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Review
. 2019 May;80(5):1179-1196.
doi: 10.1016/j.jaad.2018.03.055. Epub 2018 Apr 14.

Hair disorders in patients with cancer

Azael Freites-Martinez  1 , Jerry Shapiro  2 , Shari Goldfarb  3 , Julie Nangia  4 , Joaquin J Jimenez  5 , Ralf Paus  6 , Mario E Lacouture  7
Affiliations
Review

Hair disorders in patients with cancer

Azael Freites-Martinez et al. J Am Acad Dermatol. 2019 May.

Abstract

Cytotoxic chemotherapies, molecularly targeted therapies, immunotherapies, radiotherapy, stem cell transplants, and endocrine therapies may lead to hair disorders, including alopecia, hirsutism, hypertrichosis, and pigmentary and textural hair changes. The mechanisms underlying these changes are varied and remain incompletely understood, hampering the development of preventive or therapeutic guidelines. The psychosocial impact of chemotherapy-induced alopecia has been well documented primarily in the oncology literature; however, the effect of other alterations, such as radiation-induced alopecia, hirsutism, and changes in hair color or texture on quality of life have not been described. This article reviews clinically significant therapy-related hair disorders in oncology patients, including the underlying pathophysiological mechanisms, severity grading scales, patient-reported quality of life questionnaires, management strategies, and future translational research opportunities.

Keywords: anagen effluvium; brittleness; cancer patients; catagen effluvium; chemotherapy-induced alopecia; curling; depigmentation; eyebrow alopecia; eyelash alopecia; hair repigmentation; hirsutism; hyperpigmentation; hypertrichosis; hypopigmentation; straightening; trichomegaly.

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Figures

Figure 1
Figure 1
Chemotherapy-induced alopecia (CIA). A. Clinical image of scalp alopecia one month after first taxane-based chemotherapy cycle. B. Pohl-Pinkus constrictions observed in monilethrix-like hairs following weekly cyclophosphamide-based chemotherapy. C. Trichoscopy of CIA shows black dots, fractured hair shafts and vellus hairs.
Figure 2
Figure 2
Radiotherapy-induced alopecia (RIA). Alopecia, erythema and ulceration related to photon radiotherapy used for treating scalp metastasis. Ulceration resulted in permanent/cicatricial alopecia.
Figure 3
Figure 3
Scalp folliculitis (Skin infection grade 3 (CTCAEv4)) in a patient receiving cetuximab. A. Before therapy with oral doxycycline and topical high potency corticosteroids. B. Two weeks after dermatologic therapy.
Figure 4
Figure 4
Depigmentation and hair thinning in a patient receiving tremelimumab. A. Before therapy. B. 3 months after first dose of treatment.
Figure 5
Figure 5
Trichomegaly in a patient on erlotinib during a year.
See this image and copyright information in PMC

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