Persistent cytotoxic chemotherapy-induced alopecia is often more severe and diffuse than endocrine therapy-induced alopecia after chemotherapy, according to a study published in JAMA Dermatology.

Researchers retrospectively evaluated patients who underwent treatment with cytotoxic chemotherapy and developed either persistent chemotherapy-induced alopecia or endocrine therapy-induced alopecia for treatment outcomes, quality of life, and the effect of dermatologic therapy. Data collection included patient history of alopecia and hair regrowth after chemotherapy, patterns and severity scores of alopecia, alopecia-specific quality of life scores, and the effectiveness of dermatologic therapy.

Of the 192 women included in this study, 98 developed persistent chemotherapy-induced alopecia; 94 developed endocrine therapy-induced alopecia after chemotherapy. Breast cancer was the most common oncologic diagnosis, with 81% of the persistent chemotherapy-induced alopecia and 95% of the endocrine therapy-induced alopecia after chemotherapy cohorts having that diagnosis.

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For previous treatments, 82% of the cohort with persistent chemotherapy-induced alopecia was treated with taxane-based chemotherapy, and 62% of the cohort with endocrine therapy-induced alopecia after chemotherapy was treated with aromatase inhibitors. Those with persistent chemotherapy-induced alopecia had more diffuse alopecia (41% vs 25%; P =.04), a higher frequency of a Common Terminology Criteria for Adverse Events severity score over a grade 2 (39% vs 13%; P <.001), a lower mean number of hair shafts per follicular unit (1.3 vs 1.5; P <.001), and lower mean numbers for hair thickness (62 [13 μm] vs 68 [13 μm]; P =.02) when compared with those with endocrine therapy-induced alopecia after chemotherapy.

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Both cohorts experienced negative emotional effects, even those patients with clinically low severity. With treatment, 36 patients in the persistent chemotherapy-induced alopecia cohort showed moderate to significant improvements, and 32 patients in the endocrine therapy-induced alopecia after chemotherapy cohort showed moderate to significant improvement.

Future studies should increase the sample size, include men, identify risk factors, and explore more effective therapies.

The researchers concluded that “patients with persistent chemotherapy-induced alopecia showed predominantly diffuse and more severe alopecia than did patients with endocrine therapy-induced alopecia that developed after completion of chemotherapy.”

Disclosures: Several authors report multiple associations with pharmaceutical companies. Please see the original reference for a full list of the authors’ disclosures.

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Freites-Martinez A, Chan D, Sibaud V, et al. Assessment of quality of life and treatment outcomes of patients with persistent postchemotherapy alopecia [published online March 6, 2019]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.5071