Faculty Bibliography

Chemotherapy-induced alopecia and radiation-induced alopecia, the thinning or loss of hair due to cytotoxic chemotherapy and radiation therapy, respectively, are distressing adverse effects of cancer treatment. Chemotherapy, targeted therapies, and radiation therapy used in pediatric oncology often lead to alopecia by damaging hair follicles, with varying degrees of severity depending on the specific treatment type, mechanism of action, and damage-response pathway involved. Pediatric chemotherapy-induced alopecia, radiation-induced alopecia, and permanent alopecia, defined as hair regrowth that remains incomplete 6 months or more after treatment, have significant negative impacts on mental health, self-esteem, and social interactions, highlighting the need for further research into supportive care strategies. There are currently no standard interventions for chemotherapy-induced alopecia or radiation-induced alopecia in children, with most recommendations limited to gentle hair care and camouflaging techniques during treatment. Scalp cooling has demonstrated safety and efficacy in reducing chemotherapy-induced alopecia in adults and is currently under investigation in children and adolescents. Topical and low-dose oral minoxidil have been studied in children for other hair loss disorders and may improve hair regrowth after chemotherapy or radiation. Increased awareness and continued research into management strategies for pediatric chemotherapy-induced alopecia and radiation-induced alopecia are necessary to help mitigate its significant negative impact on quality of life.

BACKGROUND/UNASSIGNED:Chemotherapy-induced alopecia (CIA) significantly impacts patients' quality of life. While low-dose oral minoxidil (LDOM) shows promise in treating CIA after chemotherapy completion, its safety and efficacy when given during active chemotherapy remain unclear. This review examined existing literature on CIA pathogenesis, minoxidil's mechanism of action, and LDOM efficacy to explore its potential use during chemotherapy. SUMMARY/UNASSIGNED:Recent retrospective studies demonstrated LDOMs good tolerability in cancer patients post-chemotherapy, with minimal adverse effects. Scalp cooling, the only Food and Drug Administration-cleared intervention to mitigate CIA, is thought to reduce chemotherapeutic delivery to the hair follicles, whereas minoxidil, a vasodilator, increases blood flow to the follicle. Despite these differing mechanisms, preclinical studies suggest potential benefits of LDOM during chemotherapy. One study demonstrated a protective effect of subcutaneous minoxidil against cytarabine-induced alopecia, while another showed faster regrowth with systemic minoxidil administered concurrently with paclitaxel. LDOM may, therefore, exert benefits through mechanisms beyond vasodilation, potentially by its impact on the hair cycle. Studies on topical minoxidil during chemotherapy show variable results, possibly due to poor adherence or variations in application practices - limitations LDOM could address. KEY MESSAGES/UNASSIGNED:Given the psychological impact of CIA and limited treatments, investigation of LDOM's safety and efficacy when initiated during chemotherapy is warranted.

INTRODUCTION/UNASSIGNED:Primary cicatricial alopecias (PCAs) cause permanent hair loss and psychosocial distress. Management involves anti-inflammatory and hair growth-promoting therapies. A combination of tacrolimus, clobetasol, and minoxidil (TCM) may offer synergistic benefits by targeting distinct inflammatory pathways while increasing background hair density for improved camouflage. This study evaluates the safety and efficacy of TCM use in PCA patients. METHODS/UNASSIGNED:We conducted a retrospective chart review of PCA patients aged 18+ years treated with TCM between January 1, 2009, and May 31, 2025. Outcomes included inflammatory activity on trichoscopy, scalp symptoms, provider- and patient-reported disease status, and objective hair measurements. Descriptive statistics were performed using SAS v9.4. RESULTS/UNASSIGNED:Eighty-two patients (80.5% female, mean age 61.5) were included, most commonly with frontal fibrosing alopecia or lichen planopilaris. TCM was typically prescribed as a compounded solution used 1-2 times/day for an average of 24.5 months. Adverse effects included worsened itch/burning (6.1%), hypertrichosis (4.9%), scalp irritation/dryness (4.8%), and atrophy (3.7%); most (62.2%) experienced no adverse effects. Provider-assessed inflammation and disease status improved or stabilized in 69.5% and 76.9%, respectively. Objective hair measurements also improved. CONCLUSIONS/UNASSIGNED:TCM is well tolerated and, used alone or in conjunction with other therapies, appears to be effective. Improvements were seen in provider-reported outcomes and objective hair measurements.