Chemotherapy-induced hair loss

Abstract

Chemotherapy-induced alopecia (CIA) is a common side effect of chemotherapy and its incidence and severity depends most on the type and dose of cytostatics. Rapid proliferating hair follicle cells, i.e. in the anagen phase, are affected by the cytostatics, as are rapid proliferating cancer cells. CIA occurs within a few weeks after the first chemotherapy cycle and is often extensive. The underlying molecular mechanisms of hair follicle apoptosis by chemotherapy is poorly understood, but several signalling pathways are involved. CIA is usually temporary. Hair regrowth usually starts within several months following the last chemotherapy cycle, but there is often a transient change in structure or color. The impact of CIA is underestimated by nurses and medical doctors. Patients rank it among the most feared and experienced side effects. The impact of CIA is also shown by the number of patients that want to camouflage their baldness; most patients purchase a wig or other head covering. Psychological distress caused by CIA is high, in which men's experiences have been largely ignored. In addition, CIA may seriously affect one's body image, which has impact on self-esteem and self-confidence. However, anticipatory adaptation and wig use may mitigate experiences of hair loss. Before the start of chemotherapy, patients have to be prepared for potential hair loss to minimize its impact on quality of life. CIA prevention comprises attempts of using pharmacological agents and mechanical strategies, however scalp cooling is the only effective method until now. The majority of patients tolerate scalp cooling very well and it is cost-effective compared to purchasing wigs and head covers. If patients preserve their hair during chemotherapy, hairs are minimally damaged, as shown by diminished hair shaft diameters.