Faculty Bibliography

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.

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.

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.

INTRODUCTION/UNASSIGNED:Although platelet-rich plasma (PRP) is a widely used treatment for androgenetic alopecia (AGA), the impact of patient age on treatment efficacy remains underexplored. METHOD/UNASSIGNED:This retrospective study evaluated PRP outcomes in 57 AGA patients treated at NYU Langone Health, stratified into four age cohorts. Changes in trichometric hair density and width were measured from initial to final follow-up visits. Statistical significance and linear regression testing were determined using ANOVA and Rank-Based ANCOVA, respectively. RESULTS/UNASSIGNED:While overall changes in density and width did not differ significantly across age groups, younger patients trended toward greater density gains. Furthermore, greater baseline hair width was predictive of smaller improvements in width, and significant interactions between age and the number of PRP sessions suggested that older individuals may require a greater number of treatments to attain results comparable to those seen in younger cohorts. Additionally, improvements in hair density were positively associated with the number of adjunctive therapies, as patients who received more concurrent treatments experienced greater gains. PRP was well tolerated across all age groups. CONCLUSION/UNASSIGNED:These findings highlight the potential impact of patient age on PRP efficacy, informing counseling and treatment planning.

Monitoring both subjective and objective responses to alopecia treatment is critical for assessing patient perception and therapeutic efficacy. Platelet-rich plasma (PRP) therapy is a widely used treatment for alopecia, particularly androgenetic alopecia (AGA), yet the correlation between patient-reported outcomes and trichometric measurements remains poorly defined. This retrospective study analyzed data from 56 alopecia patients treated with PRP at NYU Langone Health between November 2017 and March 2025. Patients were categorized as "improved," "stable," or "worse" based on self-assessments, and changes in hair density and width were evaluated over the course of PRP treatment. Spearman's rank correlation and Kruskal-Wallis Rank Sum Tests were used for statistical analysis. Results showed that patient-reported outcomes correlated significantly with changes in hair density (p = 0.0006), but not hair width (p = 0.2688). The greatest increase in hair density was observed in the "improved" group (+ 18.9 hairs/cm²), with a more modest gain in the "stable" group (+ 7.6 hairs/cm²), while the "worse" group experienced a decrease (- 19.7 hairs/cm²). Differences in density across all three groups were statistically significant (p = 0.0012), whereas width changes were not (p = 0.5009). Subgroup analysis of AGA patients yielded similar findings. These results suggest that patient perception aligns more closely with density changes than width changes. Combining subjective assessments with objective measurements enhances clinical decision-making, expectation management, and holistic evaluation of PRP treatment efficacy in alopecia patients.