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Purpose: The aim of the study is to determine the prevalence of chemotherapy-induced alopecia and the patients’ coping methods with alopecia. Materials and Methods: This descriptive study was conducted with 240 patients who applied to chemotherapy unit of two private hospitals in Istanbul between December 2019 and January 2020. The data were collected using a patient information form developed by the researchers upon the literature review. Results: It was determined that 85.7% of the women experienced alopecia problem and the difference was significant according to their gender (p=0.00). 92.0% of patients with genitourinary system cancer and 88.5% of breast cancer patients experienced alopecia, the difference was statistically significant, and the significance was caused by experiencing alopecia more in these cancer types than the other cancer types (p=0.007). It was determined that 82.5% of the patients, who were receiving chemotherapy for less than a year, statistically significantly experienced alopecia more compared to the patients who were receiving chemotherapy for a longer period (p=0.031). It was also found that 69.7% of patients with Stage IV cancer experienced alopecia but they experienced alopecia statistically significantly less compared to the other stage patients (p=0.040). When the patients were examined in terms of diagnosis time according to family history of breast cancer, it was determined that 43.6% of those, who had family history of breast cancer, and 63.8% of those, who had no family history of breast cancer, were diagnosed in the stage II of their disease. The distribution of the cancer diagnosis time of patients according to having breast cancer history in the family was statistically significant (p=0.000). It was determined that 28.2% of the patients who had family history of breast cancer and 21.0% of the patients, who had no family history of breast cancer, noticed the lump for the first time in their regular self-breast examination. The distribution of duration of cancer diagnosis based on family history of breast cancer and the way of noticing the lump in the breast were statistically significant (p=0.000, p=0.014). It was also determined that 61.0% of the patients experiencing alopecia used a wig-bonnet (p=0.00) and there was no statistically significant difference between experiencing alopecia and age, marital status, occupation, place of residence, income status and social security. Conclusion: Alopecia was seen to be more common in women. Patients with genito-urinary system and breast cancer experienced alopecia more than other cancer patients. More than half of the women used bonnets and wigs. As the education level increased, women’s status of using bonnet and wig increased as well.

Background Chemotherapy-induced alopecia is psychologically challenging for patients undergoing cancer treatment, and scalp cooling has been shown to prevent or decrease the hair loss. Objective To evaluate whether access to scalp cooling varies by geographic area in the United States. Methods Cancer treatment centers offering scalp cooling were identified using data from the Rapunzel Project. Medicare claims data were queried to evaluate the number of chemotherapy infusions occurring in each zip code in the United States. Geographic distribution of chemotherapy infusions and scalp cooling centers was determined using ArcGIS software. The average distance from the geographic center of all 5-digit zip codes in which chemotherapy infusions occur to the nearest scalp cooling center was calculated in miles. Results There are 366 chemotherapy infusion centers in the United States that offer scalp cooling. Overall, 43.9% of Medicare-billed chemotherapy infusions in the United States occur in zip codes less than 12.5 miles from a scalp cooling center, 24.8% occur between 12.5 and 49.9 miles away, and 31.3% occur more than 50 miles away. Limitations Our results are only generalizable to patients seen at Medicare-accepting institutions in the United States. Conclusions Geographic disparities affect which patients can access scalp cooling therapy, and implementation in suburban and rural areas would increase access for patients who wish to preserve their hair while undergoing chemotherapy.

AIM: This study was planned to evaluate the perception of alopecia as a side effect of chemotherapy, and its effect on the psychosocial life of patients. METHODS: This cross-sectional and descriptive study was carried out at Sisli Hamidiye Etfal Training and Research Hospital, with inpatients in the Radiation Oncology Clinic and outpatients in the Chemotherapy Unit between January 12, 2013 and January 12, 2014. The data for the study were collected by face-to-face interviews using the Patient Identification Form, Disease and Alopecia-Related Features Form, and the Chemotherapy-induced Alopecia Quality of Life Scale, of 213 of the patients who faced chemotherapyinduced alopecia. Descriptive statistics for the statistical evaluation of the data and non-parametric tests such as the Mann-Whitney U-test and the Kruskal-Wallis test for independent group comparisons were used. RESULTS: The study group consisted mostly of elementary school graduates (71.8%), married (74.2%) and female (73.7%) patients residing in Istanbul. A large number of patients stated that they did not have any complaints when their hair began to fall, while a few patients stated that they felt itching. The Chemotherapy-induced Alopecia Quality of Life Scale average scores (23.9 +/- 5.4) were found to be low and quality of life of the patients was negatively affected by their alopecia. Also, the impact of alopecia diminished with increasing level of the patient`s education. It was found that the alopecia-related quality of life scores were lower for the patients who were already wearing a headscarf before illness, compared to the patients who started to wear a headscarf after illness. CONCLUSION: In conclusion, chemotherapy-induced alopecia is an important problem affecting the psychosocial life of patients.

"Background: Chemotherapy still represents the backbone of systemic treatment for many solid tumors. Alopecia remains one of its most distressing side effects. Scalp cooling is an effective strategy to reduce the risk of alopecia induced by chemotherapy, therefore this study aimed to assess the efficiency of DigniCap scalp-cooling system in our center. Material&Methods: 113 patients diagnosed with solid tumors, who underwent chemotherapy using the DigniCap scalp-cooling system in our center between January 2018 - December 2020, were included in the study. Alopecia was evaluated by the physician according to Dean’s scale at baseline and after the last cycle of chemotherapy. The primary endpoint was to evaluate scalp-cooling efficiency defined by a Dean's scale score of 0–2 (hair loss ≤50%). Results: 78 (72.3%) out of the 113 patients who used scalp cooling presented hair loss of 50% or less, the majority were females (91.2%) and had a diagnosis of breast cancer (49.6%) or gynecological cancer (27.4%). The mean number of chemotherapy cycles using DigniCap was 4.82 cycles. Hair loss greater than 50% of the scalp surface was observed in 27.7% of patients, the highest grade of alopecia being observed for anthracycline-based chemotherapy. No serious adverse events were reported. Conclusion: The results of this study support the evidence existing so far in the literature. Among patients who underwent chemotherapy for various cancer types, the DigniCap System significantly prevented hair loss and we consider that it should be integrated in the supportive care of patients."

Objective:Chemotherapy-induced alopecia (CIA) is a common unwanted effect related to anti-neoplastic agents. Due to potential CIA, some patients with cancer consider refusing treatment. It negatively affects a patient’s perception of appearance and sexuality. This study aimed to determine the effectiveness of reflexology massage on hair regrowth after CIA.Methods:This randomised clinical trial was conducted in 60 women with cancer with full alopecia due to chemotherapy. They were divided randomly into two groups: the experimental and control groups. The patients in the experimental group received reflexology massage for 15 min, 3 times daily (per 8 h), for 3 months. Those in the control group only received treatment as usual and routine health care. Data were obtained from the patient information and hair measurement forms. Couliss Vernier was used for hair regrowth measurement. The minimum and maximum hair lengths were measured thrice monthly after intervention started in both groups.Results:Considering baseline full alopecia in both groups, hair regrowth in the experimental group significantly improved compared with the control group (p

Scalp cooling is a widely used method to prevent chemotherapy-induced transient alopecia. Although the success rates in maintaining hair can be high, authors have expressed their concerns regarding the risk of scalp metastasis after scalp cooling. We report a case of breast cancer scalp metastasis in a patient submitted to scalp cooling for alopecia prevention and discuss the physiopathology, risks and benefits of this treatment for patients under this treatment.

The current investigation was designed to develop and optimize caffeine-loaded nanostructured lipid carriers (NLCs) for topical alopecia treatment. Screening of drug solubility in various excipients was executed. The 23 full factorial design was employed for NLCs optimization. Lipid type, surfactant type, and drug concentration were the independent variables. Entrapment efficiency (EE), particle size, polydispersity index (PDI) and % drug release were the chosen responses. Physiochemical evaluation, in vitro release, ex-vivo permeation, and stability study were achieved. The solubility of caffeine in stearic acid and glyceryl monostearate (GMS) was 47.11 ± 3.048 and 32.67 ± 2.955 mg/g, respectively. Oleic acid: garlic oil mixture at ratio 1:1 v/v was the oily phase. Tween 80 and Cremophor EL, Transcutol HP, carbonate buffer (pH 10.8 and ionic strength 200Mm) were chosen as a surfactant, co-surfactant, and aqueous phase, respectively. The optimized formula showed particle size, %EE, PDI, zeta potential of 358nm, 72.55 %, 0.912, -24.8, respectively. The % release was 92.9 ± 4.9 % after 4hours. Confocal laser scanning microscopy showed an improved permeation of caffeine-loaded NLCs to the whole skin layers. The histological examination proved the efficiency of caffeine NLCs optimized formula on promoting hair growth compared to the market formula.

CIA (Chemotherapy Induced Alopecia) is a common side effect seen during cancer treatment and a distressing symptom in many types of cancer patients. Patients exposed with alopecia during cancer treatment were accompanied by social influences and further quality of life. Although hair regrows in 3-6 months after chemotherapy, the regrown hair has changes in color, structure, texture etc. In the United States, chemotherapeutic patients had alopecia in varying degrees, where woman patients considered CIA as the most severe trauma, and even refused proper chemotherapy or have chosen an alternative therapy. Furthermore, the reported conditions of permanent CIA have been increasing. The CIA measures are mainly assessed using NCI-CTCAE, CTC, WHO, and GPA. Etiologically, CIA might be caused by therapeutic agents, genes and hormones. Diagnosis includes CST (Cross-Section Trichometry), Trichoscopy and OCT (Optical Coherence Tomography). Currently, the mainly reported used prevention of CIA is scalp cooling, and FDA has classified the scalp cooling system into class II (special controls) to provide a reasonable assurance of safety and effectiveness of the device. Scalp cooling is influenced by temperature, therapeutic agents, time and physiological factors. Besides physical interventions, several novel methods have been reported in animal models recently including drug-specific antibodies, hair growth cycle modifiers, cytokines, growth factors, antioxidants, cell cycle/proliferation modifiers or inhibitors of apoptosis, LLLT (Low-Level Laser Therapy), many drug preventions being under preclinical research. Thus, this review explores the current clinical treatment and future researches.

Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties (dermatology, oncology, and internal medicine). A 25-question survey was designed to elicit general knowledge and awareness of PCIA, as well as attitudes about referral and treatment. Responses were collected via REDCap, a secure online application, and analyzed with descriptive statistics, chi-square, and ANOVA tests. There was a significant difference in the number of subjects who had heard of PCIA prior to starting the survey (Derm 79%, Onc 30%, IM 22%, p 6 months) than IM (42% and 45% vs. 17%) and significantly more had encountered patients with the condition (47% and 45% vs. 17%). More providers in dermatology and IM knew how to diagnose PCIA compared with oncology (84% and 83% vs. 70%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA, and most providers believed that patients would accept similar types of treatment for PCIA. Dermatology HCPs were more likely to report higher confidence in their abilities to diagnose and manage PCIA than other providers. The results of this survey identify knowledge gaps about PCIA among health care providers. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA as part of survivorship care.

Photobiomodulation (PBM) or low-level laser therapy was discovered over 50 years ago, when Mester in Hungary observed regrowth of hair in mice when irradiated with a ruby laser. At the present time, several different PBM devices are marketed to assist with hair regrowth in alopecia patients. This review covers the three main types of alopecia (androgenetic, areata, and chemotherapy-induced), and discusses the mechanism of action of PBM for each disease. The different devices used (mostly low powered red laser diodes), dosimetry, animal models, and clinical trials are summarized. Criteria for patient selection are outlined. Finally a perspectives section looks forward to the future.

Çalışma, akut lösemi hastalarında alopesinin beden imajı ve benlik saygısına etkisini belirlemek ve sağlıklı bireylerle karşılaştırmak amacıyla planlandı. Tanımlayıcı nitelikte olan çalışmaya, 6 aylık sürede hematoloji polikliniği, kliniği ve ayaktan kemoterapi ünitesinde tedavi gören 91 akut lösemi hastası ile 94 sağlıklı birey dahil edildi. Çalışmanın verileri, Hasta/Sağlıklı Bilgi Formu, Kemoterapiye Bağlı Alopeside Yaşam Kalitesi Ölçeği (KBAYKÖ), Rosenberg Benlik Saygısı Ölçeği ve Beden İmajı Ölçeği ile toplandı. Verilerin değerlendirilmesinde; SPSS kullanılarak, yüzdelik, ki-kare, student t testi, ANOVA ve Pearson korelasyon analizleri yapıldı. Alopesi görülme oranı akut lösemi hastalarında %63.7, sağlıklı bireylerde ise %57.4 olarak bulundu (p>0.05). Ancak alopesi düzeyinin hastaların %84.5’inde gözle açıkça görülebilir, sağlıklı bireylerde ise %75’inde gözle belli belirsiz görülebilir şeklinde olduğu saptandı (p=0.000). Hastaların genel sağlık puanı ile benlik saygısı (p=0.000) ve beden imajı (p=0.000) arasında pozitif ilişki olduğu belirlendi. Alopesinin akut lösemi hastalarında benlik saygısını olumsuz etkilediği, beden imajını etkilemediği saptandı. Akut lösemi hastalarında genel sağlık ile ilişkisi göz önüne alındığında, alopesinin hastalar üzerindeki etkisi, benlik saygısı ve beden imajının değerlendirilmesinin gerektiği düşünülmektedir.

ObjectiveAlopecia is a frequently occurring side effect of chemotherapy and has high impact on many patients. Currently, scalp cooling is the only method to prevent this chemotherapy-induced alopecia (CIA) and it is effective in about half of the patients. Since determinants of the success are largely unknown, all patients should be prepared for potential hair loss. The objective was to provide up-to-date online information about CIA and scalp cooling to support patients in coping with CIA and in their choice regarding scalp cooling. MethodsEssential aspects of delivering information and lack of information were identified during focus groups, interviews, and a questionnaire survey among cancer patients, and in discussions with nurses. ResultsThe obtained information was used to develop a website (www.scalpcooling.org) and a web-based tool. It combines scientific evidence and practical advice about CIA and regrowth of hair, scalp-cooling tolerance, efficacy and safety, as well as an overview of possible advantages and disadvantages. The web-based tool provides tailored information about the probability of CIA with and without scalp cooling in particular chemotherapy regimens. Besides, the tool offers patients' support in decision-making by allowing them to reflect and consider their values and opinions about scalp cooling. ConclusionsThis comprehensive information is useful during nursing consultations.

We evaluated the preventive effect of the antioxidant edaravone (EDR) on chemotherapy-induced alopecia (CIA) to improve quality of life in cancer patients. Hair loss was induced by intraperitoneally administering cyclophosphamide (CPA, 75 mg/kg) to rats, and topically applying EDR ointment (100 mg/day) once daily for 16 days (when hair loss starts) or 21 days (just before hair growth). The rats were divided into four groups: control group (without CPA or EDR), EDR 0% group (CPA + EDR 0%), EDR 3% group (CPA + EDR 3%), and EDR 30% group (CPA + EDR 30%). The prevention of CIA was evaluated by the hair coverage score (five levels from 0 to 4). Furthermore, we measured the size of the hair follicle area and the expression levels of insulin-like growth factor (IGF)-1 mRNA in dermal papilla cells. The EDR 3% and EDR 30% groups exhibited higher hair coverage scores than the EDR 0% group on day 16 and day 21. On day 16, the hair follicle area in the EDR 3% and EDR 30% groups was significantly larger than that in the EDR 0% group. Furthermore, IGF-1 expression levels in the EDR 3% group were significantly higher than those in the EDR 0% group. On day 21, no significant difference was observed in hair follicle area or IGF-1 mRNA levels among the groups. Our results show that EDR administration lessened hair loss due to CPA in a dose-independent manner above doses of 3%, suggesting potential applications beside chemotherapy.

Legacy Healthcare has developed and patented a topical botanical with a unique mechanism of action, an extensive clinical data package, and excellent safety from the 2.2 million units already sold, all of which has enabled it to enter late-stage clinical development for alopecia areata (AA), chemotherapy-induced alopecia, and soon female androgenetic alopecia. As this drug candidate is very safe, the European Medicines Agency agreed to Legacy Healthcare's request to initiate late-stage clinical trial first in children, the neediest population suffering from AA. The initial trend from the phase II/III trial conducted to assess the efficacy and safety of the drug candidate in pediatric AA (RAAINBOW trial) looks promising, although no conclusions can be made. This drug candidate seems to offer several potential safety and economic advantages over other investigational synthetic and biologic compounds currently being investigated in populations with AA overall and especially for children.

Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.

IMPORTANCE: Persistent chemotherapy-induced alopecia (pCIA) has been recently described in patients with breast cancer and in its most severe form occurs in up to 10% of these patients. Genetic risk factors associated with pCIA have not been adequately explored. OBJECTIVE: To identify genetic variants associated with pCIA. DESIGN, SETTING, AND PARTICIPANTS: In this genetic association study, 215 women with breast cancer treated with docetaxel-based chemotherapy with a follow-up of 1.5 to 10 years after the end of the treatment were recruited retrospectively through 3 hospital oncology units across Spain between 2005 and 2018. Severe pCIA was defined as lack of scalp hair recovery (Common Terminology Criteria for Adverse Events, version 3.0, grade 2) 18 months or more after the end of treatment. Patients with grade 2 pCIA were selected as cases, and those with no sign of residual alopecia 12 months after the end of docetaxel treatment were selected as controls. A genome-wide association study in a discovery phase was conducted, and logistic regression was used to identify variants associated with the risk to develop this adverse effect. The validity of the association was addressed through a replication phase. EXPOSURES: Docetaxel-based chemotherapy. MAIN OUTCOMES AND MEASURES: Genotypes of single-nucleotide variants associated with pCIA. RESULTS: In total, 215 women with breast cancer (median age, 51.6 years; interquartile range, 44-60 years) were recruited (173 patients for the discovery phase and 42 patients for the replication phase). In the discovery phase, ABCB1 genetic variants were associated with risk to develop pCIA. In particular, single-nucleotide variation rs1202179, a regulatory variant located in an enhancer element that interacts with the ABCB1 promoter, was associated with the occurrence of pCIA. This finding was validated in the replication cohort (combined odds ratio, 4.05; 95% CI, 2.46-6.67; P = 3.946 × 10(−8)). This variant is associated with ABCB1 mRNA expression, and the risk allele was associated with decreased ABCB1 expression levels (P = 1.64 × 10(−20)). CONCLUSIONS AND RELEVANCE: This is the first study, to our knowledge, that identifies an association between a regulatory variant in the ABCB1 gene and the occurrence of pCIA in patients with breast cancer who were treated with docetaxel-based therapies. This finding suggests an important insight into the biological mechanisms underlying pCIA and opens the opportunity to explore personalized treatment of these patients.

Objectives To review and summarize the available literature on the management of chemotherapy-induced alopecia (CIA) including complementary and alternative medicine (CAM), and to present CIA’s effect on quality of life (QoL). Methods Nine databases were searched for CIA-related keywords, including the effect on QoL, and management options. Among 1019 articles found, 54 articles focusing on treatment/prevention or QoL were retrieved. References of selected articles were also checked manually. Results CIA was found to negatively affect QoL and body image, regardless of head covering status (i.e., for cultural or religious reasons). Most studies related to treatment/prevention of CIA reported on the use of scalp-cooling. The efficacy of CAM treatments was found to be questionable. Conclusion A high incidence rate of CIA exists with certain chemotherapies, and it significantly impairs QoL. Preventive and treatment strategies are incompletely effective. Additional literature is needed to explore potential preventive or therapeutic options for CIA.

Objective: Individuals with cancer experience the impact of chemotherapy on hair loss in different ways. The aim of this pilot study was to explore patients' experiences of alopecia through patients' drawings. Methods: Fifteen female patients diagnosed with cancer and treated with chemotherapy were recruited at the oncological day-care unit of a teaching hospital in the Netherlands. Participants completed a semi-structured interview about alopecia. They drew their head and hair before and during chemotherapy and completed the Brief Illness Perception Questionnaire (B-IPQ). Results: The drawings revealed predominantly physical effects, rather than emotions. Emotions were evident in the text that patients wrote under the drawings and in the B-IPQ open question about the perceived consequences of alopecia. The overall impact of alopecia that emerged from the drawings and the B-IPQ corresponded to the information retrieved from the interviews, namely disappointment, insecurity, sadness, and confrontation. Conclusions: Drawings expose cognitive and emotional responses to alopecia that may be relatively unexplored when using traditional assessment methods such as questionnaires or interviews. In future research, the drawing instructions need to be more specifically focused on feelings in order to better capture emotional reactions to hair loss.

Background Chemotherapy-induced alopecia (CIA) affects 65% of patients receiving chemotherapy regimens and is often identified with the massive hair loss stage. Reflectance confocal microscopy (RCM) is a noninvasive technique used in alopecia assessment for disease characterization and state of activity. Objective To describe RCM features of CIA in different timing and identify specific phases of alopecia development. Methods A total of 16 patients treated with chemotherapy underwent dermoscopy and RCM evaluations four times during the observation: 2 and 4-6 weeks after starting and 3 and 6 months after the end of chemotherapy. Ten examinations for each stage were performed. Results Four phases of CIA have been identified. Initial hair loss showed specific dots not previously described, named CIA dots. massive hair loss phase was characterized by black dots (10/10 pt), CIA dots (8/10 pt) and hair shaft abnormalities. Three months after the end of chemotherapy, during the partial regrowth phase, 10/10 patients showed thin hair in regrowth and 8/10 presented black and yellow dots. At 6 months, normal hair in regrowth appears in all patients (total regrowth phase). Conclusions Chemotherapy-induced alopecia has to be considered as a dynamic process with specific phases characterized by distinctive dermoscopic and confocal features.

Amaç: Kemoterapiyle indüklenen alopesi, onkoloji hastalarında psikososyal açıdan kanser tedavisinin en yıkıcı bulgularından bir tanesidir. Bu çalışmada, kemoterapiyle indüklenen alopesilerin değerlendirilmesinde videodermoskopik incelemenin yerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, kemoterapi alan ve klinik inceleme sonrası kemoterapiyle indüklenen alopesi tanısı konan ardışık 41 hasta dâhil edildi. Hastaların yaş, cinsiyet, deri fototipi, malignite tanısı, tedavi protokolündeki kemoterapi ajanları ve alopesinin yaygınlığı kaydedildi. Trikoskopik fotoğraflar X30-X50’lik büyütmeler ile elde edildi. Literatürdeki yayınlar ile oluşturulan kontrol listesine göre trikoskopik bulgular incelendi. Bulgular: Foliküler bulgulardan olan saç çapı değişkenliği hastaların tümünde saptandı. Siyah nokta %78, sarı nokta %75,6, kırık saç %51,2, Pohl-Pinkus %46,3, ünlem işareti saçlar ve alev figürleri %26,8 oranında izlendi. İki renkli, kısa vellus ve moniletrix-benzeri saçlar %22, domuz kuyruğu ve incelen saç %19,5, lale saç %14,6 ve zig zag saç ise %9,8 oranında görüldü. Daha nadir izlenen diğer bulgular V saç %7,3, virgül saç, peripilar bulgu ve boş folikül ise %4,9 oranında idi. Nötrofil benzeri saç (%7,3) ilk kez tanımlandı. Sonuç: Kemoterapi ile indüklenen alopesilerde zig zag saç, lale saç ve V saç yeni trikoskopik bulgulardı. Nötrofil benzeri saçlar ise ilk kez bu çalışmada tanımlandı. Kemoterapiyle indüklenen alopesilerin dermoskopisi, alopesi areata ve trikotillomani ile bazı benzer bulgular göstermektedir. Objective: Chemotherapy induced alopecia is one of the most devastating findings of cancer treatment for oncology patients psychologically. In this study, we aimed to investigate the significance of videodermoscopic features of chemotherapy induced alopecia. Material and Methods: Fourty-one patients, who were treated with chemotherapy and were diagnosed as chemotherapy induced alopecia after clinical evaluation, were included. The age, gender, skin phototype, diagnosis of malignancy, chemotherapy agents in the treatment protocol, location of the alopecia and the severity of alopecia were recorded. Trichoscopic photos were held in X30-X50 fold magnifications. All of the trichoscopic findings were examined in accordance with the checklist which was described by the features of the previous publications. Results: Hair diameter diversity were detected in all of the patients as a follicular feature. Black dots were established in 78%, yellow dots in 75.6%, broken hairs in 51.2%, Pohl-Pinkus in 46.3%, exclamation mark hairs and flame figures in 26.8% of the patients. Bicoulored, short vellus and moniletrix-like hairs were detected in 22%, pigtail and tapering hairs in 19.5%, tulip hairs in 14.6% and zigzag hairs in 9.8% of the patients. V hairs in 7.3%, comma hairs, peripilar finding and empty follicles were established in 4.9% of the patients as other rare findings. Neutrophil like hairs were detected in 7.3% of the patients for the first time. Conclusion: Zigzag hair, tulip hair and V hair were the new trichoscopy findings in chemotherapy induced alopecia. Neutrophil like hairs were defined for the first time in this study. Dermoscopic features of chemotherapy induced alopecia indicates some similar findings for alopecia areata and trichotillomania.

Background Chemotherapy-induced alopecia (CIA) ranks among the psychologically most devastating effects of cancer treatment for oncological patients, with an overall incidence of 65%. Nowadays trichoscopy is largely employed in the diagnosis of alopecia, but no description of CIA trichoscopic pattern is present in literature. Aims We want to create an organic description of CIA trichoscopic aspects. Methods Oncological patients candidate to chemotherapy drugs, afferent to our trichological outpatient were studied. Anamnesis, clinical exam, clinical global photography, pull test, trichogram, and trichoscopy were conducted at the different moments of therapeutic treatment. Results A definite trichoscopic pattern in the different phases of treatment was observed. After the first 3 weeks of chemotherapy rare and scattered black dots, broken hairs, flame hairs and pohl pinkus appeared. At the end of chemotherapy besides the features described above, numerous thin hair in regrowth were detected, together to rare terminal hair, scattered black dots and circle hair. Three months after chemotherapy a progressive increase of follicular units and elongation of the existing hair were visible. Conclusions We propose an description of CIA trichoscopic pattern and its evolution during the different phases of chemotherapy.

Chemotherapy-induced alopecia is a common and distressing adverse effect of many types of chemotherapy. Scalp cooling has been used since the 1970s for prevention of chemotherapy-induced alopecia; however, most data regarding this treatment modality are retrospective in nature, and use in the United States has been limited by safety concerns, specifically the potential for scalp metastases. Two prospective studies of scalp-cooling systems performed in the United States were published within the last year and add evidence supporting the efficacy and safety of scalp cooling in preventing chemotherapy-induced alopecia in patients receiving chemotherapy for solid tumor malignancies. Available data suggest that this technology is most effective for taxane-based chemotherapy regimens compared with anthracycline-based chemotherapy regimens. Two scalp-cooling devices have been cleared by the US Food and Drug Administration, and multiple cold caps are available for patient rental. The adverse effect profile of scalp cooling includes scalp pain, headache, and chills but is tolerable for most patients included in recent clinical trials. Retrospective data suggest that the incidence of scalp metastases related to scalp cooling is low and should not limit use of this technology. Logistic issues related to use of scalp cooling include availability of devices, inconsistent insurance coverage, and incorporation of use into typical infusion center workflow.

Introduction: Chemotherapy-induced alopecia (CIA) has a significant impact on the quality of life of many cancer patients. Scalp cooling has been in use for decades for the prevention of CIA, and w...

This case study describes the effect of Bojungikki-tang on chemotherapy-induced alopecia. Alopecia is a well-documented cause of distress to patients undergoing cancer treatment, but no approved pharmacological treatment exists for chemotherapy-induced hair loss. A 70-year-old female diagnosed with ...

Introduction/Background Chemotherapy induced alopecia is one of the most devastating side-effects, impacting on the patient‘s psycological well-being, altering body-image, and being also a visible marker of a life-threatening disease. Means to prevent hair loss with scalp hypothermia, were studied for decades but results were unsatisfactory. New tecnologies as DigniCap, use sensor-controlled scalp-cooling. DigniCap was the first system to receive FDA approval on December 2015. We wanted to study feasibility and efficacy of DigniCap system in routine practice. Methodology From September 2016 to March 2019,136 women underwent chemotherapy treatment with DigniCap. Patients shoud be >18 years old, have a diagnosis of breast or gynecological cancer and candidate for adiuvant/neoadiuvant treatment with alopecia-inducing drugs; 116 women had breast and 20 gynecological cancers. Alopecia was evaluated by WHO grading-system. Grade1: hair loss 75%. Results A total of 108 (79.4%) women completed all the chemotherapy with DigniCap, 28 stopped (27 breast and 1 gynecological cancer). Main reasons for stopping were: unefficacy, cold intolerance, therapy change. In the 89 women with breast cancer who completed the treatment, 68 (76.4.%) had a modest hair loss (41 Grade 1 and 27 Grade 2), in 21 the treatment was less effective (12 Grade 3 and 9 Grade 4). In the 19 women with gynecological cancer who completed the treatment, 15 (78.9%) had modest hair loss (10 Grade 1, 5 Grade 2), while 1 had Grade 3 and 3 Grade 4. Conclusion Around 76–79% of women had satisfactory results. Coordinating the appointments in order to give the possibility to treat all the women, was one of the main challenges, requiring an optimal organization by the nursing staff. Use of DigniCap is possible and effective in routinary setting Disclosure Nothing to disclose.

Purpose Chemotherapy-induced alopecia (CIA) is a common and often stressful adverse effect associated with chemotherapy. CIA can cause more psychosocial pressure in patients, including effects on sexuality, self-esteem, and social relationships. We analyzed publicly available data to identify drugs formulated for topical use targeting the relevant CIA molecular pathways by using computational tools. Methods The genes associated with CIA were determined by text mining, and the gene ontology of the gene set was studied using the Functional Enrichment analysis tool. Protein–protein interaction network analysis was performed using the String database. Enriched gene sets belonging to the identified pathways were queried against the Drug–Gene Interaction database to find drug candidates for topical use in CIA. Findings Our analysis identified 427 genes common to CIA text-mining concepts. Gene enrichment analysis and protein–protein interaction analysis yielded 19 genes potentially targetable by a total of 29 drugs that could possibly be formulated for topical application. Implications The findings from the present analysis would give a new thought to help discover more effective agents, and present tremendous opportunities to study novel target pharmacology and facilitate drug repositioning efforts in the pharmaceutical industry.

Damage to hair follicles following exposure to toxic chemotherapeutics can cause substantial hair loss, commonly known as chemotherapy-induced alopecia (CIA). Preventive therapies remain limited; however, recent advances in the use of scalp cooling technologies have proved successful in preventing or reducing hair loss in some patients. Further improvements in scalp cooling efficacy and/or development of novel treatments to prevent chemotherapy-induced hair loss are required. To achieve this, post-chemotherapy assessment of hair follicle damage markers, with and without scalp cooling, would provide invaluable mechanistic and prognostic information. At present, the availability of such data is extremely limited. This article describes the potential utility of a combination of biomarkers in assessing drug-induced alopecia and the protective potential of existing or new treatments. A greater understanding of the precise mechanisms of anti-CIA therapies through biomarker analysis would enhance the rationale, use, and development of such treatments.

12108 Background: CIA has been reported as the most disturbing adverse event of cancer treatment by most women receiving chemotherapy. Many strategies have been tested to minimize CIA, among which scalp cooling has proven high effectiveness. However, discontinuation rates of this technology vary from 3% to 13%, mostly due to headache, cold sensation and pain. EHW could be used to mitigate these side effects, produce heat on demand and a warming sensation. The primary objective of this study is to evaluated the impact of EHW device on the general comfort of breast cancer patients while on scalp cooling during chemotherapy treatment. Methods: Patients were randomly assigned to EHW use or observation. Thermal, sensory and general comfort were measured with pragmatic questionnaires after each chemotherapy infusion: neutral or hot as favorable thermal responses; comfortable and very comfortable as favorable sensory responses; finally, favorable outcomes in both thermal and sensory comfort questionnaires defined a positive result on the general comfort. We evaluated the impact of age (≤ or > 50 years), alopecia (grade 0 or 1/2), chemotherapy regimen (with or without taxanes) and EHW use (yes or no) in the different comfort scales using Logistic Regression (LR) models. Results: Forty women with early or locally advanced breast cancer were assigned to EHW (n = 20) or observation (n = 20) during neo(adjuvant) chemotherapy. Median age was 53 years, 67.5% concluded university education, 52.5% had comorbidities. Most patients had stage II disease (55%), largely ER/PR+ HER2- disease (67.5%), followed by triple negative (22.5%), and HER2+ (10%). Most frequent regimen was ACdd-Tdd (42.5%). Thirty-one patients (77.5%) continued scalp cooling during entire chemotherapy regimen (alopecia < grade 3). A favorable thermal response was seen in 79% of EHW applications as compared to 50% in control arm (odds ratio [OR] 3.79, P

e12537 Background: Chemotherapy induced alopecia (CIA) is one of the most distressing adverse events reported by patients undergoing chemotherapy, yet there is limited data addressing the impact of CIA on treatment acceptance. Scalp cooling (SC) has been shown to decrease CIA. Here we report our assessment of CIA as a barrier to chemotherapy and the efficacy of SC using pre- and post-treatment surveys of patient reported outcomes. Methods: Patients who received alopecia-inducing chemotherapy and utilized SC between November 2018 and September 2020 at our institution were enrolled in a prospective IRB approved registry. Surveys including the Chemotherapy Induced Alopecia Distress Scale (CADS) were administered before and within two weeks after treatment. Using the CADS survey, patients were asked about their hesitation to receive chemotherapy and the burden they feel about alopecia as a side effect of chemotherapy. Results: Of 90 patients who completed the first or last treatment survey, the most common treatment regimens were docetaxel/cyclophosphamide (TC), docetaxel/carboplatin/trastuzumab/ pertuzumab (TCHP), and paclitaxel/trastuzumab (TH). The most common disease type was breast cancer (92.2%) and all participants were females. Of 74 SC patients who completed the pre-treatment survey, the median age was 50.5 (range 26-75) and included 65 (87.8%) Caucasian, 4 (5.4%) Black, and 3 (4.0%) Asian patients. 89.2% used Paxman SC and 10.8% used Penguin SC. Of those who completed the CADS survey prior to treatment, 8 (10.8%) reported ‘quite a bit’ to ‘very high’ hesitation, and 34 (46.0%) reported feeling that alopecia was either ‘quite’ or ‘very much’ a burden of chemotherapy. All 40 SC patients (median age 53.5, range 31-76) who completed the post-treatment survey were Caucasian and used Paxman SC. Self-reported efficacy of SC in these 40 patients was less than 10% hair loss in 10 (25.0%), 11-25% hair loss in 7 (17.5%), 26-50% hair loss in10 (25.0%), 51-75% hair loss in 9 (22.5%), and 76-100% hair loss in 4 (10%). Overall, 27 (67.5%) patients reported SC limited alopecia ‘a lot’ to ‘perfectly’. Conclusions: In our study, alopecia was identified as a notable burden to nearly half our SC patients and 10.8% hesitated when making their decision to receive chemotherapy. After using SC during treatment, 67.5% of patients reported less than 50% hair loss, and 67.5% reported that SC reduced alopecia ‘a lot’ or ‘perfectly’. Our study highlights the significance of alopecia as a chemotherapy burden and potential barrier to accepting treatment, and suggests SC may be efficacious in decreasing CIA, which may allow patients to feel less hesitation towards chemotherapy.

Background: Chemotherapy-induced alopecia (CIA) is one of the most dramatic side effects of chemotherapy. Currently no guidelines are available for its prevention and treatment. Several devices and drugs are used, but results are often disappointing. Aims: Our aim is to analyze drugs and devices proposed in the literature for prevention and treatment of CIA induced by cytotoxic drugs and to discuss the evidenced-based opinion. Methods and Results: Scalp cooling is the only agent that has been approved by the US Food and Drug Administration for CIA prevention. Minoxidil and bimatoprost should not be used during chemotherapy administration, but they can be used after chemotherapy discontinuation to obtain greater regrowth. Conclusions: Therapy should always be modulated for the patient and no fixed protocol should be used. Trichoscopy and trichogram could be useful tools in supporting this treatment.

12101 Background: The Paxman scalp cooling device has been used for over 20 years to prevent CIA, obtaining FDA clearance in the U.S. in 2017. Prior studies reported 50-80% success and high patient satisfaction yet included few or no black patients. In the U.S. this may reflect disparities in access due to cost, awareness, or availability. We opened a prospective observational study combining patient-reported outcomes with clinical assessments of alopecia and planned to deliver scalp cooling to 30 black patients receiving chemotherapy for breast cancer. Methods: Patients who self-identified racially as black, had a new diagnosis of stage I-III breast cancer, and planned to receive chemotherapy with taxane-containing regimens were eligible. Anthracycline (AC) and non-anthracycline (NAC) chemotherapy agents were included; costs for the intervention were covered by Paxman and internal philanthropic funding. Patients who declined scalp cooling were approached for enrollment as controls. Primary endpoints were grade of alopecia as measured by providers and patient self-report using Modified Dean Scale and Visual Analog Scale (VAS) respectively. Hair preservation was defined as grade 3 alopecia). The 2 patients who used scalp cooling for the duration had >grade 3 alopecia before the last cycle of treatment. Conclusions: Scalp cooling is an important supportive therapy that can reduce chance of alopecia, a bothersome side effect for patients. Our experience indicates decreased efficacy in black patients with both AC and NAC regimens. This is an important negative result to explore. Discussions with the Paxman team and providers with expertise in alopecia are underway to explore contributing factors such as hair thickness, prior hair treatments, and cap design. [Table: see text]

e19334 Background: Chemotherapy induced alopecia(CIA) is the most common and afflicting chemotherapy side effect. Data on the use of scalp cooling (SC) to prevent CIA is limited and debatable due to lack of experience. This study analyzed the effectiveness and tolerability of SC in clinical practice. Methods: We prospectively analysed 100 consecutive patients who opted for Paxman scalp cooling. The assessment of alopecia was done by WHO grading system. The extent of alopecia was analyzed at baseline, during each session, and 4 weeks from the last SC session. Results: A total of 100 (94 females, 6 males) patients were enrolled. Amongst them, 69% had breast cancer, 18% had ovarian cancer and 26% had various other cancers. Majority of patients were treated with a curative intent (69%) and had a good performance status (ECOG PS 0-1). Overall 40% patients received anthracyclines, 45% received taxanes, 9% received both and 6% patient received other chemotherapeutic agents. Hair preservation rate was in 31% (Grade 0 alopecia 12%, Grade 1 alopecia 19%). After a single SC session, 30% of patients discontinued due to grade 2 alopecia. On cox regression analysis, onset of grade 2 alopecia on SC was significantly longer in patients on taxanes compared to anthracyclines (1.357 HR, 0.98-1.87 CI, p= .05). One out of 100 patients developed scalp metastases. Majority of the patients experienced mild side effects [chills (30%), headache (12%)]. One out of 100 patients discontinued SC due to intolerable side effects. None of the other predetermined factors (age, menopausal status, ECOG performance status, body mass index), were found to delay the onset of grade 2 alopecia amongst the male patients, hair preservation rate was 100% . Conclusions: Scalp cooling is very effective for hair preservation for some chemotherapy patients. In our study, we found that it is more effective in reducing alopecia in taxane chemotherapy. Scalp metastasis and SC discontinuation were observed to be very rare.