Alopecia In Patients Research Articles

Trichoscopy and LC-OCT findings in sonidegib-induced alopecia in patients with advanced basal cell carcinoma

Trichoscopy and LC-OCT findings in sonidegib-induced alopecia in patients with advanced basal cell carcinoma

Alopecia in Patients with Autoimmune Hepatitis Treated by Tacrolimus Therapy

Alopecia in Patients with Autoimmune Hepatitis Treated by Tacrolimus Therapy

Abstract PO2-12-05: Scalp Cooling with the Capelli System to Reduce Doxorubicin-induced Alopecia in Patients with Localized Breast Cancer: A Phase 2 Randomized Controlled Trial

Abstract Introduction: Chemotherapy-induced alopecia (CIA) is a distressing side effect of breast cancer (BC) treatment. Scalp cooling (SC) devices have shown promise in reducing the severity of CIA. However, the impact of reducing alopecia occurrence on the quality of life of Brazilian patients remains unclear. Objectives: This study aimed to assess the effectiveness of the Capelli System, a new SC device, in reducing CIA. Methods: This was a single-center, controlled, randomized phase 2 clinical trial involving women with TNM stage I to III BC undergoing neoadjuvant or adjuvant doxorubicin-based chemotherapy (AC regimen: doxorubicin 60 mg/m² plus cyclophosphamide 600 mg/m², i.v., q21 days), with or without a taxane (paclitaxel or docetaxel). Participants were randomized in a 1:3 ratio into the scalp cooling (n = 33) or control (n = 12) groups. All participants were advised to cut their hair short and avoid heat-inducing tools or processes throughout chemotherapy, using cold or lukewarm water and wide-toothed combs for hair washing. The primary efficacy endpoint was grade 2 alopecia (>50% hair loss or hair shaving due to alopecia) after 4 cycles of AC. Secondary endpoints included measures of hair loss distress (BRHL) and body image (BRBI) from the EORTC Quality of Life Questionnaire - Breast Cancer Module (EORTC QLQ-BR23), as well as symptoms of anxiety and depression from the Hospital Anxiety and Depression Scale (HADS). Fitzpatrick phototype and hair type were assessed. Statistical analyses utilized generalized linear models and Fisher's Exact test (p-value < 0.05). Results: Patients were enrolled from October 11, 2019, to January 17, 2022. Out of the 45 patients included, 8 were excluded: 2 due to intolerance, 1 with alopecia associated with COVID-19, and 5 who withdrew consent (2 with grade 2 headache, 3 without justification). The median age was 44.6 (min-max: 23-63) years, with 18 (40%) and 27 (60%) receiving adjuvant and neoadjuvant chemotherapy, respectively. Grade 2 alopecia or hair shaving occurred in 52% of scalp cooling patients and 100% of controls (p = 0.003), demonstrating a significant 48% reduction in alopecia. There were no significant differences in HADS-A, HADS-D, BRHL, or BRBI scores between the two groups. Alopecia occurrence did not show significant associations with skin or hair types. No serious adverse events related to the scalp cooling device were reported. Conclusions: SC with the Capelli System significantly reduced CIA by half. Some patients experienced discomfort or headaches and discontinued device use. Further research is needed to understand why reduced alopecia rates do not correlate with improvements in body image or reduced hair loss distress. Citation Format: Carlos Paiva, Fabiola Dias, Angelo Matthes, Bianca Paiva, Cristiano Souza, Domício Lacerda, Augusto Antoniazzi, Maria Fernanda Machado, Matheus Godinho, Crislaine de Lima, Cristiane Cárcano, Marina Zorzetto. Scalp Cooling with the Capelli System to Reduce Doxorubicin-induced Alopecia in Patients with Localized Breast Cancer: A Phase 2 Randomized Controlled Trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-05.

How I Treat Alopecia in Patients with Cancer

For general dermatologists, the examination, diagnosis, and treatment of hair loss in patients with a history of cancer can be challenging. Previous and current chemotherapy, radiation therapy, and anti-cancer therapies need to be considered when developing a management strategy. Here we review strategies for reviewing patient medical histories, the incorporation trichoscopic examinations to aid with diagnosis, and special treatment considerations that do not increase risk of cancer reoccurrence. As novel anti-cancer therapeutics continue to be approved, it is imperative that dermatologists serve in support networks of patients experiencing dermatologic side effects. This article aims to aid dermatologists in the safe and effective treatment of hair-related side effects that negatively impact the survivorship of patients with cancer.

Alopecia prevention during chemotherapy: from the benchmark to real clinical practice. A prospective study

Background. Alopecia is one of the main side effects of anticancer chemotherapy and has a significant impact on patients’ appearance, quality of life, social adaptation and mental health of cancer patients. Estimated number of new cancer diagnosis increases annually alongside with the proportion of patients receiving chemotherapy. That means an annual increase in the global burden of chemo-induced alopecia and associated negative consequences. The development of various methods for the prevention of alopecia in cancer patients has continued for decades. However, convincing data have been obtained only for the scalp hypothermia method. In this point, the Paxman company’s cooling systems (UK) – the Orbis and Orbis II devices – have been most widely studied. Despite the fact that Orbis devices were approved in Russia more than 10 years ago, since then just a small amount of real clinical practice has been accumulated and questions regarding the effectiveness of scalp hypothermia in patients with variable cancers still remain open.
 Aim. Analysis of local clinical practice with scalp hypothermia via the Orbis II device for the prevention of alopecia in patients receiving various chemotherapy regimens.
 Materials and methods. An open, prospective, single-center study included patients with various cancer types who were indicated for chemotherapy. Orbis II device was used for prophylactic hypothermia. The severity of alopecia was assessed according to the CTCAE version 5.0 at baseline and during anticancer therapy.
 Results. From June 2022 to May 2023, scalp cooling procedures were performed in 51 patients, of them 78% of all procedures were performed in female cancers: breast tumors – 109 (52.2%) procedures, ovarian cancer– 33 (15.8%), and cervix cancer – 22 (10.5%). The effectiveness of scalp hypothermia in preventing of severe alopecia was 73%.
 Conclusion. Scalp cooling can be considered as an effective method for the prevention of chemotherapy induced alopecia. Further studies are needed to assess larger patient populations to identify favorable and negative factors that affect potency of the hypothermia.

Scalp hypothermia for the prevention of chemotherapy-induced alopecia in breast cancer

Background. Breast cancer (BC) is a socially significant disease in women all over the world, ranking 1st in the structure and 5th in the number of deaths. Polychemotherapy in the complex treatment of BC accounts for approximately 80%. The main side effect that significantly affects the quality of life is alopecia, which occurs on average in 65% of patients.
 Aim. To evaluate the efficacy and tolerability of scalp hypothermia (SHT) for the prevention of chemotherapy-induced alopecia in patients with BC.
 Materials and methods. From June 2016 to September 2023, 75 patients with a median age of 44.1 years with stage I–IV BC were observed. All patients received cytotoxic therapy at various stages of treatment. To prevent alopecia, local SHT was used using an Orbis II device (Paxman Coolers, United Kingdom).
 Results. Stage I of the disease was observed in 18 (24%) patients, stage II in 22 (29.3%), stage III in 30 (40%), and stage IV in 5 (6.7%). Patients received 5 different neo- and adjuvant regimens of polychemotherapy. Taxane-containing combined regimens prevailed. 364 SHT sessions (4–8 sessions per patient) were performed; 48 (64%) patients received the procedure in full. Complete hair preservation was achieved in 43 (57.3%) patients. Grade 1 alopecia was observed in 19 (25.4%) patients and grade 2 in 9 (12%) patients. Of the 5 patients with advanced BC, grade 2 alopecia was reported in 1 patient, grade 3 in 3, and grade 4 in 1. Side effects were reported in 16% of cases; the most common were a feeling of cold and a slight headache. Due to the intolerance of the cold helmet, 3 patients refused to use it. No scalp metastases were observed during the follow-up. During the procedure, almost all patients noted a high level of comfort.
 Conclusion. Local SHT is an effective method of preventing cytotoxic therapy-induced alopecia in patients with BC. It improves the psychological and social adaptation of patients.

The Relationship between Seborrheic Dermatitis and Androgenetic Alopecia in Patients Referred to a Skin Clinic in Tehran, Iran: A Retrospective Study

Background: Seborrheic dermatitis (SD) is a common skin problem that generally affects the scalp. SD causes scale-like parts, skin redness, and persistent dandruff, which can also affect the fatty parts of the body. Androgenic alopecia (AGA) is an androgen-dependent hereditary disorder characterized by progressive thinning of hair with various patterns. Objectives: Considering that AGA is probably related to race, genetics, and geographical conditions, and timely treatment of SD and AGA is critical, the main objective of this study was to evaluate the relationship between SD and AGA. Methods: This descriptive-analytical study was conducted on patients with AGA referred to the skin clinic of Rasoul-Akram Hospital in Tehran, Iran, in 2021. Among the mentioned patients, 250 were randomly selected by easy sampling. The patient's age, gender, occupation, marital status, history of skin, hormonal, or systemic disease, medical history, medication history, smoking history, alcohol intake, and family history of hair loss are all required information after obtaining informed consent from the patient. Skin color and face and skin type were recorded by a researcher-made checklist. Then, the patients were examined in terms of SD, and finally, the collected data were analyzed using SPSS software Version 24 and relevant statistical tests. Results: The average age of the studied patients was 35.64 ± 8.11 169 (67.2%) were women, and 81 (32.8%) were men. The highest severity of SD was grade 1 in 116 people (46.6%). There was a significant relationship between the severity of SD and the history of hair loss in the family (P = 0.03). In addition, there was a significant correlation between the pattern of AGA in men and the severity of SD (P < 0.05). The study showed a significant relationship between dandruff symptoms and AGA patterns (P < 0.05). Conclusions: Based on the results, this issue should be evaluated with more precision and follow-up due to the relationship between the severity of SD and the AGA pattern. Moreover, eliminating the symptoms of dandruff can help in improving hair loss. In addition, evaluating a person's medical history and family history is essential to determining the pattern of hair loss, preventing its progression, and timely treatment of this problem.

Efficacy of Dr. SKS Hair Booster Serum in the Treatment of Female Pattern Alopecia in Patients With PCOS: An Open-Label, Non-randomized, Prospective Study.

Background Many patients with polycystic ovary syndrome (PCOS) exhibit female pattern hair loss (FPHL). A more advanced, efficient, and suitable therapeutic approach is required to effectively manage FPHL in patients with PCOS. Aim Dr. SKS Hair Booster Serum is composed of copper, niacinamide, hyaluronic acid, thiamine, riboflavin, and biotin; each of these constituents has demonstrated individual efficacy in promoting hair growth and enhancing hair quality. We hereby assess the effectiveness of this novel hair formulation in treating FPHL in PCOS. Methods This was an open-label, non-randomized, multicenter, prospective, large study with a wide range of age groups. The study involving 1,000 females aged 25-50 years, diagnosed with PCOS and having complaints of FPHL with Ludwig grades I and II. Each patient received a monthly session of Dr. SKS Hair Booster Serum, with 1 mL of serum administered through injection into the superficial layer (dermis) of the scalp using a tiny infusion via an insulin syringe, mesotherapy, or via a derma roller/derma pen. All the patients were subjected to standard global photography, video microscopic assessment (vellus hair counts, terminal hair counts, and hair shaft diameter), and a subject self-assessment questionnaire at baseline and six months after the treatment. Results After six months of the treatment, the hair shaft diameter, terminal hair counts, and hair growth rate were significantly increased than baseline (p≤0.0001), and a significant reduction was noted in vellus hair counts than baseline measurement (p<0.00001). These findings are suggestive of improved hair regrowth after the treatment. No adverse events were recorded during the study. Statistically significant improvements were observed in hair parameters (overall hair fall rate, hair texture, hair volume, and scalp itching) after six months of treatment than baseline. Conclusion Dr. SKS Hair Booster Serum has been shown to be an effective treatment for FPHL in patients with PCOS. This study marks the first investigation into the use of Dr. SKS Hair Booster Serum in patients with PCOS.

Retrospective cohort study of CDK4/6-inhibitor-induced alopecia in patients with breast cancer.

e13083 Background: The synergistic effects of novel combined cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) and endocrine therapy has increased their utilization for treatment of metastatic breast cancer. When compared to endocrine monotherapy, CDK4/6i may increase the risk of alopecia by nearly two-fold (Eiger D, et al. PMID: 32167397; Chan D, et al. J Clin Oncol.). The prevalence of this adverse effect underscores the importance of characterizing CDK4/6i-induced alopecia (CDKIA) and investigating therapeutic options. Methods: A retrospective cohort of 28 female patients with breast cancer and endocrine-induced alopecia (EIA) or CDKIA. Onset of alopecia was measured by time (months) between initiation of anticancer therapy and dermatology referral. Therapeutic response to minoxidil (LDOM or topical [5%] solution or foam) was assessed by both Dean Scale and qualitative clinical improvement by comparison of pre-treatment and post-treatment clinical images by 2 board certified academic dermatologists (ST and BD). Results: Androgenetic alopecia was the most common hair loss distribution (n=27, 96.4%), with CDKIA patients having preferential vertex involvement (n=7 [70.0%] CDKIA vs. n=4 [36.4%] EIA; p=0.04). Patients on CDK4/6i had shorter times to dermatology referral (mean time [months]: 44.6±37.1 for EIA vs. 9.4±13.7 CDKIA; p=0.003). After 16-24 weeks of minoxidil, moderate to significant improvement of alopecia occurred in 80% of CDKIA patients versus 94.4% of EIA patients. Despite similar baseline alopecia grade severity, significant improvement was only observed in EIA patients (mean pretreatment Dean Score – post-treatment Dean Score: -0.44; p=0.0002). Conclusions: Compared to EIA, the onset of CDKIA happened more rapidly and was more resistant to minoxidil. The preferential vertex involvement observed among patients with CDKIA may suggest combination therapy with topical or oral minoxidil and topical anti-androgens may lead to more favorable outcomes. Prompt dermatology referral should be considered for patients treated with CDK4/6i + ET. [Table: see text]

Effectiveness of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia in Patients Undergoing Breast Cancer Treatment: A Systematic Review and Meta-analysis.

Chemotherapy-induced alopecia could cause significant psychological changes, affecting patients' quality of life and their capacity to cope with the disease. The aims of this study was to analyze the effectiveness of scalp cooling (SC) to prevent chemotherapy-induced alopecia in patients with breast cancer and to compare the use of automated versus nonautomated therapy delivery devices. We searched the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Scopus, Web of Science, and ClinicalTrials.gov from their inception to October 2022. A meta-analysis was performed to assess the effects of SC to prevent chemotherapy-induced alopecia in patients with breast cancer using fixed-effects models to calculate the pooled relative risk (RR) and corresponding 95% confidence interval (CI). The 8 included studies showed a 43% reduction in the risk of chemotherapy-induced alopecia (RR, 0.57; 95% CI, 0.50-0.64) after the use of SC. Moreover, the use of automated SC devices showed a 47% reduction (RR, 0.53; 95% CI, 0.45-0.60) in the risk of chemotherapy-induced alopecia versus a 43% reduction in the risk of chemotherapy-induced alopecia for nonautomated SC devices (RR, 0.57; 95% CI, 0.44-0.70). Our results showed that SC significantly reduced the risk of chemotherapy-induced alopecia. Local cold application is a nonpharmacologic therapy that may provide a useful intervention to reduce hair loss and contribute to the psychological well-being of women. Scalp cooling contributes directly to reducing concern about altered body image and to reducing anxiety related to self-concept.

Alopecia in Patients with Collagen VI-Related Myopathies: A Novel/Unrecognized Scalp Phenotype.

Collagen VI-related myopathies are characterized by severe muscle involvement and skin involvement (keratosis pilaris and impaired healing with the development of abnormal scars, especially keloids). Scalp involvement and hair loss have not been reported among cutaneous changes associated with collagen VI mutations. The aim of this study is to describe the clinical, trichoscopic, and histological findings of the scalp changes in patients affected by COL VI mutations and to estimate their prevalence. Patients with Ullrich congenital muscular dystrophy were enrolled and underwent clinical and trichoscopic examinations and a scalp biopsy for histopathology. Five patients were enrolled, and all complained of hair loss and scalp itching. One patient showed yellow interfollicular scales with erythema and dilated, branched vessels, and the histological findings were suggestive of scalp psoriasis. Two patients presented with scarring alopecia patches on the vertex area, and they were histologically diagnosed with folliculitis decalvans. The last two patients presented with scaling and hair thinning, but they were both diagnosed with folliculitis and perifolliculitis. Ten more patients answered to a "scalp involvement questionnaire", and six of them confirmed to have or have had scalp disorders and/or itching. Scalp involvement can be associated with COL VI mutations and should be investigated.

Dosimetric investigation of whole-brain radiotherapy with helical intensity modulated radiation therapy and volumetric modulated arc therapy for scalp sparing.

Intensity-modulated radiotherapy (IMRT) is a well-established radiotherapy technique for delivering radiation to cancer with high conformity while sparing the surrounding normal tissue. Two main purposes of this study are: (1) to investigate dose calculation accuracy of helical IMRT (HIMRT) and volumetric-modulated arc therapy (VMAT) on surface region and (2) to evaluate the dosimetric efficacy of HIMRT and VMAT for scalp-sparing in whole brain radiotherapy (WBRT). First, using a radiochromic film and water-equivalent phantom with three types of boluses (1, 3, 5 mm), calculation/measurement dose agreement at the surface region in the VMAT and HIMRT plans were examined. Then, HIMRT, 6MV-VMAT and 10MV-VMAT with scalp-sparing, and two conventional three-dimensional conformal radiotherapy plans (6MV-3DCRT and 10MV-3DCRT; as reference data) were created for 30 patients with brain metastasis (30 Gy/10 fractions). The mean dose to the scalp and the scalp volume receiving 24 and 30 Gy were compared. The percentage dose differences between the calculation and measurement were within 7%, except for the HIMRT plan at a depth of 1 mm. The averaged mean scalp doses [Gy], V24Gy [%], and V30Gy [%] (1SD) for 6MV-3DCRT, 10MV-3DCRT, HIMRT, 6MV-VMAT, and 10MV-VMAT were [26.6 (1.1), 86.4 (7.3), 13.2 (4.2)], [25.4 (1.0), 77.8 (7.5), 13.2 (4.2)], [23.2 (1.5), 42.8 (19.2), 0.2 (0.5)], [23.6 (1.6), 47.5 (17.9), 1.2 (1.8)], and [22.7 (1.7), 36.4 (17.6), 0.7 (1.1)], respectively. Regarding the dose parameters, HIMRT achieved a lower scalp dose compared with 6MV-VMAT. However, the highest ability to reduce the mean scalp dose was showed in 10MV-VMAT. Scalp-sparing WBRT using HIMRT or VMAT may prevent radiation-induced alopecia in patients with BM.

The association of hair loss and coronavirus infection COVID-19 – facts and hypotheses

The main manifestations of COVID-19 are primarily interstitial pneumonia and respiratory failure. No less than 20% of patients have variable skin rashes, which try to be interpreted as markers and predictors of the peculiarities of the course of coronavirus infection. In addition, hair loss is a characteristic manifestation of COVID-19, and the salivary follicles are regarded as a target for SARS-CoV-2. The most common variants of alopecia in patients with a new coronavirus infection or vaccine-induced alopecia are acute telogenic, nondescript, and androgenetic alopecia. This review provides information on the most common variants of hair loss in patients with SARS-CoV-2 infection, the features of their manifestations, and possible mechanisms of development. Acute telogenic hair loss is the most common variant of SARS-CoV-2-induced alopecia, is characteristic of patients with subacute course of COVID-19 and can be combined with trichodynia, anosmia and aguvia, which are markers of nervous syste damage. Given the variability in the time of onset after infection, a heterogeneous pathogenesis of alopecia can be assumed. Nested alopecia after COVID-19 is often a relapse of the disease, its severity and frequency do not correlate with the severity of the infectious disease, and its prevalence in women indicates the importance of hormonal factors in its development. Androgenetic alopecia may be a predictor of high risk of infection, severe course, and recurrence of COVID-19. The first two variants of alopecia may be associated with COVID-19 vaccination, and the latter is a predictor of inadequate immune response to vaccine administration. The mechanisms of the damaging effects of SARS-CoV-2 on hair follicles have not been fully deciphered and are most likely complex, with different leading links in different types of hair loss. Deciphering these mechanisms may provide prerequisites for understanding the mechanisms of COVID-19 damage to other tissues and organs.

A Scalp Dose Threshold for Preventing Permanent Alopecia in Scalp-Avoidance Whole-Brain Irradiation With Volumetric Modulated Arc Radiation Therapy for Pediatric Patients With Medulloblastomas

Although the overall survival of patients with medulloblastoma has dramatically improved, permanent alopecia significantly affects their quality of life. Therefore, we performed scalp-avoidance whole-brain irradiation with volumetric-modulated arc therapy (SAWB-VMAT) as a component of craniospinal irradiation (CSI). We retrospectively estimated the cutoff dose to prevent permanent alopecia in patients treated with SAWB-VMAT according to the St. Jude Medulloblastoma-96 protocol. Eight pediatric patients (median age 8.0 years, range 4.7-12.8 years) with medulloblastoma at our institution who we could take photographs following completion of the St. Jude Medulloblastoma-96 protocol treatment from May 2011 to August 2018 were enrolled in this study. All patients underwent CSI and boost radiotherapy followed by four cycles of dose-intensive chemotherapy. We defined permanent alopecia as hair loss persisting for 1 year after radiotherapy completion and 9 months after chemotherapy completion, as graded by two reviewers for each patient using the Severity of Alopecia Tool (SALT) score. Grades 3 and 4 alopecia were considered severe. Equivalent doses in 2-Gy fractions (assuming α/β = 2) to 50༅ of the scalp (EQD 50%) of SAWB-VMAT was significantly reduced compared to conventional WBRT (16.6 ± 3.6 vs. 20.2 ± 5.5 Gy, P = 0.038). The optimal EQD 50% cutoff was 19.9 Gy for severe permanent alopecia (area under the curve, 84%; sensitivity, 88%; specificity, 78%). The severe alopecia area was markedly reduced based on a 19.9 Gy cutoff (15.7 vs. 84.6 %, P = 0.0001). None of the patients who received SAWB-VMAT showed disease progression 5 years after starting radiotherapy. SAWB-VMAT significantly reduced the scalp EQD 50% and the estimated cutoff EQD 50% was 19.9 Gy. Scalp-avoidance whole-brain irradiation with volumetric-modulated arc therapy (SAWB-VMAT) remarkedly reduced equivalent doses in 2-Gy fractions (assuming α/β = 2) to 50༅ of the scalp (EQD 50%) comparing with conventional WBRT. None of the patients who received SAWB-VMAT showed disease progression 5 years after starting radiotherapy. The optimal EQD 50% cutoff was 19.9 Gy for severe permanent alopecia.

Retrospective cohort study of scalp cooling in breast cancer patients

For patients with cancer, alopecia is a common side effect that negatively impacts personal identity, body image, self-esteem, quality of life, and medical decision-making. Scalp cooling is a technique used to prevent alopecia in patients undergoing chemotherapy in which patients wear a cooled cap during chemotherapy infusions, causing localized vasoconstriction of blood vessels on the scalp. Because of the recent emergence of scalp cooling, there is a need to explore further the reasons why patients pursue this treatment. A retrospective chart review of women with breast cancer treated at The Ohio State University was conducted to investigate how factors such as patient age, race, ethnicity, insurance status, stage of cancer, and chemotherapy regimen influenced patients' decisions to incorporate scalp cooling into their treatment plan as compared to those who did not. Findings revealed that patient age, race, insurance status, and chemotherapy regimen were predictors of a patient's likelihood to undergo scalp cooling. Patients diagnosed at younger age and those with private insurance were more likely to utilize scalp cooling. In comparison to White patients, non-White patients were less likely to choose scalp cooling. Furthermore, patients placed on the chemotherapy regimen of AC or AC-T were less likely to pursue scalp cooling than patients on PTCH or TC regimens. These findings provide background for the development of educational resources for both patients interested in this therapy and healthcare providers discussing this treatment option in dermatology and oncology settings.

Efficacy of low-dose oral minoxidil in the management of anticancer therapy-induced alopecia in patients with breast cancer: A retrospective cohort study

Efficacy of low-dose oral minoxidil in the management of anticancer therapy-induced alopecia in patients with breast cancer: A retrospective cohort study

Dermoscopic Findings of Alopecia in Patients with Hypothyroidism.

Thyroid hormones are essential for the growth and maintenance of hair follicles. Numerous studies have evaluated the relationship between thyroid disorders and hair loss. However, no study has assessed the dermoscopic results in patients with hypothyroidism and hair loss. This study aimed to investigate dermoscopic findings of alopecia in patients with hypothyroidism. This analytic cross-sectional study was performed on patients with hair loss referred to dermatology clinics of Guilan University of Medical Sciences, Iran. Hypothyroid patients and an equal number of euthyroid individuals were compared. After recording the demographic and clinical characteristics, all patients were subjected to hair dermoscopy. A total of 164 patients with and without hypothyroidism with hair loss were studied. The frequency of hair shaft abnormalities (P < 0.001) and vellus hair (P < 0.001) significantly differed between the two groups. Dermoscopic findings related to scale abnormalities (P = 0.002) and their perifollicular type (P < 0.001) significantly differed between the groups. Vascular changes (P < 0.001), perifollicular concentric type (P = 0.012), and interfollicular red loops type (P = 0.005) were significantly higher in patients with hypothyroidism. Also, based on the multiple logistic regression model, the chance of abnormalities of the hair shaft, scales, and vascular changes increased by 3.24, 2.73, and 3.53, respectively, in hypothyroidism compared to euthyroidism. Regarding the promising results of this study, we could detect possible dermoscopic signs of inflammation in hypothyroid patients with hair loss. Further investigations are needed because there is a shortage of evidence on this novel diagnostic method.

33805 Retrospective cohort study of scalp cooling in breast cancer patients

For patients with cancer, alopecia is a common side effect that negatively impacts personal identity, body image, self-esteem, quality of life, and medical decision making. Scalp cooling is a technique used to prevent alopecia in patients undergoing chemotherapy in which patients wear a cooled cap during chemotherapy infusions, causing localized vasoconstriction of blood vessels on the scalp. Because of the recent emergence of scalp cooling, there is a need to explore further the reasons why patients pursue this treatment and the associated patient-centered outcomes. A retrospective chart review of women with breast cancer treated at The Ohio State University was conducted to investigate how factors such as patient age, race, ethnicity, insurance status, stage of cancer, and chemotherapy regimen influenced patient’s decisions to incorporate scalp cooling into their treatment plan as compared with those who did not. Findings revealed that patient race and chemotherapy regimen were predictors of a patient’s likelihood to undergo scalp cooling. In comparison to White patients, non-White patients were less likely to choose scalp cooling. Furthermore, patients placed on the chemotherapy regimen of AC-T were less likely to pursue scalp cooling than patients on AC, PCTH, and TC regimens. These findings provide background for the development of educational resources for both patients interested in this therapy and healthcare providers discussing this treatment option in dermatology and oncology settings.

Alopecia signals associated with calcitonin gene-related peptide inhibitors in the treatment or prophylaxis of migraine: A pharmacovigilance study.

Although rarely observed in clinical trials, alopecia has been reported in migraine patients treated with calcitonin gene-related peptide (CGRP) inhibitors during the postmarketing period. This study sought to assess whether CGRP inhibitors are associated with disproportionate alopecia reporting relative to other drugs including those indicated for migraine treatment or prophylaxis in a real-world setting. Retrospective disproportionality analysis. Spontaneous adverse events reported to the United States Food and Drug Administration Adverse Event Reporting System (FAERS) through the fourth quarter of 2021. Thirteen Medical Dictionary for Regulatory Activities preferred terms were used to define alopecia cases in FAERS. Disproportionality was measured by calculating proportional reporting ratios (PRR) and 95% confidence intervals (CI). A PRR >2.0 with a lower 95% CI >1.0 and ≥3 cases was considered a positive signal. During the study period, CGRP inhibitors were reported as suspect products in 55,994 adverse events including 1827 (3.26%) alopecia cases. Compared with all other drugs across FAERS, alopecia signals were detected for the collective CGRP inhibitor class (PRR 4.06; 95% CI 3.88-4.25) and fremanezumab (PRR 5.42; 95% CI 4.66-6.29), erenumab (PRR 4.29; 95% CI 4.05-4.54), galcanezumab (PRR 4.11; 95% CI 3.78-4.48), and eptinezumab (PRR 2.06; 95% CI 1.25-3.40) individually. CGRP inhibitors were consistently associated with alopecia signals relative to triptans (PRR 12.46; 95% CI 10.22-15.18) and celecoxib (PRR 3.50; 95% CI 3.19-3.83), but not in comparison with anticonvulsants, onabotulinumtoxinA, or beta-blockers across analyses. Within the CGRP inhibitor class, an alopecia signal was observed for biologics relative to drugs (PRR 6.11; 95% CI 3.79-9.87). Significant alopecia signals were identified for CGRP inhibitors relative to all other drugs and certain comparator migraine therapies based on adverse events reported to FAERS, with CGRP-targeting biologics primarily driving disproportionate reporting. Future observational data will be necessary to better characterize the potential association between real-world use of CGRP inhibitors and incident alopecia in patients with migraine.

Characteristics of Patients with Hair Loss after Isotretinoin Treatment: A Retrospective Review Study.

Background: Oral isotretinoin has been used to treat acne for decades. Although the side effects of isotretinoin are mostly predictable, one less common side effect of isotretinoin use is hair loss, typically telogen effluvium.Objective: This study is a retrospective report on the development of alopecia in patients on isotretinoin therapy.Methods: To characterize these patients, they were further compared to other patients in the same time period who were prescribed isotretinoin and did not experience hair loss.Results: Of 6330 patients with hair loss, 48 had been prescribed isotretinoin at some time between 2013 and 2018. Of these 48 patients, hair loss occurred concurrently or within two years after taking isotretinoin in 19 patients. When compared to controls, patients who experienced hair loss from isotretinoin were older, had greater cumulative isotretinoin doses, and had longer durations of treatment.Conclusion: Although the exact mechanism of how retinoids affect hair loss is still unclear, our findings suggest dosage or duration of usage may be associated. This information may be useful in counseling patients who may be concerned about hair loss when considering isotretinoin treatment.