Abstract
Background:
Eyebrow and eyelash loss, known as madarosis, can occur after breast cancer-directed therapy. The purpose of this study was to ascertain the proportion of breast cancer survivors who experience madarosis, contributing factors, and associations between this symptom and quality of life.
Methods:
Breast cancer survivors were invited to participate in an ongoing longitudinal cohort study as a part of the Mayo Clinic Breast Disease Registry (MCBDR). Consenting participants were mailed a survey approximately one year after diagnosis. The proportions of participants who reported eyebrow and eyelash loss were evaluated overall and according to treatment type. Quality of life (QOL) was also explored in this cohort.
Results:
Eight hundred and thirty-eight breast cancer survivors responded to survey. The median age of survivors was 59.4 years (range 22–100 years), 315 (37%) had received chemotherapy (+/− endocrine therapy), 415 (50%) had received endocrine therapy only. Nearly half of participants reported eyebrow loss (49%) or eyelash loss (49%) that occurred after their diagnosis of breast cancer. Eyebrow loss was reported by 89% of chemotherapy recipients, by 27% of endocrine therapy only recipients, and by 19% of those not treated with either therapy. 102 (32%) of those with chemotherapy-associated eyebrow loss reported that it was complete. Eyelash loss was reported by 274 (87%) of chemotherapy recipients, 112 (27%) of endocrine therapy only recipients, and 23 (21%) of those who received neither therapy.
Conclusions:
Madarosis is a common symptom in breast cancer survivors and future investigation into the predictors and treatment of madarosis is needed.
Keywords: breast cancer treatment, madarosis, chemotherapy, endocrine therapy, eyebrow loss, eyelash loss, mental health
Micro Abstract:
Madarosis (eyebrow or eyelash loss) may occur in patients undergoing breast cancer therapy. While this is a distressing symptom, data regarding the incidence, contributing factors, and associations with patient reported quality of life are lacking. This cohort study found that madarosis was reported by approximately half of breast cancer survivors, and that patients with madarosis reported lower mental health scores.
Introduction:
Breast cancer is the most common cancer among women worldwide and often requires systemic therapies, including hormonal therapy, targeted therapy, and/or chemotherapy1,2. Women with breast cancer describe hair loss as a highly feared treatment-related toxicity that can affect treatment decisions11,12. While scalp hair loss is a commonly reported side effect of therapy, women undergoing breast cancer treatment may also experience loss of eyebrows and eyelashes, termed madarosis5,10. According to one survey study of breast cancer survivors, approximately two-thirds reported madarosis; a second study primarily investigated scalp alopecia but noted that approximately one-third of patients with persistent scalp alopecia also reported eyebrow/eyelash loss4. While breast cancer-directed chemotherapy agents, including taxanes, alkylating agents and anthracyclines are known causes of madarosis, endocrine therapy agents, including aromatase inhibitors and selective estrogen receptor modulators, may also contribute to this symptom4,8. However, the frequency and predictors of madarosis associated with each breast cancer-directed therapy – including madarosis associated with endocrine therapy alone -- have been insufficiently characterized.
The characterization of madarosis is particularly important as preliminary investigations suggest it may persist in some women after completion of cancer-directed therapy19. While eyelashes may regrow in some women as early as two weeks after completion of chemotherapy, some experience persistent eyelash loss at 6 months post treatment13. Indeed, preliminary results from a prospective longitudinal study of over 300 patients found madarosis in 35% of their cohort after receipt of both chemotherapy and endocrine therapy6. While madarosis related to cancer-directed treatment has been largely reversible, there are some data suggesting that it is irreversible 5% of the time9.
Furthermore, eyebrow and eyelash changes negatively impact the quality of life of breast cancer survivors3. Eyebrows and eyelashes functionally protect the eyes from sweat, dust, and light; and madarosis can contribute to discomfort from foreign debris11,12. Furthermore, eyebrows and eyelashes help to provide expressions of emotion, serve as an important feature of appearance, and help to form personal identity5,13. Preliminary results of one focus group-based study of breast cancer survivors reported that many patients were distressed by madarosis, with some reporting a change in their interactions in public as a result13. Many also reported utilizing aesthetic tools such as supplemental eyelashes and eye pencils to address this symptom13. Associations between type of breast cancer-directed therapy, madarosis, and quality of life warrant further investigation.
The present study was developed to characterize madarosis in breast cancer survivors and to help inform breast cancer survivors about the frequency and predictors of madarosis related to cancer-directed therapies.
Materials and Methods:
Participants:
Approval to perform this study was obtained via the Mayo Clinic Institutional Review Board (IRB). The Mayo Clinic Breast Disease Registry (MCBDR), a cohort of patients with a diagnosis of breast cancer who are followed longitudinally with annual surveys, was used to identify patients with breast cancer who had received breast cancer-directed therapy. Participants in the MCBDR provided permission for researchers to review their medical history. Participating breast cancer survivors were mailed a registry survey at baseline and annually thereafter; this study utilized the data from participants who completed the questionnaire mailed one year after diagnosis. The one-year questionnaire inquired about participants’ breast cancer-related symptoms and treatments and included questions about the presence and degree of eyebrow and eyelash loss. All participants in the MCBDR who were eligible for the one-year questionnaire and had undergone any breast cancer directed therapy were eligible for inclusion in this study.
Data Collection:
Breast cancer survivors participating in the ongoing prospective MCBDR were mailed a survey one year after diagnosis; data collection spanned May 2020 to September 2022. Participants were asked to respond to two questions related to their experience with madarosis: 1) “Since your breast cancer diagnosis, how much have you experienced loss of your eyebrows?” 2) “Since your breast cancer diagnosis, how much have you experienced loss of your eyelashes?” Participants were asked to recall the presence and severity of both eyebrow and eyelash loss on a scale from 1 “no loss”, 2 “a little loss”, 3 “a lot of loss” and 4 “complete loss”.
Patient demographics, including age, clinical information, including stage of breast cancer, and treatments for breast cancer (including receipt of chemotherapy only, endocrine therapy only, both, or neither), were self-reported among patients in this cohort. Furthermore, patient perceptions of quality of life were collected via the Patient Reported Outcomes Measurement and Information System (PROMIS®) project scales, which describes patients’ global physical and mental health15.
Statistics:
Descriptive statistics in the form of means, medians, percentages were utilized in generating hypotheses. Eyebrow and eyelash loss were stratified by therapy type and PROMIS project score. Data obtained from participants who did not provide pre- and post-severity scores remained missing.
Results:
Patient characteristics:
A total of 1164 breast cancer survivors were sent the one-year post enrollment survey; 838 (72.6%) responded and were included in this madarosis study. Of these, 96% of participants were White, 78% had ductal cancers, 69% were Stage I-II disease at diagnosis, 10% had stage III and 5% had stage IV. The median age of survivors was 59.4 years (range 22–100 years) (Table 1). Twenty-five percent of patients received both chemotherapy and endocrine therapy, 12% received only chemotherapy, 50% received endocrine therapy only, and 13% received neither.
Table 1.
Demographic and clinical information on 838 subjects enrolled in the Mayo Clinic Breast Disease Registry who responded to the 1-year post-enrollment survey, May 2020 to September 2022.
| Variable | Number | % |
|---|---|---|
| Self-Reported Ethnicity | ||
| Non-Hispanic | 810 | 97% |
| Hispanic | 11 | 1% |
| Unknown/Missing | 17 | 2% |
| Self-Reported Race | ||
| White | 802 | 96% |
| Asian | 19 | 2% |
| Black | 6 | 1% |
| Other | 3 | 0% |
| Unknown/Missing | 8 | 1% |
| Median age | 59.4 years | |
| Tumor Type | ||
| Ductal | 651 | 78% |
| Lobular | 92 | 11% |
| Mixed | 13 | 2% |
| Other/Unknown/Missing | 82 | 9% |
| Stage of Disease at Enrollment | ||
| Stage 0 | 140 | 17% |
| Stage 1 | 369 | 44% |
| Stage 2 | 207 | 25% |
| Stage 3 | 84 | 10% |
| Stage 4 | 38 | 5% |
| Hormone Receptor Status | ||
| ER/PR+, HER2+ | 34 | 4% |
| ER/PR+, HER2− | 346 | 41% |
| ER/PR+, HER2 missing | 69 | 8% |
| ER/PR−, HER2+ | 20 | 2% |
| ER/PR−, HER2− | 58 | 7% |
| ER/PR−, HER2 missing | 12 | 1% |
| ER/PR/HER2 missing | 299 | 36% |
| Therapy Received | ||
| Chemotherapy + Endocrine therapy | 212 | 25% |
| Chemotherapy alone | 103 | 12% |
| Endocrine therapy alone | 415 | 50% |
| Neither chemotherapy Nor endocrine therapy | 108 | 13% |
The majority of patients on endocrine therapy received an aromatase inhibitor (69%), 29% received a selective estrogen receptor modulator (SERM; tamoxifen), and 2% received a selective estrogen receptor degrader (SERD; fulvestrant). Ten percent received a gonadotropin-releasing hormone agonist (GnRHa) (e.g., leuprolide or goserelin), along with another form of endocrine therapy. Chemotherapy agents received included anthracyclines (43%), alkylating agents (58%), platinum (7%), and microtubule inhibitors/taxanes (71%) inhibitors.
Frequency/Severity of Madarosis
Eyebrow loss
Nearly half (49%) of participants reported experiencing eyebrow loss of any severity. Thirteen percent of all participants reported ‘complete’ eyebrow loss (Table 2a). Participants who received chemotherapy alone reported the highest proportion of eyebrow loss (91%), and 42% of these participants reported complete eyebrow loss (Table 3a). Among participants who received only endocrine therapy, 27% reported eyebrow loss; 1% reported complete eyebrow loss. Among participants who did not receive chemotherapy or endocrine therapy, 19% reported eyebrow loss.
Table 2a and b.
Degree of Eyebrow and Eyelash loss among all 838 Participants enrolled in the Mayo Clinic Breast Disease Registry who responded to the 1-year post-enrollment survey, May 2020 to September 2022.
| Degree | Total | Percentage |
|---|---|---|
| Complete loss | 105 | 13% |
| A lot of loss | 128 | 15% |
| A little loss | 179 | 21% |
| No loss | 425 | 51% |
| Total | 837 | 100% |
| Degree | Total | Percentage |
| Complete loss | 108 | 13% |
| A lot of loss | 120 | 14% |
| A little loss | 181 | 22% |
| No loss | 427 | 51% |
| Total | 836 | 100% |
Table 3a.
Degree of eyebrow loss with different cancer therapies
| Chemotherapy and Endocrine Therapy | Chemotherapy Only | Endocrine Therapy Only | Neither Chemotherapy nor Endocrine Therapy | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | ||||
| Complete loss | 59 | 28% | 43 | 42% | 3 | 1% | 0 | 0% | |||
| A lot of loss | 77 | 36% | 29 | 28% | 21 | 5% | 1 | 1% | |||
| A little loss | 49 | 23% | 22 | 21% | 88 | 21% | 20 | 19% | |||
| No loss | 26 | 12% | 9 | 9% | 303 | 73% | 87 | 81% | |||
| Total | 212 | 100% | 103 | 100% | 415 | 100% | 108 | 100% | |||
Eyelash loss
Nearly half (49%) of participants reported experiencing eyelash loss of any severity. Thirteen percent of all participants reported ‘complete’ eyelash loss (Table 2b). Participants who received chemotherapy alone reported the highest proportion of eyelash loss (90%), and 41% reported that this was complete eyelash loss (Table 3b). Among those who received endocrine therapy alone, 27% reported having any eyelash loss, none of which was complete.
Table 3b.
Degree of eyelash loss with different cancer therapies
| Chemotherapy and Endocrine Therapy | Chemotherapy Only | Endocrine Therapy Only | Neither Chemotherapy nor Endocrine Therapy | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | ||||
| Complete loss | 65 | 31% | 42 | 41% | 1 | 0% | 0 | 0% | |||
| A lot of loss | 73 | 34% | 28 | 27% | 14 | 3% | 5 | 5% | |||
| A little loss | 43 | 20% | 23 | 22% | 97 | 23% | 18 | 17% | |||
| No loss | 30 | 14% | 10 | 10% | 302 | 73% | 85 | 79% | |||
| Total | 212 | 100% | 103 | 100% | 415 | 100% | 108 | 100% | |||
Quality of Life
Using PROMIS® project scales, global mental health scores were collected, and associations with degree of eyebrow and eyelash loss were assessed. Among the participants with the lowest mental health scores (5–8), 55% reported having eyebrow loss of any severity; among the participants with the highest mental health scores (17–20), 43% reported eyebrow loss of any severity (Table 4a). Similarly, among those with the lowest mental health scores, 60% had some degree of eyelash loss, while only 40% of those with the highest mental health score had eyelash loss (Table 4b). Given that more intensive cancer treatment may both reduce quality of life and cause eyelash/eyebrow loss, we assessed these rates separately in recipients of different types of cancer therapy. Among patients who received any form of chemotherapy, eyebrow loss was reported by 89% and eyelash loss was reported by 91% of those who had poor or moderate mental health scores (5–12); similarly, eyebrow loss was reported by 89% and eyelash loss by 86% of those who had good or very good mental health scores (13–20) (Table 5a). Among patients who received only endocrine therapy, eyebrow loss was reported by 30% and eyelash loss by 27% of those who had the poor or moderate mental health scores (5–12); similarly, eyebrow loss was reported by 26% and eyelash loss by 27% of those who had the good or very good (13–20) mental health scores (Table 5b).
Table 4a.
Global Mental Health Scores based on degree of eyebrow loss.
| Complete loss | A lot of loss | A little loss | No loss | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | ||||
| Poor (5–8) | 2 | 10% | 4 | 20% | 5 | 25% | 9 | 45% | |||
| Moderate (9–12) | 16 | 10% | 25 | 16% | 43 | 28% | 71 | 46% | |||
| Good (13–16) | 56 | 14% | 62 | 16% | 82 | 21% | 193 | 49% | |||
| Very good (17–20) | 28 | 11% | 34 | 14% | 44 | 18% | 142 | 57% | |||
Table 4b.
Global Mental Health Scores based on degree of eyelash loss.
| Complete loss | A lot of loss | A little loss | No loss | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | ||||
| Poor (5–8) | 4 | 20% | 5 | 25% | 3 | 15% | 8 | 40% | |||
| Moderate (9–12) | 21 | 14% | 26 | 17% | 36 | 23% | 72 | 46% | |||
| Good (13–16) | 54 | 14% | 52 | 13% | 96 | 24% | 191 | 49% | |||
| Very good (17–20) | 28 | 11% | 31 | 13% | 41 | 17% | 147 | 60% | |||
Table 5a.
Eyebrow and Eyelash Loss stratified by Global Mental Health Score for Chemotherapy Recipients
| Eyebrow Loss | Eyelash Loss | |||
|---|---|---|---|---|
| n | % of group | n | % of group | |
| Poor (5–8) | 8 | 100% | 8 | 100% |
| Moderate (9–12) | 59 | 88% | 61 | 90% |
| Good (13–16) | 137 | 91% | 134 | 89% |
| Very good (17–20) | 70 | 84% | 65 | 79% |
| Total | 274 | 89% | 268 | 87% |
Table 5b.
Eyebrow and Eyelash Loss stratified by Global Mental Health Score for Endocrine Therapy Recipients
| Eyebrow Loss | Eyelash Loss | |||
|---|---|---|---|---|
| n | % | n | % | |
| Poor (5–8) | 2 | 20% | 3 | 30% |
| Moderate (9–12) | 21 | 32% | 17 | 26% |
| Good (13–16) | 53 | 27% | 56 | 29% |
| Very good (17–20) | 31 | 24% | 31 | 24% |
| Total | 107 | 27% | 107 | 27% |
Discussion:
The present study confirms that nearly half of breast cancer survivors experience madarosis, supporting the growing body of literature illustrating that eyebrow and eyelash loss are common in breast cancer survivors7. However, the current study reports higher rates than previously described; here, 90% of chemotherapy recipients reported eyebrow/eyelash loss in this study, whereas only one- to two-thirds of chemotherapy recipients reported madarosis in prior studies4. Furthermore, this study is one of few to indicate that madarosis is reported by survivors who receive endocrine therapy without chemotherapy. These findings illustrate that madarosis is a common problem that warrants clinical attention and further investigation.
In the current study, madarosis experienced by breast cancer survivors who received endocrine therapy without chemotherapy was less severe than madarosis experienced by survivors who also received chemotherapy. This is not surprising given the known effects of chemotherapy on the hair shaft/follicle18. Among the patients who experienced eyebrow and eyelash loss the differences in mental health are more apparent based on the type of therapy received – endocrine therapy versus chemotherapy. This is important to consider as existing literature highlights the role that eyebrows and eyelashes serve in esthetic beauty and their impact on perceived quality of life5,13.
While this study illustrates that madarosis is a symptom that can occur among women who receive chemotherapy and endocrine therapy, breast cancer survivors have reported in other studies that madarosis is infrequently discussed in clinical appointments13. Furthermore, one large theme from a focus group study evaluating perceptions of madarosis was that breast cancer survivors felt unprepared to handle madarosis13.
While there are no FDA-approved treatments for madarosis, there are two potential therapies that have been studied in small groups of breast cancer survivors. The first, topical bimatoprost, appears to be a promising treatment for eyelash loss. It can be applied to both the upper lash line and the eyebrow area. In one study, twenty patients who used bimatoprost eye gel after receipt of chemotherapy for breast cancer experienced improved eyelash length, pigment, and thickness, as well as patient satisfaction14. Second, oral low dose minoxidil has been found to improve madarosis in patients with other etiologies of hair loss, including frontal fibrosing alopecia (which can result in scarring), especially if used early; further study among breast cancer survivors is needed16.
This study is the first to report on the frequency and severity of both eyebrow and eyelash loss related to both chemotherapy and endocrine therapy among a large cohort of breast cancer survivors. Limitations include the fact that the cohort is largely comprised of white individuals, and studies of madarosis in women of color are sorely needed, as madarosis risk may be influenced by hair texture17. Furthermore, this study is limited by its retrospective nature; prospective studies should define the incidence, future predictors, and full duration of madarosis among breast cancer survivors. The impact of surgery and radiation on hair loss is unknown. In addition, with the increasing use of cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors, which was found to be related to alopecia, investigation into the effects of these agents on madarosis is also warranted20. Finally, preventive strategies and treatments for eyebrow/eyelash loss associated related to cancer therapy are greatly needed.
Conclusion:
In addition to scalp alopecia, which is known to be caused by both chemotherapy and endocrine therapy, madarosis (eyebrow and eyelash loss) is common in breast cancer survivors. Further investigation into this distressing symptom and strategies to mitigate this are needed.
Table 4c.
Global Mental Health Score stratified by treatment type.
| Both Chemotherapy and Endocrine Therapy | Chemotherapy Only | Endocrine Therapy Only | Neither Chemotherapy nor Endocrine Therapy | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | ||||
| Poor (5–8) | 5 | 1% | 3 | 1% | 10 | 1% | 2 | 1% | |||
| Moderate (9–12) | 50 | 18% | 18 | 13% | 66 | 12% | 22 | 16% | |||
| Good (13–16) | 95 | 46% | 55 | 55% | 195 | 47% | 48 | 45% | |||
| Very good (17–20) | 59 | 35% | 24 | 30% | 131 | 40% | 34 | 38% | |||
Clinical Practice Points:
Madarosis, or the loss of eyebrows and eyelashes can occur in patients with breast cancer
Important to discuss this side effect with patients
Consider re-growth strategies for patients
Educate survivors about madarosis and available resources
Acknowledgments
This publication was supported by Grant Number P30 CA015083 from the National Cancer Institute and K12AR084222. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health.
Footnotes
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References:
- 1.Cancer.Net. Breast Cancer Statistics
- 2.Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol. 2020;50(3):225–229. doi: 10.1093/jjco/hyz213 [DOI] [PubMed] [Google Scholar]
- 3.Senna M, Ko J, Glashofer M, et al. Predictors of QOL in Patients with Alopecia Areata. Journal of Investigative Dermatology 2022; 142: 2646–2650.e2643. DOI: 10.1016/j.jid.2022.02.019. [DOI] [PubMed] [Google Scholar]
- 4.Freites-Martinez A, Chan D, Sibaud V, Shapiro J, Fabbrocini G, Tosti A, et al. Assessment of quality of life and treatment outcomes of patients with persistent postchemotherapy alopecia. JAMA Dermatol. 2019;155(6):724–728. doi: 10.1001/jamadermatol.2018.5071 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Starace M, Cedirian S, Alessandrini AM, et al. Impact and Management of Loss of Eyebrows and Eyelashes. Dermatol Ther (Heidelb). 2023;13(6):1243–1253. doi: 10.1007/s13555-023-00925-z [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.The CHANCE study: Persistent hair disorder-related quality of life in women with nonmetastatic breast cancer. Journal of the American Academy of Dermatology 2019; 81: AB283. DOI: 10.1016/j.jaad.2019.06.1227. [DOI] [Google Scholar]
- 7.Pierrisnard C, Baciuchka M, Mancini J, Rathelot P, Vanelle P, Montana M. Body image and psychological distress in women with breast cancer: a French online survey on patients’ perceptions and expectations. Breast Cancer. 2018;25(3):303–308. doi: 10.1007/s12282-017-0828-2 [DOI] [PubMed] [Google Scholar]
- 8.Fujii T, Ichiba K, Honda C, Tokuda S, Nakazawa Y, Ogino M, et al. Prospective observational study of chemotherapy-induced alopecia after sequential FEC + taxane and the effects of age in breast cancer patients. Breast Cancer. 2021;28(2):329–34. [DOI] [PubMed] [Google Scholar]
- 9.Chan J, Adderley H, Alameddine M, Armstrong A, Arundell D, Fox R, et al. Permanent hair loss associated with taxane chemotherapy use in breast cancer: a retrospective survey at two tertiary UK cancer centres. Eur J Cancer Care (Engl). 2021;30(3): e13395. [DOI] [PubMed] [Google Scholar]
- 10.Boyle FM, Shaw J, Young A, et al. Management of Alopecia Due to Cancer Therapies. In: Olver I (ed) The MASCC Textbook of Cancer Supportive Care and Survivorship. Cham: Springer International Publishing, 2018, pp.621–631. [Google Scholar]
- 11.Griffin AM, Butow PN, Coates AS, Childs AM, Ellis PM, Dunn SM et al. (1996) On the receiving end. V: patient perceptions of the side effects of cancer chemotherapy in 1993. Ann Oncol 7(2):189–195 [DOI] [PubMed] [Google Scholar]
- 12.Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D (2002) Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 95(1):155–163 [DOI] [PubMed] [Google Scholar]
- 13.Smith K, Winstanley J, Boyle F et al. Madarosis: a qualitative study to assess perceptions and experience of Australian patients with early breast cancer treated with taxane-based chemotherapy. Support Care Cancer 26, 483–489 (2018). 10.1007/s00520-017-3852-z [DOI] [PubMed] [Google Scholar]
- 14.Morris CL, Stinnett S, Woodward J. The role of bimatoprost eyelash gel in chemotherapy-induced madarosis: an analysis of efficacy and safety. Int J Trichology. 2011;3(2):84–91. doi: 10.4103/0974-7753.90809 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Hays RD, Schalet BD, Spritzer KL, Cella D. Two-item PROMIS® global physical and mental health scales. J Patient Rep Outcomes. 2017;1(1):2. doi: 10.1186/s41687-017-0003-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Pirmez R, Spagnol Abraham L. Eyebrow Regrowth in Patients with Frontal Fibrosing Alopecia Treated with Low-Dose Oral Minoxidil. Skin Appendage Disord. 2021;7(2):112–114. doi: 10.1159/000511744 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Adotama P, Callender V, Kolla A, et al. Comparing the clinical differences in white and black women with frontal fibrosing alopecia. British Journal of Dermatology 2021; 185: 1074–1076. DOI: 10.1111/bjd.20605. [DOI] [PubMed] [Google Scholar]
- 18.Botchkarev VA. Molecular mechanisms of chemotherapy-induced hair loss. J Investig Dermatol Symp Proc. 2003;8(1):72–75. doi: 10.1046/j.1523-1747.2003.12175.x [DOI] [PubMed] [Google Scholar]
- 19.Nguyen B, Hu JK, Tosti A. Eyebrow and Eyelash Alopecia: A Clinical Review. Am J Clin Dermatol. 2023;24(1):55–67. doi: 10.1007/s40257-022-00729-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Rose L, Lustberg M, Ruddy KJ, Cathcart-Rake E, Loprinzi C, & Dulmage B (2023). Hair loss during and after breast cancer therapy. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 31(3), 186. 10.1007/s00520-023-07634-5 [DOI] [PubMed] [Google Scholar]