Skip to main content

55-Year-Old Female with Alopecia of the Scalp and Body After Chemotherapy

  • Chapter
  • First Online:
Clinical Cases in Alopecia

Part of the book series: Clinical Cases in Dermatology ((CLIDADE))

  • 179 Accesses

Abstract

Anagen effluvium is diffuse hair loss that occurs after toxic or inflammatory insult to hair follicles during the anagen, or growth phase, of the hair cycle, disrupting bulb matrix epithelial cell mitotic activity. Most hairs (80%–90%) on the scalp at any given moment are in the anagen phase and thus, patients can experience a uniform loss of hair of this magnitude. The most common cause of anagen effluvium is classically seen in those undergoing chemotherapy, as dividing cells display high metabolic activity and thus take up the drug more rapidly, but other medications and inflammatory disorders have also been implicated. Hair loss in anagen effluvium is often reversible as the quiescent stem cells responsible for the initiation of follicular regrowth are unharmed. Removal of the offending agent or treatment of the implicated conditions often results in resolution and regrowth. The clinical picture with a thorough history and physical exam is key for diagnosis but clinicians may also rely on laboratory techniques such as microscopy and even biopsy for an anagen-to-telogen ratio. Management is centered around patient education, coping strategies, and decreasing the duration and amount of hair loss experienced. Patient education should focus on the natural course and likely reversibility of hair loss as well as daily preventative measures including grooming strategies and hair care. While these aid in the management of both psychological and emotional distress these patients may experience, it is important to assure social support and to offer counseling appropriately. With appropriate use, external devices, such as scalp cooling, which induces vasoconstriction, and scalp tourniquet application, which clamps arteries supplying the scalp, have been shown to reduce the degree of hair loss. Medical intervention, with agents such as minoxidil, which induces arterial vasodilation, may be used topically to promote hair growth but does not prevent hair loss.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Kanwar AJ, Narang T. Anagen effluvium. Indian J Dermatol Venereol Leprol. 2013;79(5):604–12.

    Article  Google Scholar 

  2. Rossi A, Caro G, Fortuna MC, Pigliacelli F, D’Arino A, Carlesimo M. Prevention and treatment of chemotherapy-induced alopecia. Dermatol Pract Concept. 2020;10(3):e2020074.

    Article  Google Scholar 

  3. Yu V, Juhász M, Chiang A, Atanaskova MN. Alopecia and associated toxic agents: a systematic review. Skin Appendage Disord. 2018;4(4):245–60.

    Article  Google Scholar 

  4. Trüeb RM. Chemotherapy-induced hair loss. Skin Therapy Lett. 2010;15(7):5–7.

    Google Scholar 

  5. Phillips TG, Slomiany WP, Allison R. Hair loss: common causes and treatment. Am Fam Physician. 2017;96(6):371–8.

    Google Scholar 

  6. Kang D, Kim IR, Choi EK, Im YH, Park YH, Ahn JS, et al. Permanent chemotherapy-induced alopecia in patients with breast cancer: a 3-year prospective cohort study. Oncologist. 2019;24(3):414–20.

    Article  CAS  Google Scholar 

  7. Ghias MH, Amin BD, Kutner AJ. Albendazole-induced anagen effluvium. JAAD Case Rep. 2020;6(1):54–6.

    Article  Google Scholar 

  8. Qi J, Garza LA. An overview of alopecias. Cold Spring Harb Perspect Med. 2014;4(3):a013615.

    Article  Google Scholar 

  9. Fonia A, Cota C, Setterfield JF, Goldberg LJ, Fenton DA, Stefanato CM. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients. J Am Acad Dermatol. 2017;76(5):948–57.

    Article  CAS  Google Scholar 

  10. Tallon B, Blanchard E, Goldberg LJ. Permanent chemotherapy-induced alopecia: case report and review of the literature. J Am Acad Dermatol. 2010;63(2):333–6.

    Article  Google Scholar 

  11. Wasserman D, Guzman-Sanchez DA, Scott K, McMichael A. Alopecia areata. Int J Dermatol. 2007;46(2):121–31.

    Article  CAS  Google Scholar 

  12. Delmonte S, Semino MT, Parodi A, Rebora A. Normal anagen effluvium: a sign of pemphigus vulgaris. Br J Dermatol. 2000;142(6):1244–5.

    Article  CAS  Google Scholar 

  13. Shanshal M. COVID-19 related anagen effluvium. J Dermatolog Treat. [published online: July 16, 2020]. https://doi.org/10.1080/09546634.2020.1792400.

  14. van den Hurk CJ, van den Akker-van Marle ME, Breed WP, van de Poll-Franse LV, Nortier JW, Coebergh JW. Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer. Eur J Oncol Nurs. 2013;17(5):536–40.

    Article  Google Scholar 

  15. Seol JE, Kim DH, Park SH, Cho GJ, Kim H. Three cases of radiation-induced temporary alopecia with hair microscopic examination: "Coudability hair" might not be specific for alopecia Areata. Int J Trichol. 2018;10(1):40–3.

    Article  Google Scholar 

  16. Komen MM, Smorenburg CH, van den Hurk CJ, Nortier JW. Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. Oncologist. 2013;18(7):885–91.

    Article  Google Scholar 

  17. Shin H, Jo SJ, Kim DH, Kwon O, Myung SK. Efficacy of interventions for prevention of chemotherapy-induced alopecia: a systematic review and meta-analysis. Int J Cancer. 2015;136(5):E442–54.

    Article  CAS  Google Scholar 

  18. Rugo HS, Voigt J. Scalp hypothermia for preventing alopecia during chemotherapy. A systematic review and meta-analysis of randomized controlled trials. Clin Breast Cancer. 2018;18(1):19–28.

    Article  Google Scholar 

  19. Betticher DC, Delmore G, Breitenstein U, Anchisi S, Zimmerli-Schwab B, Müller A, et al. Efficacy and tolerability of two scalp cooling systems for the prevention of alopecia associated with docetaxel treatment. Support Care Cancer. 2013;21(9):2565–73.

    Article  Google Scholar 

  20. Dunnill CJ, Al-Tameemi W, Collett A, Haslam IS, Georgopoulos NT. A clinical and biological guide for understanding chemotherapy-induced alopecia and its prevention. Oncologist. 2018;23(1):84–96.

    Article  Google Scholar 

  21. Goren A, Naccarato T, Situm M, Kovacevic M, Lotti T, McCoy J. Mechanism of action of minoxidil in the treatment of androgenetic alopecia is likely mediated by mitochondrial adenosine triphosphate synthase-induced stem cell differentiation. J Biol Regul Homeost Agents. 2017;31(4):1049–53.

    CAS  Google Scholar 

  22. Suchonwanit P, Thammarucha S, Leerunyakul K. Minoxidil and its use in hair disorders: a review. Drug Des Devel Ther. 2019;13:2777–86.

    Article  CAS  Google Scholar 

  23. Duvic M, Lemak NA, Valero V, Hymes SR, Farmer KL, Hortobagyi GN, et al. A randomized trial of minoxidil in chemotherapy-induced alopecia. J Am Acad Dermatol. 1996;35(1):74–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lawless, M., Kirk, S., Sampath, S., Trotter, S.C. (2022). 55-Year-Old Female with Alopecia of the Scalp and Body After Chemotherapy. In: Trotter, S.C., Sampath, S. (eds) Clinical Cases in Alopecia. Clinical Cases in Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-031-15820-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-15820-9_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-15819-3

  • Online ISBN: 978-3-031-15820-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics