Table 4. Management of hair disorders in patients receiving anticancer therapies.
| Hair disorder | Interventions | Level of evidence |
|---|---|---|
| Chemotherapy-induced alopecia (CIA) |
Preventive strategies: Scalp cooling: caps or cooling systems, only for cancer patients with solid tumors Contraindications to scalp cooling include hematological malignancies, and the following: cold sensitivity and cold trigged diseases, central nervous system malignancies, small cell carcinoma of the lung, cancers of the head and neck, skin cancer, and in pediatric patients Topical minoxidil 2% daily, over the entire scalp throughout chemotherapy and up to 4 months post-chemotherapy |
Level IB |
| Level IB | ||
| Radiotherapy-induced alopecia (RIA) |
Reactive strategies: Topical minoxidil 5% daily (radiation dermatitis should be managed first with topical corticosteroid, if present) |
Level IV |
| Alopecia attributed to targeted therapies (e.g. EGFR inhibitors, VEGFR/PDGFR/BRAF inhibitors) |
Reactive strategies: Non-inflammatory alopecia (VEGFR/PDGFR): topical minoxidil 5% daily continued until 6 months after therapy ends If scalp inflammation (EGFR inhibitors): topical corticosteroids; if secondary infection present treat with culture/sensitivity-driven oral antibiotics |
|
| Alopecia attributed to Immunotherapies (e.g. CTCLA-4, PD1, PDL-1) | High potency topical corticosteroid if alopecia areata; rule out thyroid dysfunction (immune related adverse event) | |
| Alopecia attributed to stem cell transplant | If alopecia areata, topical corticosteroids or Janus kinase inhibitors If diffuse or pattern alopecia (similar pattern to CIA); topical minoxidil 5% daily | |
| Alopecia attributed to vismodegib |
CTCAEv4.0 grade 1 and grade 2: Topical minoxidil 5% daily continued until 6 months post-therapy |
|
| Endocrine therapy-induced alopecia (EIA) |
CTCAEv4.0 grade 1 and grade 2: Topical minoxidil 5% daily |
|
| Eyebrow and eyelashes alopecia | Chemotherapy-induced alopecia: topical bimatoprost solution 0.03% | Level IB |
| Pigmentary and textural hair changes | If needed, options such as hair coloring and changes in hairstyle should be recommended (e.g. hair straightener, hair permanent) | Level IB |
| Hirsutism and hypertrichosis |
Reactive strategies: TCAEv4.0 grade 1 (mild hair growth): Local therapy such as epilation, depilation, shaving, eflornithine, laser treatment CTCAEv4.0 grade 2 (prominent thick hairs, associated with psychosocial impact): Laser or intense pulsed light Trimming for eyelash trichomegaly, referral to an ophthalmologist when irritation or discomfort is present Patients can be reassured that these hair changes are temporary; normal growth should begin within 1 month after cessation of medication |
Level III |
| General recommendations | As a prevention of patient distress, we recommend patient education and support Most of the hair changes are temporary. However, if therapy is requested, this should be discussed to have realistic expectations of therapy outcome Camouflaging techniques (e.g. crayons, powder, volumizers, hair weaves/hair extension, scalp micropigmentation/tattoo and hairpieces) could be recommended If emotionally affected; psychological counseling is recommended Involve nurses and other health care providers in the cancer patients hair care |
|
CTCAEv4.0, Common Terminology Criteria for Adverse Events Version 4.0; CTLA-4, cytotoxic T-lymphocyte-associated protein 4; EGFRI, epidermal growth factor inhibitor; Nd:YAG, neodymium-doped yttrium aluminium garnet; PDGF-R, Platelet-derived growth factor receptors; PD-1, programmed cell death protein 1; PD-L1, programmed death-ligand 1; VEGF, vascular endothelial growth factor.