Chemotherapy Induced Alopecia (CIA)

  • Slide 1: The Importance of Hair

    Slide 1: The Importance of Hair

    Hair has been a social symbol throughout time, cultivating perceptions of age, social status, beliefs, and more importantly, individuality and a sense of attractiveness.<sup>1</sup>

  • Slide 2: The Patient’s Point of View

    Slide 2: The Patient’s Point of View

    Chemotherapy-induced alopecia (CIA) is one of the more troubling aspects of chemotherapy to patients.<sup>2</sup> While hair loss may seem trivial, it can lead to poor self esteem and ultimately unwanted psychological effects.<sup>2</sup>

  • Slide 3: Hair Anatomy and Physiology

    Slide 3: Hair Anatomy and Physiology

    Normal hair growth is comprised of three phases: 1) Anagen, 2) Catagen and 3) Telogen.<sup>3</sup> Exogen then occurs when hair is released from the follicle.<sup>3</sup>

  • Slide 4: Pathophysiology of CIA

    Slide 4: Pathophysiology of CIA

    The anagen phase is primarily affected in CIA, which is thought to result from the disruption of matrix cells proliferation and Pohl-Pinkus constrictions, which is characterized by diminished follicle function.<sup>3</sup>

  • Slide 5: Chemotherapeutic Agents Causing CIA

    Slide 5: Chemotherapeutic Agents Causing CIA

    This is a listing of some agents that may cause CIA.<sup>6</sup>

  • Slide 6: Grading of CIA

    Slide 6: Grading of CIA

    CIA is graded based by severity and need for camouflage. Grade 1 is defined by hair loss of >50% that is noticeable upon close inspection; grade 2 is characterized by hair loss of >50% that is readily noticeable, requires camouflage to conceal loss, and causes psychosocial impact.<sup>5</sup>

  • Slide 7: Topical Treatments

    Slide 7: Topical Treatments

    Minoxidil therapy requires daily application, as discontinuation can lead to loss of benefits obtained.<sup>7</sup>

  • Slide 8: Scalp Cooling as Treatment for CIA

    Slide 8: Scalp Cooling as Treatment for CIA

    Scalp cooling may help reduce hair loss in some patients receiving chemotherapy.<sup>8</sup>

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Compared to the severe adverse effects of chemotherapy, chemotherapy-induced alopecia (CIA) is surprisingly one of the more troubling aspects of chemotherapy to patients.[2] (Slide 1) In a study of 18- to 38-year-old males and females with cancer, both genders expressed feelings of being exposed and judged.[9]

Normal hair growth is comprised of three phases: 1) Anagen—matrix cells proliferate and differentiate; 2) Catagen—involution occurs as the dermal papilla moves upward, below the hair bulge; and 3) Telogen—the dormant phase where the hair shaft matures.[3] (Slide 3) The anagen phase is primarily affected in CIA, which is thought to result from the disruption of matrix cells proliferation and Pohl-Pinkus constrictions; this is characterized by diminished follicle function.[3] (Slide 4)

CIA can be observed in patients within days to weeks of the start of chemotherapy, with complete hair loss observed by 2 to 3 months.[7] While CIA may be permanent in some patients (those who experience incomplete or no hair growth 6 months after chemotherapy discontinuation), hair may grow back 1 to 3 months upon discontinuation of chemotherapy; differences in hair thickness, color, or texture upon regrowth may be evident.[7] (Slide 5)

A variety of cytotoxic drug classes, used in the management of different cancers, may cause CIA. (Slide 6) Current therapies for CIA include topical minoxidil, which has an unclear mechanism of action. In a study of 22 women undergoing adjuvant chemotherapy, patients were treated with 2% topical minoxidil during therapy. While minoxidil did not prevent alopecia, it did shorten the time to regrowth and lengthened the time for maximal hair loss.[7] (Slide 7) Scalp cooling during chemotherapy is another option available to reduce hair loss; however, available evidence evaluated through a review of studies demonstrates its efficacy may vary based on patient characteristics and study design.[8] (Slide 8)

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