Chemotherapy Alopecia

Alopecia affects approximately 65% of patients who undergo chemotherapy (QT) treatments. About 8% of women would reject chemotherapy for hair loss.

In most cases it is a temporary alopecia that recovers after 3 months after stopping treatment.

Approximately QT permanent alopecia can appear in 1-4% of cases. Permanent alopecia due to chemotherapy is considered to be one that does not fully recover 6 months after the end of treatment

In which cases is it more frequent?

Patients with conditioning therapy prior to a bone marrow transplant (high-dose busulfan and cyclophosphamide)

Patients who have received QT for breast cancer (taxanes, cyclophosphamide, and adriamycin).

The pathogenesis of permanent alopecia caused by QT is unknown, but it is believed that one of the mechanisms that could produce it would be the definitive damage to the stem cells of the protuberance of the follicles by certain drugs.

Temporary Alopecia by Chemotherapy

  1. Begins 7-10 days after the start of treatment.
  2. It becomes clearly visible in 1-2 months.
  3. Other areas such as the beard, eyebrows, eyelashes, armpits or genitals may be affected.
  4. In most cases, complete hair density recovers 3-6 months after stopping treatment.
  5. Sometimes new hair can present changes in color or texture.
  6. Shaving the head does not prevent permanent QT alopecia or ensure that hair recovers with the same force. However, on a psychological level, it is a recommended practice to take control of the oncological process.
  7. Since QT-induced alopecia is usually reversible, no treatment is necessary.
  8. Most often, the patient uses camouflage methods such as hair prostheses, scarves, or hair integration systems.

Permanent Alopecia by Chemotherapy

When alopecia persists after 6 months after stopping treatment. Alopecia can be total or partial.

It can improve with medical treatment, thanks to the improvement of the capillary density when thickening the miniaturized follicles. There are both drugs and complementary therapies that we can use in cases of permanent alopecia. Both on the scalp and on the eyebrows and eyelashes.

PRP or platelet-rich plasma infiltrations:

The PRP or platelet-rich plasma or “biostimulation with autologous plasma rich in growth factors”, consists of the application of the fraction of platelet-rich plasma of the patient in a tissue to promote their regeneration or stimulate their growth.

Low Level Laser Therapy Treatment (LLLT):

What are the benefits of LLLT treatment or low intensity laser therapy?

  1. Improves the health and appearance of hair (color, shine and thickness of existing hair).
  2. Increases the energy production of cellular organs.
  3. Improves circulation.
  4. Increases the supply of nutrients to hair follicles.

Scalp cooling or scalp cooling system:  

Cooling of the scalp during QT sessions can decrease the risk of QT alopecia by 50% in patients with solid tumors (mainly studied in women with breast cancer).

* Has FDA approval to prevent QT alopecia in patients treated for breast cancer.

Radiation Therapy Alopecia

Depending on the radiation dose the patient receives, radiation therapy can lead to permanent or reversible alopecia.

Hair loss usually begins in the 2nd-3rd week of radiation exposure. Some drugs increase radiosensitivity.

If alopecia is self-resolving, the patient usually recovers the previous capillary density at the 4th month.

When RT alopecia is scarring, and therefore permanent, you can choose to perform a hair transplant.

Alopecia and Hormone Therapy

Hormone therapy is used in the treatment and prevention of various hormone-dependent tumors.

The drugs that most frequently produce alopecia are tamoxifen, raloxifene, anastrazole, letrozole, exemestane, and the new cyclin inhibitors.

Alopecia due to hormonal treatment produces a clinic similar to common baldness (predominance in the crown and frontal region) that progresses during the treatment.

To improve this type of alopecia, various drugs and complementary therapies (PRP, microneedling and low-power laser) can be used.

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