60-Year-Old-Female with Hair Loss After Treatment for Reactive Lymphoid Hyperplasia

Abstract

Radiation therapy, both for treatment and diagnosis, is becoming increasingly prevalent in medical practice. Alopecia is a potential side effect that warrants substantial consideration, with many patients claiming this as the most distressing aspect of their procedure, and some even stating they would forgo curative treatment due to potential alopecia. Hair loss is typically localized to the area of treatment and occurs in a dose-dependent fashion a few weeks after exposure to radiation. In addition to the cumulative dose of radiation that a patient receives, severity of hair loss may also be increased by the method of radiation delivery, patient-related factors such as smoking, and the use of certain antineoplastic agents. Diagnosis is based on clinical presentation and a history of radiation exposure, with dermoscopy findings for lower doses being similar to that of alopecia areata. Although most cases will spontaneously resolve within 6 months, prevention and treatment options do exist for refractory cases of alopecia. Newer treatment delivery methods that reduce off-target radiation, preventative therapies, topical medications, injections, surgery, and transplantation have all been used with some success. Of note, scalp cooling has not been shown to be an effective prevention strategy in alopecia due to radiation.