II. Definitions
III. Pathophysiology
- Inciting event impairs Hair Follicle mitotic and metabolic activity during Anagen phase (active phase)
- Toxins result in damage to Hair Shaft and breakage
- Hair Loss occurs when the Hair Bulb is damaged
IV. Causes
- Systemic conditions
- Medications
- Chemotherapy (affects 65% of patients, onset 1-3 weeks after Chemotherapy started)
- Cyclophosphamide
- Nitrosureas
- Doxorubicin (Adriamycin)
- Endocrine
- Elements
- Bismuth
- Arsenic
- Gold
- Miscellaneous
- Chemotherapy (affects 65% of patients, onset 1-3 weeks after Chemotherapy started)
V. Symptoms
- Diffuse hairs loss onset days to within 2 weeks (peaks at 1-2 months) after offending agent (often Chemotherapy)
- Self-limited and hair regrows after Chemotherapy or other toxic agent is discontinued
VI. Signs
- Non-scarring Alopecia
VII. Labs: Indicated in prolonged Hair Loss or thinning (esp. after Chemotherapy)
- Thyroid Stimulating Hormone (TSH)
- Vitamin D Level
- Zinc
- Serum Iron and Ferritin
VIII. Management: General
- Wig until resolution
- Minoxidil 5% may be effective during regrowth period
IX. Management: Chemotherapy Induced
- Prevention
- Scalp and hair cooling
- Has been shown effective in Chemotherapy induced Hair Loss
- May cause Headaches, Nausea, claustrophobia
- However cooling may not be recommended, as it may reduce medication distribution to the scalp
- Not recommended for Hematologic Cancer or Skin Cancer
- Not recommended in certain solid tumors (e.g. Small Cell Lung Cancer)
- References
- Scalp and hair cooling
- Treatment
- Coverings (hats, scarves, wigs)
- Consider Minoxidil 5% after Chemotherapy completed
- Other agents that may be used but not generally recommended
- Biotin 2.5 mg daily
- Orthosilicic acid 10 mg daily
- Bimatoprost ophthalmic solution (for eyelash growth stimulation)