Guidelines for Complications of Cancer Treatment Vol VIII Part B

AlopeciaCommon drugs causing alopecia are given below (Table 2) 1Table 2CyclophosphamideDaunorubicinDoxorubicinEtoposideIfosfamidePaclitaxelVinblastineVincristineAt any given time, 85% of hair on the human scalp is in thisgrowth phase or anagen 2 when an antimitotic chemotherapeuticagent is initiated, the abrupt cessation of mitotic activity inrapidly dividing hair matrix cells causes the hair shaft to thinand break at the surface of the skin. The resulting alopecia istermed anagen effluvium 3 In general; anagen effluviumtypically starts in the first few days to weeks after thechemotherapy. The degree, timing, and impact of hair lossdepend on the agent given, its half-life, dose, schedule, androute of administration.It has been shown, for example, that taxanes in lower dosesgiven once weekly cause a less severe alopecia than taxanesgiven in higher doses every third week. Docetaxel’s course isunique with hair loss being sudden and complete, usuallyduring the third week after a patient’s first 1-hourinfusion 4Although chemotherapy-induced alopecia primarily affectsscalp hairs, other sites such as, these hairs face, arms, legs,and groin may be involved. Fortunately, however, the processis usually reversible with cessation of the agent and mostpatients show regrowth after 3 to 4 months 5. Regrowth canoccur because chemotherapy usually spares the stem cells inthe hair follicle bulb.A notable exception to this is busulfan,which has been reported to induce a permanent alopecia bydestruction of the lower hair follicle region 6 Interestingly,473