Roughly 65% of people present process chemotherapy will expertise chemotherapy-induced hair loss, which is normally short-term and utterly reversible when remedy ends.3 The usage of molecularly focused brokers in most cancers remedy has additionally been related to hair loss charges as excessive as 60%. Chemotherapy-induced hair loss has been proven to decrease affected person shallowness and deprive sufferers of their privateness as a result of the general public generally associates hair loss with most cancers. Forty-seven % of feminine most cancers sufferers think about hair loss to be probably the most traumatic facet of chemotherapy, with 8% of them stating they might decline remedy for worry of hair loss.4,5
Hair loss related to most cancers remedy is expounded to the chosen anticancer agent(s) and the remedy routine. Chemotherapy-induced hair loss mostly impacts the scalp, though armpit and pubic hair, eyebrows, and eyelashes may be misplaced. The hair loss might be seen inside days to weeks of the initiation of remedy, with full loss occurring 3 months after remedy has begun. Hair usually begins to develop again in 1 to three months after remedy ends, with some sufferers experiencing variations in hair thickness, shade, or texture upon regrowth.4,5
Chemotherapy is believed to trigger hair loss by attacking quickly diving cells within the physique, together with the dividing hair matrix cells, one of many quickest rising cell populations within the human physique.6 The reason for hair loss related to molecularly focused brokers has not been completely investigated. Every chemotherapy agent has a unique likelihood of inducing hair loss (Desk 13,8,9,12), and utilizing a mix of brokers could also be extra prone to trigger hair loss in contrast with utilizing 1 agent.3
Prevention and Administration
Many preventive measures have been tried to cut back chemotherapy-induced hair loss. Nevertheless, at current, there aren’t any accepted pharmacologic interventions to evade the hair loss related to most cancers remedy.7 Therapeutic approaches embody reducing drug supply to the dividing hair bulb and pharmacologic interventions to dam the hair loss impact (On-line Desk 27).
Desk 2: Stopping Hair Loss7
Decreased drug supply:
â— Scalp tourniquet
â— Scalp hypothermia
â— Various levels of nerve compression
â— Complications, claustrophobia
â— Topical minoxidil 2%
â— Burning/irritation of remedy space
â— Undesirable hair development elsewhere on physique
Decreased Drug Supply
Two mechanisms used to cut back the quantity of chemotherapy reaching the scalp embody a tourniquet or the induction of scalp hypothermia. The tourniquet is a pneumatic gadget positioned across the hairline that inflates throughout infusion, leading to mechanical obstruction of blood circulation to the scalp. These tourniquets are worn for five to 10 minutes earlier than chemotherapy till half-hour after completion.11 In research to show this system’s effectiveness, the info are troublesome to interpret.3
Scalp hypothermia causes vasoconstriction of the blood vessels and limits treatment absorption on the scalp. Examine outcomes from this system are additionally troublesome to interpret, nonetheless, as many experiments use numerous temperatures and different strategies. The cooling is began 5 minutes earlier than chemotherapy and continued as much as 1 hour following completion.11 There’s concern that scalp cooling could shield scalp metastases from the results of remedy.3,10
Many pharmacologic interventions have been prompt to cut back or forestall hair loss; nonetheless, none have been confirmed so. Topical 2% minoxidil has an unclear mechanism of motion, however is believed to switch the hair cycle by prolonging the anagen section.3 This treatment is utilized to the scalp 24 hours earlier than remedy and continued all through remedy and as much as 4 months following remedy.10 It has not been proven to stop hair loss, but it surely has shortened time to regrowth and lengthened the time to maximal hair loss.3 Different brokers, akin to cyclosporine A, AS101, calcitriol, cyclin-dependent kinase 2 inhibitors, and tocopherol, have all been used to stop chemotherapyinduced hair loss with minimal success.11
Though there is no such thing as a confirmed methodology to stop hair loss related to most cancers remedy, there are strategies to assist handle it as soon as it has begun (On-line Desk 3). Schooling concerning this subject is extraordinarily vital, and sufferers needs to be recommended on their choices.
Desk 3: Strategies to Assist Handle Hair Loss11,12
Keep away from bodily or chemical trauma to the hair (eg, bleaching, coloring, perming, utilizing hair dryers which might be too sizzling, utilizing curling irons or sizzling rollers). Use light hair care strategies all through chemotherapy.
Use a satin pillowcase for sleeping as a result of it’s much less prone to entice and catch fragile hair. Use a soft-bristle hairbrush. Wash hair solely as usually as obligatory. Use a mild shampoo.
Minimize hair brief or shave hair. Brief hair tends to look fuller than lengthy hair and is much less noticeable when the hair is shed. Hair that has been lower brief could assist sufferers transition to complete hair loss.
Shaving the top could also be simpler for securing a wig or hairpiece.
Use a sunscreen, hat, scarf, or wig to guard the scalp from the solar.
Dr. Moore is an assistant professor at Howard College School of Pharmacy.
- Most cancers statistics. Nationwide Most cancers Institute web site. www.most cancers.gov/about-cancer/what-is-cancer/statistics. Accessed August 1, 2015.
- Passik SD, Kirsh KL, Rosenfeld B, McDonald MV, Theobald DE. The changeable nature of sufferers’ fears concerning chemotherapy: implications for palliative care. J Ache Symptom Handle. 2001;:21(2):113-120.
- Trüeb RM. Chemotherapy-induced alopecia. Semin Cutan Med Surg. 2009;28(1):11-14. doi: 10.1016/j.sder.2008.12.001.
- McGarvey EL, Baum LD, Pinkerton RC, Rogers LM. Psychological sequelae and alopecia amongst ladies with most cancers. Most cancers Pract. 2001;9(6):283-289.
- Munstedt Okay, Manthey N, Sachsse S, Vahrson H. Adjustments in self-concept and physique picture throughout alopecia induced most cancers chemotherapy. Help Care Most cancers. 1997;5(2):139-143.
- Paus R, Haslam IS, Sharov AA, Botchkarev VA. Pathobiology of chemotherapy-induced hair loss. Lancet Oncol. 2013;14(2):e50-e59. doi: 10.1016/S1470-2045(12)70553-3.
- Grevelman EG, Breed PM. Prevention of chemotherapy-induced hair loss by scalp cooling. Ann Oncol. 2005;16(3):352-358.
- Lacy C, American Pharmacists Affiliation, et al. Drug Info Handbook. nineteenth ed. Hudson, Ohio: Lexi-Comp; Washington, DC: American Pharmacists Affiliation; 2010-2011.
- Hair loss or alopecia. www.most cancers.web/navigating-cancer-care/side-effects/hair-loss-or-alopecia. American Society of Medical Oncology Most cancers.web web site. Accessed August 4, 2015.
- A information to chemotherapy. American Most cancers Society web site. www.most cancers.org/remedy/treatmentsandsideeffects/treatmenttypes/chemotherapy/understandingchemotherapyaguideforpatientsandfamilies/understanding-chemotherapy-common-side-effects-hair-loss. Up to date June 9, 2015. Accessed August 1, 2015.
- Rosman S. Most cancers and stigma: expertise of sufferers with chemotherapy-induced alopecia. Affected person Educ Couns. 2004;52(3):333-339.
- Pores and skin reactions: hair loss (alopecia). Affected person Useful resource web site. www.patientresource.com/Derm_Reactions_Hair.aspx. Accessed August 5, 2015.