Faculty Bibliography

Alopecia is a medical condition that impact many people worldwide and has diverse causes, ranging from autoimmune to genetic factors. Hair transplantation represents a key therapeutic option for patients with progressive hair loss who are seeking improvement beyond the capacity of medications or less invasive procedures. While hair transplantation is most commonly utilized for androgenetic alopecia, individuals with other alopecia diagnoses may also benefit. The two main techniques for hair transplantation include follicular unit transplantation and follicular unit excision. Hair transplantation is particularly important given the profound psychosocial implications and cosmetic disfigurement associated with alopecia. Chronic hair loss patients may experience reduced self-esteem, increased depression and anxiety, and poorer quality of life. Despite the significance of hair transplantation, comprehensive guidelines informing the clinical and surgical management of transplant candidates remain limited. Therefore, this review aims to explore patient candidacy criteria, pretransplant medical therapy optimization, intraoperative considerations, and postoperative complications and medical management.

Despite the wide variety of treatment options for alopecia areata (AA), androgenetic alopecia (AGA), and primary cicatricial alopecias, these options become more limited for women who are breastfeeding, given concerns surrounding potential transfer into breast milk and subsequent adverse effects (AEs) on the newborn infant. Alopecia is associated with significant psychological distress, poorer quality of life (QOL), and negative impacts on self-esteem and body image, which may be exacerbated by undergoing the physical, hormonal, and emotional changes of pregnancy and breastfeeding. Furthermore, many of these medications must be taken continuously to maintain their benefits, reinforcing the importance of understanding which therapies are compatible with breastfeeding. This review aimed to help guide clinicians in choosing safe and appropriate hair loss therapies for women during lactation, including a detailed discussion of medication transfer to breast milk and infant blood serum levels, potential neonatal AEs, and further clinical considerations specific to each treatment option.

Patients with, survivors of, and women at increased risk of breast cancer may experience various hair loss disorders, including those related to cancer treatments (such as chemotherapy- or endocrine therapy-induced alopecia), alopecia areata, androgenetic alopecia, and cicatricial alopecias. In the USA, approximately 1 in 8 women (13.1%) will develop breast cancer during their lifetime, emphasizing the importance of understanding safe treatment options for this population. Management of scarring and nonscarring alopecias in patients with or those at high risk of breast cancer requires the selection of therapies that do not impact breast cancer risk, treatment, or outcomes. In this review, we examine the safety of common medications used in the treatment of alopecia areata, androgenetic alopecia, and cicatricial alopecias with regard to breast cancer. We provide evidence-based recommendations for the use of these treatments in patients with and women at elevated risk of breast cancer while highlighting areas where further research is needed.

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.