Alopecia and cancer
Alopecia refers to abnormal hair loss, which can occur due to various factors, including cancer treatments like chemotherapy and radiation therapy. Chemotherapy, in particular, targets rapidly dividing cells, affecting not only cancer cells but also the germinal matrix cells responsible for hair growth. As a result, individuals undergoing chemotherapy may experience varying degrees of hair loss, from patchy thinning to complete baldness. While hair loss from chemotherapy is often temporary and hair typically regrows once treatment concludes, the extent of recovery can depend on the specific drugs used and their dosages.
Radiation therapy can also lead to hair loss, with the outcome being influenced by the radiation dose. Higher doses may cause permanent loss in the treated area, while lower doses are more likely to result in temporary hair loss. Treatments for alopecia caused by cancer therapies can include nutritional supplements aimed at promoting healthy hair, though these should be discussed with healthcare providers to avoid interfering with cancer treatment. Overall, while hair loss can be a distressing side effect of cancer care, many individuals can expect hair regrowth after their treatment has ended.
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Alopecia and cancer
Also known as: Alopecia disseminata, alopecia universalis, alopecia totalis, baldness, hair loss, acomia, pelade
Related conditions: Anagen effluvium, telogen effluvium
Definition:Alopecia is abnormal loss of hair, a common side effect of treatments for cancers, including chemotherapy and radiation therapy. There are many types of alopecia, with many causes, including certain skin cancers and other types of cancer that spread to the skin, although marked hair loss from skin cancer is extremely rare.
Risk factors: Chemotherapy for any cancer greatly increases the risk of alopecia, and radiation therapy increases the risk of hair loss from the irradiated area.
Etiology and the disease process: Each human hair grows from a hair follicle, an elongated pouch formed during fetal development by growth of the upper part of the skin, the epidermis, down into the lower part, the dermis. The lower part of the follicle, the hair bulb, contains the germinal matrix, the cells that form the hair. Each hair goes through a three-phase growth cycle: anagen, or active growth; catagen, or regression; and telogen, or resting. When the telogen phase for each hair is complete, a new anagen phase begins. Human hairs complete their recurring growth cycle, as old hairs are pushed out by new hairs, in random order. According to The MASCC Textbook of Cancer Supportive Care and Survivorship (2011), at any given time, about 90 percent of hairs are in the anagen, or active growth phase. Chemotherapeutic agents target rapidly reproducing cells, like cancer cells. Unfortunately, these agents do not know the difference between a cancer cell and the rapidly reproducing cells of the germinal matrix in a hair bulb. They stop cell division, or mitosis, in matrix cells, just as they do in cancer cells. The anagen phase comes to a stop, and in many cases, all the hair that is in the anagen phase is shed. Hair lost through chemotherapy almost always regrows, because the hair follicle is left intact. Radiation therapy also stops the reproduction of rapidly dividing cells, but in higher doses, radiation can damage the hair follicles it touches, preventing regrowth of hair.
Incidence: At least some degree of hair loss is likely with many forms of chemotherapy. Certain drugs or combinations of drugs are virtually certain to cause some degree of hair loss. A few drugs cause nearly complete hair loss.
Symptoms: Symptoms of alopecia related to cancer range from temporary thinning or breakage of a small patch of hair to loss of hair all over the body (alopecia disseminata, alopecia universalis, alopecia totalis), and hair loss can be temporary or permanent, depending on the cause.
Screening and diagnosis: Diagnosis of chemotherapy-related alopecia follows visible hair loss within days or weeks of administration of chemotherapeutic drugs.
Treatment and therapy: Therapies for alopecia caused by chemotherapy include administration of vitamins, minerals, or omega-6 and omega-3 fatty acids, substances that promote healthy hair. The benefit of these therapies on cancer-related hair loss is still being researched, and consumption of some vitamins and minerals may reduce the effectiveness of chemotherapy, so any treatment for hair loss during therapy should be approved by the treating physician. Treatment for cancer-caused alopecia includes treatment for the underlying cancer, which may include surgery or chemotherapy. Again, noticeable hair loss from cancer itself is extremely rare.
Prognosis, prevention, and outcomes: The prognosis for alopecia caused by chemotherapy depends on the chemicals used, the dosage, and the frequency of treatment. More intensive treatment is likely to cause more extensive hair loss. Whatever the amount or type of hair loss from chemotherapy, the prognosis is eventual regrowth of hair. Patchy regrowth may begin before chemotherapy is completed, an average of three to five months after initial hair loss from the first treatment, as noted in 2009 by oncology nurses Gale Snyder-Port, Janice Gibson, and Kathleen Spurrier of the University of Pennsylvania. Because chemotherapy disrupts the matrix from which the hair is formed, including the melanocytes, or cells that give hair its color, regrown hair may differ in color or texture from the original hair. There has been some limited success in preventing scalp hair loss from chemotherapy through use of scalp cooling (cryotherapy) or a hairline tourniquet during administration of the chemotherapy. These, however, have been successful with only certain chemical agents. Their use has been questioned by some oncologists because, while they protect scalp follicles from damage, they also protect any cancer cells present in the scalp. The Mayo Foundation for Medical Education and Research reported in 2012 that the topical medication Rogaine does not appear effective for hair loss prevention for patients undergoing chemotherapy but has shown some promise in regenerating lost hair. Research trials are being conducted on other treatments that may reduce hair loss from chemotherapy. The prognosis for alopecia caused by radiation therapy depends on the dosage of radiation. High doses usually cause permanent hair loss to the irradiated area; low doses more often cause temporary, local hair loss.
Bibliography
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