BI39 Oncological therapies and hair disorders: a narrative approach on permanent chemotherapy-induced alopecia. A literature review of cancer-related therapies and their associated hair and scalp disorders
Authors: Rui Goncalves, Nuala O’Donoghue, Matthew Harries, Leila Asfour
Journal: British Journal of Dermatology (2024)

Abstract Alopecia is known to be one of the most psychologically distressing side-effects of chemotherapy. Patients view it as a constant reminder of the illness and it is frequently associated with distorted self-perception and social isolation. Studies suggest that 8% of women would decline chemotherapy because of their concerns regarding hair loss (Freites-Martinez A, Shapiro J, van den Hurk C et al. Hair disorders in cancer survivors. J Am Acad Dermatol 2019; 80: 1199–213). Permanent chemotherapy-induced alopecia (pCIA), with an incidence of 15–30% in patients with breast cancer, is a nonscarring, diffuse alopecia often resembling androgenetic alopecia. This patient-led narrative focuses on the experiences of two women with chemotherapy-induced alopecia regarding information and advice received pretreatment, the impact on self-esteem and suggestions for improving support for patients in similar circumstances. We present these patients to highlight this increasingly recognized phenomenon. We report patients’ perspective on pCIA in a 31-year-old who was treated with chemotherapy at the age of 15 years for aplastic anaemia and a 60-year-old who received chemotherapy for breast cancer. Both patients stated they were not informed of the impact and duration of alopecia, which they felt was presented as a ‘simply cosmetic side-effect’ that ‘would grow back’. This led to them thinking it would be a temporary consequence, easily amendable with ‘being fitted for a wig (to use) for a short period’. When they experienced alopecia, the impact was severe and disabling: ‘I felt like being hit by a train when I realized this was permanent’; ‘had a nervous breakdown’. Additionally, commonly used measures to overcome this side-effect were not seen as helpful: ‘Initially I struggled to wear wigs as I felt they were uncomfortable and did not look natural.’ Alopecia affected their sense of femininity and limited their activities because of the anxiety caused by wearing a wig or hat in social contexts. In addition to contributing to increased levels of social anxiety, the effects on self-esteem were profound: ‘I often do not feel “womanly” or feminine due to the hair loss. I feel it makes me look old, ill and witch-like. Whilst wigless, I view myself as disgusting.’ Both patients have been keen to trial pharmacotherapies to help address their hair loss. There is an increased awareness in mainstream and social media in relation to cancer-related therapies affecting hair growth permanently. With growing numbers of people surviving cancer, increasing emphasis is appropriately now placed on post-treatment quality of life. Our presentation aims to highlight the different hair and scalp disorders associated with chemotherapy-, radiotherapy- and immunotherapy-related treatments to support dermatologists in managing these patients and advising oncology teams.