with a state-of-the-art and clinical practice-driven review, assessing in a comprehensive manner the distinct mechanisms involved in cancer-related alopecia, their respective frequencies and the current and future treatment approaches
This latter discovery is manifested by a lesser knowledge of Persistent CIA (pCIA) by oncologists compared to dermatologists [28]. pCIA is defined by the presence of alopecia beyond 6 months after chemotherapy completion
Summary
Alopecia, which is defined as a decrease in hair density, exhibits a wide range of features It may be localized, diffuse or total, acute or chronic, sudden or gradual, reversible or permanent. Effluvium corresponds to a sudden, abundant and diffuse hair loss, which can be acute or chronic and affect anagen or telogen hair [1]. It is not life threatening, alopecia represents one of the most important parameters affecting the quality of life (QoL) of patients with cancers, in terms of the psychological and social aspects [2–4]. The scope of this review is to provide physicians with a state-of-the-art and clinical practice-driven review, assessing in a comprehensive manner the distinct mechanisms involved in cancer-related alopecia, their respective frequencies and the current and future treatment approaches
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