Permanent Hair Loss Research Articles

Serum Dicckopf-1 Level in Patients of Cicatricial and Non- Cicatricial Alopecia

Hair loss disorders are divided into 2 major groups: Cicatricial and non-Cicatricial Alopecies. Cicatricial alopecies are disorders in which the hair follicle is replaced by fibrous scar tissue leading to permanent hair loss. In Non-cicatricial alopecies hair follicles are preserved and hair growth can resume when the cause of the problem is eliminated [1].Dickkopf-1 encodes a potent and specific endogenously-secreted Wnt antagonist that binds and inhibits LRP (Lipoprotein Receptor-Related Protein)5/6 receptors that are involved in canonical Wnt signaling during hair induction and growt[2]

34163 Impact of race/ethnicity and skin type on illness perceptions and quality of life in patients with discoid lupus erythematosus

Background: Discoid lupus erythematosus (DLE) is a chronic dermatologic condition with the potential for permanent disfigurement and hair loss. Long-term sequelae including scarring and post-inflammatory pigmentary change may especially affect patients with darker skin types. While some studies investigated illness perceptions and quality of life in patients with DLE, none have evaluated the influence of patient skin type or race/ethnicity on these measures.

678 Efficacy of topical LXR agonist in the treatment of primary cicatricial alopecia in Scd1−/− mouse

Primary cicatricial alopecias (PCAs) are heterogeneous disorders characterized by the replacement of hair follicle (HF) structures by fibrous tissue, leading to permanent hair loss. The underlying pathogenesis and treatment options are poorly characterized due to the lack of preclinical research models. The asebia mouse, which harbors mutations in the stearoyl-CoA desaturase 1 (Scd1) gene, was previously proposed as a model for PCA, however, the immunopathogenic mechanisms underlying permanent hair loss in Scd1−/− mice are largely unknown.

Lichen Planopilaris Responsive to a Novel Phytoactive Botanical Treatment: A Case Series.

IntroductionLichen planopilaris (LPP) is characterized by chronic scarring alopecia that is progressive and typically refractory to therapy. Current drug treatments are suboptimal and not applicable for long-term use because of the high potential for adverse effects, warranting safer and more effective treatment alternatives.MethodsBased on our previous success in treating a patient with central centrifugal cicatricial alopecia using a topical botanical formulation (Gashee), we reviewed records of four patients with biopsy-proven LPP treated with the topical formulation alone or in combination with its oral preparation. Three patients had failed previous treatment with intralesional steroid injections, topical minoxidil, tacrolimus, and clobetasol. Physical examination and photographic documentation were also used as outcome measures. Treatment duration with the botanical formulations ranged from 6 weeks to 9.5 months.ResultsAll patients showed overall improvement in surrogate indicators of LPP activity as evidenced by the disappearance of symptoms (pruritus, tenderness, scalp irritation, and hair shedding), improvement in hair growth, and reduction in redness. All reported a high satisfaction level and no adverse effects.ConclusionsPatients with treatment-refractory LPP responded to a novel botanical treatment. To the best of our knowledge, this is the first published report of LPP responding to a plant-based natural treatment. Further evaluation of this treatment in a controlled trial with a larger number of patients is warranted.

RONC-11. Permanent alopecia in pediatric patients with medulloblastoma treated by craniospinal irradiation: looking for a threshold dose

Abstract BACKGROUND: Permanent alopecia in adult survivors of childhood cancer is a late effect that has a negative impact on vitality and social function, and it is not clear if it is only associated with radiotherapy or also with high-dose chemotherapy. In this study, we analysed a cohort of medulloblastoma survivors treated with craniospinal irradiation (CSI) with long follow-up looking for radiotherapy parameters associated with permanent hair loss. METHODS: We retrospectively analysed 42 patients with medulloblastoma with median follow up of 10 years. In 27 pts, Eclipse subgroup, the scalp was accurately re-contoured and were estimated specifics dosimetric parameters. Any relationship between presence of alopecia and other characteristics was investigated by univariate and multivariate analysis, in both groups. For each significant predictor variable, a Receiver Operating Characteristic curve was drawn for calculating the Area Under the Curve and identifying the optimal dose discriminatory cut-off value for prediction of alopecia. RESULTS: The best predictor for the occurrence of permanent alopecia was the dose of CSI (OR: 1.002; 95%CI: 1.001-1.003; p=0.003), with a cut-off value of 30.9 Gy. In Eclipse subgroup median Dose hair skin was statistically significant, (OR: 1.216; 95%CI: 1.030-1.435; p=0.021), with a cut-off value of 28.7 Gy. If the median dose of each Gy unit of D median is exceeded, the probability of alopecia increases by 21.6% (3.0% - 43.5%), with a specificity of 90.9%. None of the other variables was statistically significant. CONCLUSIONS: Pediatric Medulloblastoma survivors have a high risk of developing permanent alopecia.Our study supports the finding that permanent hair loss is dose-dependent and identified a threshold dose, the median dose of 28.7 Gy, to prevent the occurrence of permanent alopecia in paediatric patients undergoing radiotherapy. Therefore, we suggest that this dosimetric parameter should be evaluated when planning radiation treatment, especially when planning CSI in low- and standard-risk medulloblastoma.

Depilatory laser miniaturizes hair by inducing bystander dermal papilla cell necrosis through thermal diffusion.

Depilatory laser targeting melanin has been widely applied for the treatment of hypertrichosis. Both selective photothermolysis and thermal diffusion have been proposed for its effect, but the exact mechanism of permanent hair reduction remains unclear. In this study, we explore the role of thermal diffusion in depilatory laser-induced permanent hair loss and determine whether nonpigmented cells are injured by thermal diffusion. C57BL/6 mice in anagen and telogen were treated with alexandrite laser (wavelength 755 nm, pulse duration 3 milliseconds, fluence 12 J/cm2 , spot size 12 mm), respectively. Histological analysis, terminal deoxynucleotidyl transferase dUTP nick-end labelingassay, and transmission electron microscopic imaging were employed to evaluate the injury to hair follicle (HF)cells. The proliferation status of HF cells was examined by 5-bromo-2'-deoxyuridinepulse labeling. The number of HF stem cells was quantified by fluorescence-activated cell sorting. The size of the regenerated hair was determined by measuring its length and width. We found that irradiating C57BL/6 mice in anagen with alexandrite laser led to hair miniaturization in the next anagen. In addition to thermal disruption of melanin-containing cells in the precortex region, we also detected necrosis of the adjacent nonpigmented dermal papilla cells due to thermal diffusion. Dermal papilla cells decreased by 24% after laser injury, while the number of bulge stem cells remained unchanged. When the laser was delivered to telogen HFs where no melanin was present adjacent to the dermal papilla, thermal necrosis and cell reduction were not detected in the dermal papilla and no hair miniaturization was observed. Our results suggest that depilatory laser miniaturizes hair by inducing thermal necrosis of dermal papilla cells due to secondary thermal diffusion from melanin-containing precortex cells in the anagen hair bulbs.

Clinico-Epidemiology and Histopathologic Spectrum of Primary Scarring Alopecia: A Cross-Sectional Study.

Primary scarring alopecias (PSAs) are a rare group of dermatological disorders with overlapping clinical features. They result in permanent hair loss and significant psychological morbidity. To analyze the clinico-epidemiology of PSAs of the scalp, along with clinico-pathological correlation. We conducted a cross sectional, observational study including 53 histopathologically confirmed cases of PSA. Clinico-demographic parameters, hair care practices, and histologic characteristics were noted and statistically analyzed. Among 53 patients (mean age 30.9 ± 8.1 years, M: F 1:1.2, median duration 4 years) with PSA, lichen planopilaris (LPP) was most common (39.6%, 21/53), followed by pseudopelade of Brocq [30.2%, 16/53], discoid lupus erythematosus (DLE) [16.9%, 9/53], and non-specific scarring alopecia (SA) (7.5%, 4/53), while central centrifugal cicatricial alopecia (CCCA), folliculitis decalvans, and acne keloidalis nuchae (AKN) accounted for 1 case each. Forty-seven patients (88.7%) demonstrated predominant lymphocytic inflammatory infiltrate, while basal cell degeneration and follicular plugging were the commonest histological changes. Perifollicular erythema and dermal mucin deposition were noted in all patients with DLE (both P < 0.05). Nail involvement (P = 0.004) and mucosal involvement (P = 0.8) were more common in LPP. Single alopecic patches were characteristic of DLE and CCCA. Hair care practices (non-medicated shampoo > oil) had no significant association with the subtype of PSA. (P = 0.4). PSAs are a diagnostic challenge for dermatologists. Thus, histology and clinico-pathological correlation should be performed in all cases for proper diagnosis and treatment.

Greater understanding about hair loss caused by chemotherapy

Abstract Linked Article: Piccini et al. Br J Dermatol 2022; 186:129–141. One of the more severe and most-feared side-effects of chemotherapy is hair loss, which can significantly affect the quality of life of patients undergoing these treatments. Sometimes, this can even lead to rejection of treatment by patients, especially women. Luckily, in almost all patients, the hair regrows within 3 months of stopping treatment. However, in some patients, hair loss can be permanent and this can result in substantial distress. Unfortunately, there are no established treatments to prevent or restore hair growth in these patients. In this international study, we used hair samples taken from the scalp of healthy people to induce a condition that simulates the effects of chemotherapy in patients with cancer in the laboratory. We showed that chemotherapy can result in damage to the cells in the hair follicle that are responsible for replenishing the cells in charge of hair growth, a subset of cells called stem cells. Not only does chemotherapy bring about events that eventually resulted in death of these stem cells, but it can also stimulate the transformation of these cells into scarring tissue, an irreversible process that prevents the growth of new hairs. With this greater understanding of the mechanisms that lead to hair damage, we have tried using a compound, called NAGED (N-acetyl-GED-0507-34-Levo), to protect the stem cells from depletion and damage in the laboratory. Although still far from being able to use this new information in a clinical setting, this study offers hope for the development of a potential treatment that could be applied to the scalp and that can be used to potentially prevent permanent hair loss in patients with cancer undergoing chemotherapy. Linked Article: Piccini et al. Br J Dermatol 2022; 186:129–141.

How can we assess severity and treatments in frontal fibrosing alopecia?

British Journal of DermatologyVolume 185, Issue 6 p. e204-e204 Plain Language Summary How can we assess severity and treatments in frontal fibrosing alopecia? First published: 17 December 2021 https://doi.org/10.1111/bjd.20791AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Linked Article: Olsen et al. Br J Dermatol 2021; 185:1221–1231. Frontal fibrosing alopecia (FFA) is one of the most common causes of permanent or scarring hair loss. This distressing condition may affect both sexes and all races, although it is most common in post-menopausal white women. The cause of this hair loss condition is unknown, although there may be a genetic susceptibility and hormonal factors may be important. The associated inflammation in the scalp occurs at the level of where the hair follicle stem cells reside, leading to permanent loss of the follicle and the hair shaft that it produces. Classically there is slowly progressive hair loss affecting the front of the scalp and the temples often with redness and scaling around the follicle openings. Some patients notice itching or burning at the involved sites. Eyebrow hair loss occurs in almost 90% of individuals and can precede the scalp hair loss. To date, treatment is usually with antinflammatory topical and systemic agents and anti-androgens but clinical trials assessing the effectiveness of each treatment are currently lacking. In this paper, an international team of experts in hair disorders from 21 countries sought to obtain a consensus agreement on the criteria for diagnosing and assessing the severity of FFA. Each recommendation needed at least 90% agreement from authors for acceptance. A point scoring method that includes clinical features as well as features seen on biopsy (where a small section of tissue is removed for testing) allows for two categories of FFA – those with the typical hairline recession and those who may present with some of the alternate findings first. Other clinical features that are frequently seen with FFA are tiny yellowish or skin-coloured bumps (papules) on the face and prominent veins on the forehead and they are included in a staging recommendation that captures all of the main clinical features. The authors also propose a method of assessing the degree of hair loss or regrowth after treatment through measuring hair density across the affected scalp before and at set timepoints in follow-up after treatment. Recommendations for a quality of life tool to assess patient response to treatment is also noted. The authors hope these guidelines will allow the collection of accurate and reproducible clinical and laboratory data, providing the means to both determine the cause of FFA, and to assess the safety and effectiveness of treatment. Volume185, Issue6December 2021Pages e204-e204 RelatedInformation

Role of Hair Transplantation in Scarring Alopecia-To Do or Not to Do.

Alopecia in the scalp region leads to psychosocial embarrassment for an individual. Alopecia could be due to several reasons, including genetic, hormonal, traumatic and infections. Cicatricial alopecias (CAs) are considered as trichological emergency, since their progression is rapid and always results in permanent hair loss. The pathogenesis, disease progression and prognosis of CA are poorly understood, and the treatment process is still evolving. An early diagnosis must be established, and aggressive treatment protocol should be followed in the management of scarring alopecia. This article presents various aspects of CA and determines whether hair transplant (HT) should be done in this condition.

Evolving Scalp Lesions in an 8-day-old Infant

Evolving Scalp Lesions in an 8-day-old Infant

Discoid Lupus Erythematosus of the Scalp in a Patient with Systemic Lupus Erythematosus: A Case Report with Complete Hair Regrowth

Scalp involvement with hair loss is common in systemic lupus erythematosus. Discoid lupus erythematosus may cause scarring alopecia, characterized by well-delimited erythematous plaques with scales, follicular hyperkeratosis and atrophy, which is considered a trichological emergency. Early diagnosis and treatment are necessary in order to prevent permanent hair loss. We describe a 44 years’ old female patient with systemic lupus erythematosus for 4 years, with multiple areas of occipitoparietal alopecia, erythematous plaques, atrophy, scales and some bloody crusts. Trichoscopy, histopathology and direct immunofluorescence led to the diagnosis of discoid lupus erythematosus. After 9 months treatment with thalidomide there was complete hair regrowth.

Permanent Alopecia in Breast Cancer Patients: Role of Taxanes and Endocrine Therapies.

Permanent chemotherapy-induced alopecia (PCIA) has been described following high-dose chemotherapy regimens for allogeneic bone marrow transplants; however, reports of PCIA in breast cancer patients are increasing. Many prior reports involve treatment with taxanes, but the role of endocrine therapies has not been well defined. Permanent alopecia in breast cancer patients appears to be a potential adverse effect of taxanes and endocrine therapies. Although the cytotoxic effects of taxanes may lead to permanent hair loss, the influence of endocrine therapies on the remaining follicles may affect the pattern of hair loss. Further characterization of these cases may elucidate risk factors for developing permanent alopecia, allowing for more appropriate risk stratification and counseling. We describe 3 patients with breast cancer who experienced PCIA following chemotherapy with taxanes.

Permanent hair loss associated with taxane chemotherapy use in breast cancer: A retrospective survey at two tertiary UK cancer centres.

Taxane chemotherapy is commonly used in the management of breast cancer. Hair loss (alopecia) is an expected side effect which may have a significant effect on quality of life. Alopecia is normally temporary but permanent chemotherapy-induced alopecia (pCIA) is increasingly recognised especially following docetaxel chemotherapy. However, the prevalence following docetaxel is not well understood and there is no published literature for paclitaxel chemotherapy. The aim of this study is to investigate the prevalence and patterns of pCIA resulting from both docetaxel and paclitaxel chemotherapy at two tertiary UK cancer centres. In collaboration between Clatterbridge Cancer Centre and The Christie NHS Foundation Trusts, a retrospective survey was conducted for breast cancer patients who had received taxane chemotherapy in the neoadjuvant and adjuvant settings. Patients who had concluded chemotherapy at least a year previously were contacted by post and invited to participate by completing a questionnaire and returning it to their treatment centre. Data collected included the incidence and pattern of pCIA using the Savin pictorial hair loss scale, and the methods used by patients to manage it. Fisher's exact test was used to compare pCIA between the docetaxel and paclitaxel cohorts. 383 patients responded to the survey (a 63.3% overall response rate). These comprised 245 patients receiving docetaxel and 138 patients treated with paclitaxel. pCIA was reported by 23.3% of patients receiving docetaxel and 10.1% paclitaxel (p<0.01). Overall 16.7% of patients in both groups reported the ongoing use of products or appliances such as wigs to camouflage their pCIA. In the docetaxel group, pCIA appeared to be more frequent in post-menopausal women than peri- or pre-menopausal women (37.8%, 12.3% and 19.6% respectively [Chi-square test p<0.01]). Also in the docetaxel group, there appeared to be a trend for more severe scalp alopecia when the patient also received an aromatase inhibitor (AI) or tamoxifen and this difference was most marked in those who had received both an AI and tamoxifen as components of their treatment regime (p=0.04). The use of scalp cooling was only recorded in the Christie paclitaxel group (n=12). Of these 12 patients, 83.3% reported no hair loss. While overall rates of permanent eyebrow, eyelash and nostril hair loss were low, this pattern of hair loss appeared more frequent in the paclitaxel than the docetaxel group 4.3% vs. 1.8% (p=0.29). Both docetaxel and paclitaxel may cause permanent scalp hair loss, but it is significantly more prevalent with docetaxel compared with paclitaxel. Clinicians should counsel patients regarding the risk of permanent alopecia prior to embarking upon taxane chemotherapy and routinely offer scalp cooling if available. More research is required to understand the pathobiology of this important and previously under recognised long-term side effect to enable more active preventive and management approaches.

Dermoscopy of discoid lupus erythematosus - a systematic review of the literature.

Discoid lupus erythematosus (DLE) may lead to disfiguring scarring and permanent hair loss. Dermoscopy may serve as a noninvasive tool useful in the preliminary diagnosis of hair loss and inflammatory skin diseases. The aim of the paper was to summarize and analyze the dermoscopic features of DLE lesions in various anatomical locations. A systematic review of PubMed, Scopus and Web of Science was performed using the search terms: 'lupus' OR 'discoid lupus' OR 'cutaneous lupus' combined with 'dermoscopy' OR 'dermatoscopy' OR 'videodermoscopy' OR 'videodermatoscopy' OR 'trichoscopy' OR 'mucoscopy' OR 'onychoscopy'. About 29 out of 318 initially identified papers were included in the analysis. In scalp DLE (n=166), the most common findings were: white structureless areas (62%), arborizing vessels (57.8%), white scales (54.2%), follicular keratotic plugs (47%), absent follicular openings (45.8%), perifollicular scaling (43.9%), pink-white background (40.4%), speckled brown pigmentation (38%), and fibrotic white dots (33.7%). In non-scalp DLE (n=129), the most frequent features were: follicular keratotic plugs (66.7%), white perifollicular halo (65.9%), white scale (39.5%), speckled brown pigmentation (38.8%), white structureless areas (37.2%), and arborizing vessels (34.9%). There are scarce data in the literature on dermoscopic findings in labial (n=8), mucosal (n=3) and ungual DLE (n=1). DLE is characterized by a wide variety of dermoscopic findings with variable frequencies depending on the location of the lesions. Nevertheless, further studies are needed in order to reliably assess frequencies, correlation with disease stage and significance of individual dermoscopic features.

&lt;p&gt;Optimal Management of Frontal Fibrosing Alopecia: A Practical Guide&lt;/p&gt;

Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia that is often considered a clinical variant of lichen planopilaris (LPP) due to their shared histopathologic features. FFA is characterized by the recession of the frontal, temporal, or frontotemporal hairline; the clinical pattern is distinct and usually includes eyebrow hair loss, as well as other associated symptoms. Pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia may also occur in addition to the frontotemporal recession and eyebrow loss classically seen. Early diagnosis and prompt treatment are critical as FFA is a progressive disorder that can result in permanent hair loss. FFA is challenging as patients may not present or be recognized until the disease has progressed. Additionally, there is currently no consensus or standard treatment regimen for FFA. While many different therapies have been reported as beneficial, there are a limited number of published guidelines for the treatment of FFA. This article is a review of the literature on treatment modalities for FFA and the objective is to offer a practical guide for clinicians on the evidence-based management options currently available in the literature.

Quality of life and mental health status in patients with lichen planopilaris based on Dermatology Life Quality Index and General Health Questionnaire-28 questionnaires.

BackgroundLichen planopilaris (LPP) is a relatively uncommon inflammatory skin condition that causes permanent hair loss. Irreversible hair loss can have a significant psychosocial and psychological impact on patients’ lives. Limited studies have assessed the psychological status of patients suffering from LPP, and to our knowledge, none have evaluated patients with LPP as a separate group in this regard.ObjectiveThis study aimed to assess the quality of life (QoL) and general health of patients with LPP using the Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire-28 (GHQ-28), respectively.MethodsOur study employed a cross-sectional design. In total, 41 patients with LPP attending the follow-up skin clinic at the Razi Hospital in Tehran, Iran were asked to complete the DLQI and GHQ-28. Furthermore, selected demographic information was obtained from patients to evaluate their association with general health and QoL.ResultsForty-one patients (14 men and 27 women) with a mean age of 44.02 ± 10.8 years completed both questionnaires. QoL was affected moderately to extremely in 70.7% of patients. Also, 26 patients (63.4%) were at risk for psychological disorders. Lower QoL was reported by patients age <45 years (p < .05). Both QoL and general health had a negative relation with the disease activity index (p < .05), but were not affected by sex, marital status, education level, treatment type, presence of mucous lesions, and disease duration.ConclusionLPP significantly affects patients’ QoL and general health. Dermatologists should address these issues in patients with LPP alongside treating physical symptoms.

Primary Cicatricial Alopecia among Lybian patients: A Clinicopathological and Epidemiological study

Introduction: Cicatricial alopecias are a group of disorders characterized by hair follicle destruction with the consequence of permanent hair loss. The current study was conducted to evaluate the epidemiological and clinicopathological characteristics of cicatricial alopecia in Libyan community. Methods: Thirty-one patients with confirmed diagnosis of cicatricial alopecia by biopsy and tricoscopy during Jan 2018 to Dec 2019 were included in this study. Data were collected by filling a pre-designed questionnaire by all included patients. Descriptive statistics were used for analyzing the results. Chi-squared test was performed to test the relationship between different variables using SPSS 22. Results: Out of 31 cases, 16.1% of patients suffered from lichen planopilaris (LPP), 25.8% discoid lupus erythematosus (DLE), 6% Folliculitis decalvans, 6.45% pseudopelade of brocq, and 16.12% Frontal fibrosing alopecia. Conclusions: Cicatricial alopecia was found to affect mainly middle-aged individuals, particularly females. Early diagnosis and treatment can decrease the burden of this concern.

Permanent Hair Loss Associated with Taxane Chemotherapy Use in Breast Cancer: a Retrospective Review at Two Tertiary UK Cancer Centres

Purpose: Permanent chemotherapy-induced alopecia (pCIA) is an increasingly recognised complication of taxane-based chemotherapy that may be associated with significant psychological morbidity [1]. The prevalence of pCIA following docetaxel is poorly understood and there are no published data on paclitaxel chemotherapy. Here we analyse prevalence and patterns of pCIA in patients who received docetaxel or paclitaxel across two UK tertiary cancer centres.

Hair loss due to scalp ringworm irradiation in childhood: health and psychosocial risks for women

BackgroundUntil 1960, hundreds of thousands of children worldwide had been treated for scalp ringworm by epilation via irradiation. The discovery of late health effects in adulthood prompted investigation of the medical aspects of irradiation in childhood and led to the establishment of strict protocols for the use of X-ray irradiation. These studies ignored alopecia, which affects some individuals who underwent irradiation for scalp ringworm as children. This study examined the impact of alopecia due to irradiation for scalp ringworm on the health and psychosocial status of affected women.MethodsWe analysed a random sample of 130 medical files of women recognised by Israel’s state committees as suffering from permanent hair loss as a result of scalp ringworm irradiation in childhood. The coded medical data included demographic variables, self-reported mental health conditions, self-reported physical health conditions, self-reported social conditions, and spousal relationship.ResultsCompared with the general population of women in Israel, research participants reported significantly higher rates of depression, anti-depressant and/or anti-anxiety drug use, psychotherapy or psychiatric hospitalisation, attempted suicide, migraines, cancer, and divorce. Many described humiliating social experiences due to their appearance, both in childhood and adulthood, that led them to curtail their social interactions. The participants also reported that alopecia negatively affected their spousal relationships.ConclusionsLife with hair loss from scalp ringworm irradiation in childhood has a negative impact on women’s health status and psychosocial state. Health policy-makers must broaden their approach to women who underwent scalp ringworm irradiation by addressing the effects of their hair loss in addition to the effects of the radiation treatment per se. This may be achieved by guiding physicians who provide medical services to these women to take into account the psychosocial and health risks related to hair loss in their diagnosis and treatment as well as by creating a cadre of specially trained mental health professionals who can address their unique psychosocial needs. They must also consider including the specialized mental health services tailored for these women’s unique needs in the Healthcare Basket.