Chemotherapy-induced Hair Loss Research Articles

Supporting patients who are affected by chemotherapy-induced hair loss

Those who suffer from treatment-related alopecia often experience depression and anxiety as a result of their altered appearance. Although breast cancer is the most common cancer in the UK, there is little specialist and readily available psychological support from patients who have lost their hair after undergoing chemotherapy. Melissa Pilkington explores the pertinent issues relating to this condition

Chemo-induced hair loss: prevention of a distressing side-effect

temperature of below 15˚C. Both scalp cooling techniques require a pre-cooling time of 30 minutes for the cap to be maintained during chemotherapy administration and 1–3 hours post cooling time, which is dependent on the chemotherapy drugs administered. Post-cooling time is dependent on the chemotherapy drug but is generally 45–90 minutes. Van den Hurk et al (2012) conducted a large prospective multi-centre study on scalp cooling in patients having chemotherapy. It aimed to provide patient information by estimating the results of scalp cooling in chemotherapy regimens. Characteristics associated with these results were also identified in order to provide a better understanding of the determinants that may improve scalp cooling results. The results were recorded in the open patient registry; they were positive for most chemotherapy regimens, justifying the use of scalp cooling by all eligible patients. Most patients tolerated scalp cooling well, with common side-effects including transient light-headedness, dizziness, headaches and an unpleasant feeling, which can be due to the heaviness of the cap. There was some indication that the success of decreasing chemotherapyinduced hair loss may be dependant on a combination of factors including the

Pathobiology of chemotherapy-induced hair loss

Hair loss can be a psychologically devastating adverse effect of chemotherapy, but satisfactory management strategies for chemotherapy-induced alopecia remain elusive. In this Review we focus on the complex pathobiology of this side-effect. We discuss the clinical features and current management approaches, then draw upon evidence from mouse models and human hair-follicle organ-culture studies to explore the main pathobiology principles and explain why chemotherapy-induced alopecia is so challenging to manage. P53-dependent apoptosis of hair-matrix keratinocytes and chemotherapy-induced hair-cycle abnormalities, driven by the dystrophic anagen or dystrophic catagen pathway, play important parts in the degree of hair-follicle damage, alopecia phenotype, and hair-regrowth pattern. Additionally, the degree of hair-follicle stem-cell damage determines whether chemotherapy-induced alopecia is reversible. We highlight the need for carefully designed preclinical research models to generate novel, clinically relevant pointers to how this condition may be overcome.

Chemoprevention of doxorubicin-induced alopecia in mice by dietary administration of l-cystine and vitamin B6

Chemotherapy-induced hair loss is one of the most serious and feared adverse effects of cancer therapy. Almost all traditional chemotherapeutic agents induce a more or less severe alopecia. At present, there is no effective treatment capable of preventing this damage. Several different experimental approaches, using various animal models, have been investigated over the last years, with promising results. Sulphur-containing amino acids (cystine, cysteine) are essential components for the health of normal hair. L-Cystine is used in the treatment of various forms of alopecia. Vitamin B6 plays an important role in the development and maintenance of the skin and it is useful in reducing hair loss. In the present study, we demonstrated that the combined oral administration at high dosages of L-cystine (1,600 or 800 mg/kg body weight/day) and vitamin B6 (160 or 80 mg/kg body weight/day) is an effective chemopreventive treatment against alopecia induced by doxorubicin treatment (1.1 mg/kg body weight intravenously) in C57BL/6 mice.

The α-Lipoic acid derivative sodium zinc dihydrolipoylhistidinate reduces chemotherapy-induced alopecia in a rat model: A pilot study

Alopecia is one of the most common side effects of chemotherapy for which treatments have not been developed. In the present study, we evaluated the effects of sodium zinc dihydrolipoylhistidinate (DHLHZn), a new derivative of the multifunctional antioxidant α-lipoic acid, to treat chemotherapy-induced alopecia. Wistar rats (8 days old) were treated with cytosine arabinoside (AraC; 20 mg/kg by daily intraperitoneal injection; days 0-6) and DHLHZn (0%, 0.5%, or 1% topically applied in a white petrolatum base; days 0-12). A control group received daily saline injections (days 0-6) and topical application of white petrolatum (days 0-12). On day 12, we evaluated hair loss and histologic changes to scalp tissue for each group (n = 10). Rats treated with AraC and 0% DHLHZn cream exhibited complete hair loss; however, treatment with 0.5% or 1% DHLHZn significantly reduced chemotherapy-induced hair loss. Histological analysis revealed that AraC treatment promoted inflammatory cell infiltration of the hair follicles, but this inflammatory response was attenuated by DHLHZn. Our findings demonstrate that DHLHZn attenuates chemotherapy-induced alopecia, indicating the potential use of this α-lipoic acid derivative as a therapeutic agent against this common side effect of chemotherapy.

P330 Evaluation of DigniCap™ system for the prevention of chemotherapy-induced hair loss in breast cancer patient

P330 Evaluation of DigniCap™ system for the prevention of chemotherapy-induced hair loss in breast cancer patient

Presentation, impact and prevention of chemotherapy-induced hair loss: scalp cooling potentials and limitations

Background: This article provides an overview of the incidence and severity, presentation and impact of chemotherapy-induced alopecia (CIA), one of the most common and distressing side effects of cancer therapy. Furthermore, prevention of CIA by scalp cooling is described, as well as suggestions for improvement of scalp cooling application and clinical research approaches. Methods: This article focuses on the availability of options to treat CIA and on scalp cooling in particular. It presents an overview of 58 scalp cooling publications and three personal communications, describing its working mechanism, determinants of success rates, side effects and controversies. Results: CIA occurs in many chemotherapy regimens and is nearly always reversible. Up to now, scalp cooling is by far the best method to reduce CIA. Concerns about the protection of malignant cells in the scalp skin by scalp cooling have been proven to be exaggerated. The majority of patients tolerate scalp cooling very well. Scalp cooling is ...

Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Dąbrowski T. Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia. 2011;15(2):95-101. doi:10.5114/wo.2011.21813. APA Dąbrowski, T. (2011). Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia, 15(2), 95-101. https://doi.org/10.5114/wo.2011.21813 Chicago Dąbrowski, Tomasz. 2011. "Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature". Contemporary Oncology/Współczesna Onkologia 15 (2): 95-101. doi:10.5114/wo.2011.21813. Harvard Dąbrowski, T. (2011). Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia, 15(2), pp.95-101. https://doi.org/10.5114/wo.2011.21813 MLA Dąbrowski, Tomasz. "Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature." Contemporary Oncology/Współczesna Onkologia, vol. 15, no. 2, 2011, pp. 95-101. doi:10.5114/wo.2011.21813. Vancouver Dąbrowski T. Hair loss as a consequence of cancer chemotherapy – physical methods of prevention. A review of the literature. Contemporary Oncology/Współczesna Onkologia. 2011;15(2):95-101. doi:10.5114/wo.2011.21813.

Scalp-cooling by DIGNICAP system for the prevention of chemotherapy-induced hair loss in breast cancer patients.

e11034 Background: The DigniCap system (Dignitana AB, Sweden) is an established, highly effective and safe device to prevent hair loss by cooling the scalp. This study evaluates the DigniCap system and presents the results of scalp hypothermia on breast cancer patients undergoing chemotherapy. Methods: DigniCap is using a digitized system for controlled scalp-cooling with a refrigerator integrated into a control unit with the soft and tight-fitting silicon cap. Scalp temperature was maintained at +5 centigrades throughout drug administration and for at least 30 min after discontinuing the infusion. Photographs of each patient's scalp were taken before starting chemotherapy. The evaluation was made using a visual analogue scale. All patients answered a questionnaire with 15 questions regarding physical and psychological issues. Results: From August 2007 to October 2009, 255 patients, aged 25-77 yrs (mean 47.4), with breast cancer were examined completely. The patients were treated with either paclitaxel (6...

P53-dependent transcriptional regulation of EDA2R and its involvement in chemotherapy-induced hair loss

The p53 tumor suppressor coordinates a multitude of cellular and organismal processes and exerts its activities mainly by activation of gene transcription. Here we describe the transcriptional activation of ectodysplasin A2 receptor (EDA2R) by p53 in a variety of cell types and tissues. We demonstrate that treatment of cancer cells with the ligand EDA-A2, known to specifically activate EDA2R, results in p53-dependent cell death. Moreover, we show that EDA2R is transactivated by p53 during chemotherapy-induced hair-loss, although its presence is not necessary for this process. These data shed new light on the role of EDA2R in exerting p53 function.

Scalp cooling to prevent chemotherapy-induced hair loss: practical and clinical considerations

The objective of this prospective multicenter study was to obtain insight into the severity and burden of hair loss among cancer patients treated with chemotherapy. In addition, we described the effectiveness and burden of scalp cooling and the satisfaction with wigs, with hair regrowth, and with body image. Breast cancer patients treated with (n = 98) and without (n = 168) scalp cooling completed questionnaires before chemotherapy and 3 weeks and 6 months after completion of chemotherapy. Scalp cooling was effective in preventing chemotherapy-induced hair loss in 32 of 62 available patients (52%). Even though patients knew hair loss was temporary, it was a burden to 54% of them (n = 100). Scalp cooling was a burden for only 17 out of 51 patients (33%). Most patients who used a wig or head cover were satisfied with it (82%, n = 126). Patients were moderately satisfied with the regrowth of their hair after chemotherapy (mean 11.6; SD 2.53; range 0-20). Successfully cooled patients rated their hair as less important for their body image compared to patients who did experience hair loss (p = 0.014). Chemotherapy-induced hair loss is perceived as burdensome. It may be prevented by offering scalp cooling which is often an effective method to prevent this form of hair loss and is tolerated well by patients. However, if possible, scalp-cooling techniques should be improved and their effectiveness should be increased because if scalp cooling is unsuccessful, patients' rate their hair loss as more burdensome compared to noncooled patients.

Anticipating an altered appearance: Women undergoing chemotherapy treatment for breast cancer

Chemotherapy treatment for cancer can have a profound impact on appearance, and is often experienced as distressing. Few qualitative studies explore experiences of chemotherapy, and seldom focus on the process of anticipation and preparation for an altered appearance. We report findings from an interview study of 19 women which explored their expectations of chemotherapy-induced hair loss, their anticipated reactions to hair loss and how women intend to prepare for an altered appearance. The results demonstrate that women are active in anticipating hair loss and adopt a range of different strategies to manage their alopecia--even before it has occurred. Four key themes were identified: (a) anticipating hair loss, (b) coming to terms with the inevitability of hair loss, (c) becoming ready, and (d) taking control. We argue that this can be seen as a form of anticipatory coping, which involves affective and behavioural rehearsal so that women can feel more in control of their experience of the side effects of chemotherapy treatment for cancer. We suggest seeing these activities as a form of anticipatory coping, and understanding the psychological reasons why women engage in these activities, may help nursing professionals to better support women through this often traumatic time.

Zinc as an ambivalent but potent modulator of murine hair growth in vivo– preliminary observations

Oral zinc (Zn(2+)) is often employed for treating hair loss, even in the absence of zinc deficiency, although its mechanisms of action and efficacy are still obscure. In the current study, we explored the in vivo effects of oral zinc using the C57BL/6 mouse model for hair research. Specifically, we investigated whether continuous administration of high-dose ZnSO(4) x 7H(2)O (20 mg/ml) in drinking water affects hair follicle (HF) cycling, whether it retards or inhibits chemotherapy-induced alopecia (CIA) and whether it modulates the subsequent hair re-growth pattern. Here, we show that high doses of oral zinc significantly inhibit hair growth by retardation of anagen development. However, oral zinc also significantly retards and prolongs spontaneous, apoptosis-driven HF regression (catagen). Oral zinc can also retard, but not prevent, the onset of CIA in mice. Interestingly, Zn(2+) treatment of cyclophosphamide-damaged HFs also significantly accelerates the re-growth of normally pigmented hair shafts, which reflects a promotion of HF recovery. However, if given for a more extended time period, zinc actually retards hair re-growth. Thus, high-dose oral zinc is a powerful, yet ambivalent hair growth modulator in mice, whose ultimate effects on the HF greatly depend on the timing and duration of zinc administration. The current study also encourages one to explore whether oral zinc can mitigate chemotherapy-induced hair loss in humans and/or can stimulate hair re-growth.

Prevention of chemotherapy-induced hair loss by scalp cooling

Chemotherapy-induced temporary hair loss is one of the most common and distressing side-effects of cancer therapy. Scalp cooling to reduce this hair loss is a controversial issue for many doctors and nurses. This may be due to inadequate knowledge. This review from 53 publications and three personal communications focuses on the efficacy of the treatment, side-effects, possible disadvantages and the controversies in these areas. Scalp cooling has become an increasingly effective method to prevent hair loss, especially when anthracyclines or taxanes are used. Unfortunately, many studies were small and badly designed and are therefore difficult to compare. There is a considerable variation in the success rates in the various studies. This remains unexplained, but the cooling time, the chemotherapy used and the temperature seem to be influential. Scalp cooling should not be used if chemotherapy is given with a curative intent in patients with generalised haematogenic metastases. The majority of patients tolerate cooling very well. Scalp cooling is effective but not for all chemotherapy patients. Further psychological, clinical and biophysical research is needed to determine exact indications for cooling and to improve the effect, tolerance, side-effects and the cooling procedure. Multicentre trials should be carried out to gather this information.

The importance of hair

Far from being accepted by men, chemotherapy-induced hair loss has profound implications on their well being, including body image and social support aspects. Paula Kuzbit looks at the psychology of alopecia in testicular cancer

A study on the effect of the leaf essential oil of Ocimum gratissimum Linn. on cyclophosphamide-induced hair loss

Hair loss is one of the most feared side effects of cancer chemotherapy. This preliminary study investigated the efficacy of the leaf essential oil of Ocimum gratissimum Linn (Ocimum oil) in promoting hair growth in cyclophosphamide-induced hair loss. Shaved sites, ⩾4 cm 2 , were created on the flanks of 6 groups each of 7 freshly weaned 4-week old rats. Four groups (groups 2, 4, 5 and 6) were treated with 30 mg/kg cyclophosphamide (Cpd) intra-peritoneally daily to simulate changes seen in human chemotherapy-induced hair loss. Ocimum oil was administered topically alone (group 3) or in combination with Cpd in groups 2, 4 and 5 for 14 days and in group 6 for 8 days. Group 1 received no test substance. Tissue biopsies were obtained from 2 rats selected at random from each group on treatment day 9 for histological examination. Surviving animals were further observed for 7 days after treatment. Histopathology and gross morphologic observations for hair re-growth at shaved sites revealed active follicular proliferation in Ocimum alone and Cpd + Ocimum oil treated groups. Ocimum oil may, therefore, be capable of enhancing normal hair growth and promoting follicular proliferation in cyclophosphamide-induced hair loss.

What is wrong with the 30-year-old practice of scalp cooling for the prevention of chemotherapy-induced hair loss?

Since about 1970 scalp cooling has been used to prevent chemotherapy-induced hair loss, one of the most common and emotionally distressing side effects of cancer therapy. Generally accepted opinions, uncertainty and controversy, topics to study and recommendations for improving the results of scalp cooling are the subjects of this article which was also presented at the MASCC Symposium, June 2003, Berlin.

Molecular mechanisms of chemotherapy-induced hair loss.

Hair loss (alopecia) is a much-feared side-effect of many chemotherapy protocols and is one of the most psychological devastating aspects of cancer therapy. So far, no satisfactory strategy for suppressing chemotherapy-induced alopecia is at hand. During the last decade, some progress in understanding molecular mechanisms of chemotherapy-induced hair loss has been achieved using rodent models. However, the pathobiology of the response of human hair follicle to chemotherapy remains largely unknown. Here, we review molecular mechanisms that control apoptosis in the hair follicle induced by chemotherapy and delineate the basic strategy for pharmacological inhibition of this devastating side-effect of cancer treatment. We focus on the roles of p53 and its target genes that are essential in mediating responses of hair follicle cells. We assume that local pharmacological inhibition of p53 activity may serve as an effective treatment to prevent chemotherapy-induced hair loss. Sufficient pharmacological inhibition of chemotherapy-induced hair loss may require a combination of inhibitors to block complementary or redundant pathways of apoptosis in hair follicles.

Fas and c-kit are involved in the control of hair follicle melanocyte apoptosis and migration in chemotherapy-induced hair loss.

Chemotherapy alters the structure and function of hair follicle melanocytes. Molecular mechanisms controlling melanocyte responses during chemotherapy-induced hair loss, however, remain largely unknown. Using immunohistology and multicolor confocal microscopy, we show here that cyclophosphamide administration to C57BL/6 mice alters the activity and fate of hair follicle melanocytes. After 24-48 h, hair bulb melanocytes expressing Fas undergo apoptosis. The number of apoptotic follicular melanocytes is significantly reduced (p<0.01) in cyclophosphamide-treated Fas knockout mice compared to wild-type controls, suggesting that Fas signaling contributes to chemotherapy-induced melanocyte death. After 3-5 d, surviving hair bulb melanocytes express c-kit receptor, proliferate, and appear to migrate up the outer root sheath. Tyrosinase-positive and melanogenically active cells then appear in the epidermis. By Western blotting and immunohistochemistry, expression levels of the c-kit ligand, stem cell factor, in skin and epidermis are strongly increased after cyclophosphamide treatment. Cyclophosphamide-induced migration of the hair follicle melanocytes into epidermis is completely abrogated by administration of c-kit neutralizing antibody. These data suggest that chemotherapy induces a complex response in the hair follicle melanocytes, which includes apoptosis, proliferation, and migration. Pharmacologic manipulation of Fas and c-kit signaling pathways might be useful for the correction of skin hyperpigmentation as a side-effect of chemotherapy.

Cutting hair loss

An important breakthrough in the search for a drug to prevent chemotherapy-induced hair loss has been reported by Stephen Davis and colleagues (Science 2001, Vol. 291, 134–137). Many anti-tumour agents cause hair loss because they target rapidly dividing cells, including those of the hair follicle. Davis and co-workers showed that an inhibitor of cyclin-dependent kinase 2, which drives the cell cycle, blocked hair follicle cell division and prevented chemotherapy-induced hair loss in neonatal rats. These results offer the hope of a treatment for one of the distressing side-effects of anti-cancer therapies. RC