Chemotherapy-induced Hair Loss Research Articles

Alopecia due to chemotherapeutics, hedgehog inhibitors, targeted antibody therapies and immune checkpoint inhibitors : Pathogenesis, clinical picture, diagnostics and prophylaxis

The incidence and severity of alopecia vary mainly depending on the chemotherapeutic agent used or other drug groups. The pathogenetic characteristics of the different forms of alopecia are reflected in the clinical presentation and, in some cases, in the resulting recommendations for prophylaxis. To provide an overview of the pathogenesis, clinical presentation, diagnosis and prophylaxis of alopecia with chemotherapeutic agents, hedgehog inhibitors, targeted therapies and immune checkpoint inhibitors. Based on the current S3guideline "Supportive therapy", an extensive literature search was carried out. Chemotherapy-induced hair loss (CIA) occurs in up to 65% of cases. Anagen effluvium is observed as early as 1-3weeks after the start of treatment and is reversible in most cases. Alopecia associated with inhibitors of the Sonic Hedgehog signaling pathway (HHIA) such as vismodegib or sonidegib are observed in up to 60% of cases. They are characterized by telogen effluvium. BRAF or immune checkpoint inhibitors lead significantly less frequently to alopecia (BRAFA, CPIA). According to taxane-based chemotherapy protocols, scalp cooling can help to prevent higher-grade CIA. If CIA or other forms of alopecia are expected, early contact with self-help organizations and early prescriptions for wigs should be offered.

The effect of a helmet type, home-use low-level light therapy device for chemotherapy-induced alopecia: study protocol for a randomized controlled trial

BackgroundAlopecia is one of the most common adverse effects of chemotherapy. It reduces the patient’s self-esteem and quality of life and the effect of therapy. Scalp cooling is the only verified current method for prevention but success is not guaranteed, particularly after receiving anthracycline-based combinations.Low-level light therapy has been clinically proven to inhibit the progress of androgenic alopecia. A previous study using human subjects shows limited benefits for low-level light therapy for patients who suffer chemotherapy-induced alopecia but an increase in the number of probes and the optimization of light sources may improve the efficacy. This study determines the efficacy of low-level light therapy for the prevention of chemotherapy-induced hair loss for patients with breast cancer using a randomized controlled trial.MethodsOne hundred six eligible breast cancer patients were randomly distributed into a low-level light therapy group and a control group, after receiving chemotherapy. Subjects in the low-level light therapy group received 12 courses of intervention within 4 weeks. Subjects in the control group received no intervention but were closely monitored.The primary outcome is measured as the difference in the hair count in a target area between the baseline and at the end of week 4, as measured using a phototrichogram (Sentra scalp analyzer). The secondary outcomes include the change in hair count at the end of week 1, week 2, and week 3 and hair width at the end of week 1, week 2, week 3, and week 4, as measured using a phototrichogram, and the change in distress, the quality of life, and self-esteem due to chemotherapy-induced alopecia, at the end of week 4, as measured using a questionnaire.DiscussionThis study improves cancer patients’ quality of life and provides clinical evidence.Trial registrationRegistered at ClinicalTrials.gov—NCT05397457 on 1 June 2022.

Advanced Sensor-Based Cap Cooling System for Mitigating Chemotherapy-Induced Hair Loss

Advanced Sensor-Based Cap Cooling System for Mitigating Chemotherapy-Induced Hair Loss

"I Decked Myself Out in Pink"

"I Decked Myself Out in Pink"

Alopecia in oncology: the practical significance of fundamental research

Purpose. To reflect the current understanding of the frequency, molecular mechanisms, and means of overcoming alopecia in cancer patients, taking into account the fundamental data of recent years on the physiology of the hair follicle and the pharmacological profile of the toxicity of anticancer drugs.Material and Methods. A literature search using Medline, Pubmed, etc. databases was carried out. More than 200 publications devoted to the study of alopecia were found, of which 42 were included in this review.Results. Chemotherapy-induced hair loss is a common adverse effect in cancer patients undergoing treatment. The frequency and molecular mechanism of the development of alopecia are related to the pharmacological features of the drug-based treatments, initial nutritional premorbid status, and predisposing polymorphisms of genes involved in drug conversion and excretion. Focal or diffuse alopecia may be the first sign of malignant growth within the paraneoplastic syndrome, primary or metastatic malignancies of the scalp, or be a manifestation of nutritional insufficiency. Baldness negatively affects the psycho-emotional state of patients, exacerbating depressive disorders, anxiety, reducing self-esteem and adherence to treatment. Thus, prevention or rapid overcoming of alopecia can significantly improve the quality of life of cancer patients. The use of scalp cooling or ‘cold caps’ is proven to be an effective way of combating chemotherapy-induced hair loss.Conclusion. Further studies are needed to prevent and treat alopecia in cancer patients.

Mild oxidative stress protects against chemotherapy-induced hair loss.

Chemotherapy induces hair loss in most cancer patients who undergo treatment, which causes them significant psychosocial trauma. Scalp cooling has demonstrated some efficacy in attenuating chemotherapy-induced alopecia, but response rate varies between patients and chemotherapy class. Here, we showcase in rats a proof-of-concept treatment of using subcutaneous hydrogen peroxide and cumene hydroperoxide injections to provide total protection from hair loss against multiple classes of chemotherapy. We found that subcutaneous peroxides induce cell cycle arrest via P53 activation, thereby protecting hair follicles from the cytotoxic effects of chemotherapy on actively dividing cells. This treatment represents a highly effective and accessible way for cancer patients to maintain quality of life while undergoing treatment for cancer.

Effect of chemotherapy induced hair-loss on distress levels among cancer patients visiting public and private hospitals of Punjab

Chemotherapy is an essential part of a multimodal strategy in the treatment of many cancers. Chemotherapy-induced hair loss is believed to affect 65 percent of people. According to the study, chemotherapy-induced hair loss has been associated to anxiety, depression, a poor body image, low self-esteem, and a decreased sense of health. Objectives: To find out chemotherapy-induced alopecia distress levels among cancer patients' in Punjab's public and private hospitals. To find out the relationship between demographic variables and chemotherapy induced alopecia distress. Methods: A cross sectional study was conducted in public and private hospitals of Punjab, over the duration of 6 months, from October 2021 to March 2022. A sample of 323 respondents with the age range 19-54 was obtained. Data collection tool was adapted version of chemotherapy-induced alopecia distress scale (CASD). Frequencies and percentages of categorical variables were reported and Chi-square test was used to find out associations. Results: High distress level was 61% (n=196) while low distress level was 39% (n=127). Majority of the sample population consisted of participants belonging to age group 18-34 (n=146, 45.2%). Most of them were male 53% (n=173). Respondents diagnosed at stage2 had low distress level (54%) as compare to respondents who were diagnosed at stage3 and stage 4. Significant association (p-value ≤0.05) was found between Gender, family income, employment status, disease stage at diagnosis, number of chemotherapy cycles received and current active treatment. Conclusion: Chemotherapy-induced alopecia distress was associated with all of five domains i.e. physical, emotional, daily activities, relationships and treatment. To reduce the suffering caused by alopecia in cancer patients, appropriate therapies must be developed.

Minoxidil-loaded hyaluronic acid dissolving microneedles to alleviate hair loss in an alopecia animal model

Alopecia is defined as hair loss in a part of the head due to various causes, such as drugs, stress and autoimmune disorders. Various therapeutic agents have been suggested depending on the cause of the condition and patient sex, and age. Minoxidil (MXD) is commonly used topically to treat alopecia, but its low absorption rate limits widespread use. To overcome the low absorption, we suggest microneedles (MNs) as controlled drug delivery systems that release MXD. We used hyaluronic acid (HA) to construct MN, as it is biocompatible and safe. We examined the effect of HA on the hair dermal papilla (HDP) cells that control the development of hair follicles. HA enhanced proliferation, migration, and aggregation of HDP cell by increasing cell-cell adhesion and decreasing cell substratum. These effects were mediated by the cluster of differentiation (CD)-44 and phosphorylation of serine‑threonine kinase (Akt). In chemotherapy-induced alopecia mice, topical application of HA tended to decrease chemotherapy-induced hair loss. Although the amount of MXD administered by HA-MNs was 10% of topical treatment, the MXD-containing HA-MNs (MXD-HA-MNs) showed better effects on the growth of hair than topical application of MXD. In summary, our results demonstrated that HA reduces hair loss in alopecia mice, and that delivery of MXD and HA using MXD-HA-MNs maximizes therapeutic effects and minimize the side effects of MXD for the treatment of alopecia. Statement of significance(1) Significance, This work reports a new approach for treatment of alopecia using a dissolving microneedle (MN) prepared with hyaluronic acid (HA). The HA provided a better environment for cellular functions in the hair dermal papilla cells. The HA-MNs containing minoxidil (MXD) exhibited a significant reduction of hair loss, although amount of MXD contained in them was only 10% of topically applied MXD., (2) Scientific impact, This is the first report demonstrating the direct anti-alopecia effects of HA administrated in a transdermal route and the feasibility of novel therapeutics using MXD-containing HA-MNs. We believe that our work will excite interdisciplinary readers of Acta Biomaterialia, those who are interested in the natural polymers, drug delivery, and alopecia.

Translated article] Chemotherapy, Alopecia, and Scalp Cooling Systems

Chemotherapy-induced hair loss in cancer is usually temporary but can take a significant emotional toll on patients and lead to treatment refusal in many cases. Although hair loss is usually reversible, regrowth can take months, causing greater psychological distress. Recent years have seen the emergence of cold caps, or scalp cooling systems, designed to prevent or at least reduce chemotherapy-induced hair loss. The results to date are encouraging. We review the evidence on the effects and effectiveness of these systems, which are making their way into routine clinical practice.

All that a Dermatotrichologist needs to know about Hair Camouflage: A Comprehensive Review.

Hair loss can impact a person's quality of life in ways incomprehensible. People value hair for different reasons, but value it nonetheless. There is a myriad of conditions that impede hair growth or cause hair to grow in an unattractive manner such as androgenetic alopecia, alopecia areata, and chemotherapy-induced hair loss. For conditions like cicatricial alopecia, there are hardly any options available once permanent loss of hair sets in. The role of hair transplantation too is limited in such cases where the donor area has been compromised. Thus, addressing the concern of hair loss and presenting all possible options available even after medical and surgical options flounder due to their limitations is a responsibility every dermatotrichologist carries and a plethora of camouflage options are available to improve the appearance of hair right from hairpieces to more permanent methods like scalp micropigmentation.

Prevention of chemotherapy-induced hair loss by peroxisome proliferator-activated receptor-γ modulation.

Abstract Linked Article: Piccini et al. Br J Dermatol 2022; 186:129–141.

Alopecia, quimioterapia y gorras de frío o «scalp cooling system»

Chemotherapy-induced hair loss in cancer is usually temporary but can take a significant emotional toll on patients and lead to treatment refusal in many cases. Although hair loss is usually reversible, regrowth can take months, causing greater psychological distress. Recent years have seen the emergence of cold caps, or scalp cooling systems, designed to prevent or at least reduce chemotherapy-induced hair loss. The results to date are encouraging. We review the evidence on the effects and effectiveness of these systems, which are making their way into routine clinical practice.

Inhibition of Shh Signaling through MAPK Activation Controls Chemotherapy-Induced Alopecia

Chemotherapy-induced hair loss (alopecia) (CIA) remains a major unsolved problem in clinical oncology. CIA is often considered to be a consequence of the antimitotic and apoptosis-promoting properties of chemotherapy drugs acting on rapidly proliferating hair matrix keratinocytes. Here, we show that in a mouse model of CIA, the downregulation of Shh signaling in the hair matrix is a critical early event. Inhibition of Shh signaling recapitulated key morphological and functional features of CIA, whereas recombinant Shh protein partially rescued hair loss. Phosphoproteomics analysis revealed that activation of the MAPK pathway is a key upstream event, which can be further manipulated to rescue CIA. Finally, in organ-cultured human scalp hair follicles as well as in patients undergoing chemotherapy, reduced expression of SHH gene correlates with chemotherapy-induced hair follicle damage or the degree of CIA, respectively. Our work revealed that Shh signaling is an evolutionarily conserved key target in CIA pathobiology. Specifically targeting the intrafollicular MAPK-Shh axis may provide a promising strategy to manage CIA.

LB968 Inhibition of sonic hedgehog signalling via MAPK activation controls chemotherapy-induced alopecia

Abstract Chemotherapy-induced hair loss (alopecia, CIA) remains a major unsolved problem in clinical oncology. CIA is often considered to be a consequence of the anti-mitotic and apoptosis-promoting properties of chemotherapy drugs acting on rapidly proliferating hair matrix keratinocytes. Here we show that in a mouse model of CIA, down-regulation of Shh signaling in the hair matrix is a critical early event. Inhibition of Shh signaling recapitulated key morphological and functional features of CIA, whereas recombinant Shh protein partially rescued hair loss. Phospho-proteomics analysis revealed that activation of the MAPK pathway is a key upstream event, which can be further manipulated to rescue CIA. Finally, in organ-cultured human scalp hair follicles as well as in patients undergoing chemotherapy, reduced expression of SHH gene correlates with chemotherapy-induced hair follicle damage or the degree of CIA, respectively. Our work revealed that Shh signaling is an evolutionarily conserved key target in CIA pathobiology. Specifically targeting the intrafollicular MAPK-Shh axis may provide a promising strategy to manage CIA.

The effect of cold hat use on chemotherapy-induced hair loss in breast cancer patients: An experimental study in Tehran

The effect of cold hat use on chemotherapy-induced hair loss in breast cancer patients: An experimental study in Tehran

The effect and mechanism of YH0618 granule on chemotherapy- induced hair loss in patients with breast cancer: study protocol for a randomized, double-blind, multi-center clinical trial

BackgroundHair loss is one of the most common side effects of chemotherapy, and can cause persistent negative emotions, further affecting therapeutic effects and reducing the quality of life. However, there are no clinically safe and effective methods to solve the problem at present. Our previous clinical and animal studies showed that a medicinal and edible decoction, YH0618, could significantly promote hair growth in cancer patients after chemotherapy, without interfering with the anti-tumor effects of chemotherapy. Besides, the theory of Chinese Medicine believes that the “Essence of the kidney is reflected on the hair”. Therefore, this study will further explore the efficacy of YH0618 granule on chemotherapy-induced hair loss in patients with breast cancer by a randomized, double-blind, multi-center clinical trial and elucidate the potential mechanism from the aspect of kidney deficiency or renal dysfunction.Methods/designEligible breast cancer patients who will start chemotherapy will be randomly divided into group A (YH0618 granule) and group B (placebo). The chemotherapeutic agents contain taxanes or/and anthracyclines, and the chemotherapy regimen will be for at least six cycles with a cycle every 3 weeks. Subjects assigned to group A will receive YH0618 granules twice a day (6 g each time), 6 days a week, mixed with 300 ml warm water from the first to the fourth chemotherapy cycle. Subjects in group B will receive the placebo granule in the same manner. The primary outcome is the time point of occurrence of hair loss reaching grade II as assessed by the WHO Toxicity Grading Scale, and objective indices of hair quality and hair-follicle growth recorded by a hair and scalp detector before the fifth chemotherapy cycle. Secondary outcomes include changes of facial color and thumbnail color, grading of thumbnails ridging, assessment of quality life, level of fatigue, routine blood test results, hepatic and renal function, and certain medical indicators which can reflect kidney deficiency in Chinese Medicine.DiscussionThis research is of great significance for the treatment of cancer and improving the quality of life of cancer patients. The study may provide the most direct evidence for meeting clinical needs and lay a solid scientific foundation for later product development.Trial registrationChinese Clinical Trial Registry, ID: ChiCTR1800020107. Registered on 14 December 2018.

A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients.

PurposeMany breast cancer patients suffer from chemotherapy-induced hair loss. Accurate information about temporal changes in chemotherapy-induced hair loss is important for supporting patients scheduled to receive chemotherapy, because it helps them to prepare. However, accurate information, on issues such as the frequency of hair loss after chemotherapy, when regrowth starts, the condition of regrown hair, and the frequency of incomplete hair regrowth, is lacking. This study aimed to clarify the long-term temporal changes in chemotherapy-induced hair loss using patient-reported outcomes for chemotherapy-induced hair loss.MethodsWe conducted a multicenter, cross-sectional questionnaire survey. Disease-free patients who had completed adjuvant chemotherapy consisting of anthracycline and/or taxanes for breast cancer within the prior 5 years were enrolled from 47 hospitals and clinics in Japan. Descriptive statistics were obtained in this study. The study is reported according to the STROBE criteria.ResultsThe response rate was 81.5% (1511/1853), yielding 1478 questionnaires. Hair loss occurred in 99.9% of patients. The mean time from chemotherapy until hair loss was 18.0 days. Regrowth of scalp hair occurred in 98% of patients. The mean time from the completion of chemotherapy to the beginning of regrowth was 3.3 months. Two years after chemotherapy completion, the scalp-hair recovery rate was <30% in approximately 4% of patients, and this rate showed no improvement 5 years after chemotherapy. Eighty-four percent of the patients initially used wigs, decreasing to 47% by 1 year after chemotherapy and 15.2% after 2 years. The mean period of wig use was 12.5 months. However, a few patients were still using wigs 5 years after completing chemotherapy.ConclusionsOur survey focused on chemotherapy-induced hair loss in breast cancer patients. We believe these results to be useful for patients scheduled to receive chemotherapy.

Chemotherapy-Induced Hair Loss: The Use of Biomarkers for Predicting Alopecic Severity and Treatment Efficacy.

Damage to hair follicles following exposure to toxic chemotherapeutics can cause substantial hair loss, commonly known as chemotherapy-induced alopecia (CIA). Preventive therapies remain limited; however, recent advances in the use of scalp cooling technologies have proved successful in preventing or reducing hair loss in some patients. Further improvements in scalp cooling efficacy and/or development of novel treatments to prevent chemotherapy-induced hair loss are required. To achieve this, post-chemotherapy assessment of hair follicle damage markers, with and without scalp cooling, would provide invaluable mechanistic and prognostic information. At present, the availability of such data is extremely limited. This article describes the potential utility of a combination of biomarkers in assessing drug-induced alopecia and the protective potential of existing or new treatments. A greater understanding of the precise mechanisms of anti-CIA therapies through biomarker analysis would enhance the rationale, use, and development of such treatments.

A Descriptive Study to Analyze Chemotherapy-Induced Hair Loss and its Psychosocial Impact in Adults: Our Experience from a Tertiary Care Hospital.

Background:Hair loss is one of the most commonly reported and psychologically distressing adverse effects of chemotherapeutic agents. Studies on its impact on psychosocial aspect of cancer patients are lacking at present.Objective:To study the chemotherapeutic agents causing hair loss and its psychosocial implications in adults.Materials and Methods:Observational study was done for a period of 1 year, wherein all cancer patients, more than 18 years of age who developed hair loss while on chemotherapy were assessed for type of malignancy, details of chemotherapy protocol, their knowledge about chemotherapeutic agents induced hair loss, and its impact on their social life and patterns of adjustment to deal with it. A prevalidated closed-ended questionnaire was used as a data collection tool.Results:Out of 179 patients, 96 (53.6%) were males as against 80 (44.6%) females, and 49 (27.3%) patients were between 18 and 30 years of age. Carcinoma lung was the most common malignancy seen in 46 (25.6%) patients followed by rectosigmoid carcinoma in 41 (22.9%) patients. Combination of cyclophosphamide and doxorubicin was the most common combination resulting in hair loss in 49 (27.3%) cancer patients. A total of 101 (56.4%) patients felt that hair loss was the worst side effect of chemotherapy, while 29 (16.2%) had to continue because it was life-saving. A total of 129 (72%) patients said hair loss is affecting their social life; 37 (20.6%) patients were using hair accessories while 69 (38.5%) did not even attempt to hide hair loss as they were too occupied with fear of disease.Conclusion:Chemotherapy-induced hair loss is a common adverse effect in cancer patients undergoing treatment. A thorough counseling about it and methods to deal with it should be a part of management of the patients.

17P - Painful scalp during chemotherapy induced hair loss is associated to permanent alopecia in breast cancer patients

17P - Painful scalp during chemotherapy induced hair loss is associated to permanent alopecia in breast cancer patients