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Kaiser M, Abdin R, Yaghi M, Gaumond SI, Jimenez JJ, Issa NT. Beard Alopecia: An Updated and Comprehensive Review of Etiologies, Presentation and Treatment. J Clin Med 2023; 12:4793. [PMID: 37510908 PMCID: PMC10381635 DOI: 10.3390/jcm12144793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Facial hair is an important social and psychologic aspect of clinical appearance for men. The purpose of this review is to provide a comprehensive overview of the causes of alopecia of the beard including the prevalence, pathophysiology, clinical presentation, and treatment. In this review, we highlight more common causes of beard alopecia including alopecia areata and pseudofolliculitis barbae, infectious causes such as tinea barbae and herpes simplex folliculitis, and rare causes including dermatopathia pigmentosa reticularis and frontal fibrosing alopecia. This review serves as an important resource for clinicians when faced with patients suffering from beard alopecia.
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Affiliation(s)
- Michael Kaiser
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Rama Abdin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Marita Yaghi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Simonetta I Gaumond
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Joaquin J Jimenez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Naiem T Issa
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Forefront Dermatology, Vienna, VA 22182, USA
- Issa Research and Consulting, LLC, Springfield, VA 22152, USA
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2
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Lodewijckx J, Robijns J, Claes M, Pierson M, Lenaerts M, Mebis J. The use of photobiomodulation therapy for the management of chemotherapy-induced alopecia: a randomized, controlled trial (HAIRLASER trial). Support Care Cancer 2023; 31:269. [PMID: 37060420 DOI: 10.1007/s00520-023-07743-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The purpose of this trial was to evaluate if photobiomodulation (PBM) can accelerate hair regrowth after chemotherapy in breast cancer patients and if this is correlated with a better quality of life (QoL). METHODS A randomized controlled trial with breast cancer patients that underwent an anthracycline and taxane-containing chemotherapy regimen was set up at the Jessa Hospital (Hasselt, Belgium). Patients were randomized into the control group (no intervention) or the PBM group (three PBM sessions each week for 12 weeks, starting the last day of their chemotherapy). Hair regrowth was evaluated based on photographic assessments. Two blinded researchers independently scored the hair regrowth using a numerical rating scale (NRS). In addition, the QoL was measured using the European Organization for Research and Treatment-QOL questionnaire and Breast Cancer-specific module (EORTC QLQ-C30 and QLQ-BR23). Data were collected on the day of their last chemotherapy session and 1, 2, and 3 months post-chemotherapy. RESULTS A total of 32 breast cancer patients were included in the trial between June 2020 and February 2022. Significantly higher NRS scores were observed in the PBM group at 1-month post-chemotherapy compared to baseline, whereas they remained constant in the control group. Patients allocated to the PBM group scored their global health significantly higher at all time points compared to the control. CONCLUSION Based on the results of the HAIRLASER trial, PBM seems to accelerate hair regrowth after chemotherapy in breast cancer patients resulting in an improved global health status and better body image. The study was registered in July 2019 at ClinicalTrials.gov (NCT04036994).
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Affiliation(s)
- Joy Lodewijckx
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
| | - Jolien Robijns
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Marithé Claes
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Maud Pierson
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Melissa Lenaerts
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Jeroen Mebis
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Medical Oncology, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
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3
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Saki N, Aslani FS, Sepaskhah M, Shafiei M, Alavizadeh S, Hosseini SA, Asl FA, Ahramiyanpour N. Intermittent chronic telogen effluvium with an unusual dermoscopic finding following
COVID
‐19. Clin Case Rep 2022; 10:e6228. [PMID: 35957778 PMCID: PMC9361802 DOI: 10.1002/ccr3.6228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Various conditions, including infections, can cause telogen effluvium (TE). One of them is coronavirus disease 2019 (COVID‐19), where hair loss usually begins between 2 and 12 weeks after the illness. TE can be acute or chronic, and the chronic type can be intermittent. Here, we present the case of a 17‐year‐old girl with severe and widespread hair loss following an upper respiratory infection suspected to be COVID‐19, with the patient having a history of such attacks since childhood. Evidence from biopsy and dermoscopy indicated a diagnosis of TE.
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Affiliation(s)
- Nasrin Saki
- Molecular Dermatology Research CenterShiraz University of Medical SciencesShirazIran
- Department of Dermatology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Fatemeh Sari Aslani
- Molecular Dermatology Research CenterShiraz University of Medical SciencesShirazIran
- Pathology DepartmentShiraz University of Medical SciencesShirazIran
| | - Mozhdeh Sepaskhah
- Molecular Dermatology Research CenterShiraz University of Medical SciencesShirazIran
- Department of Dermatology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohadese Shafiei
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of MedicineKerman University of Medical SciencesKermanIran
| | - Sara Alavizadeh
- Department of Dermatology, School of MedicineShiraz University of Medical SciencesShirazIran
| | | | - Fatemeh Ansari Asl
- Department of Dermatology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Najmeh Ahramiyanpour
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of MedicineKerman University of Medical SciencesKermanIran
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4
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Starace M, Orlando G, Bruni F, Alessandrini A, Piraccini BM. Anagen effluvium and the role of trichoscopy. Clin Exp Dermatol 2021; 47:589-591. [PMID: 34642956 DOI: 10.1111/ced.14982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M Starace
- Dermatology Division, IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - G Orlando
- Department of Medicine (DIMED), Unit of Dermatology, University of Padua, Padua, Italy
| | - F Bruni
- Dermatology Division, IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - A Alessandrini
- Dermatology Division, IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - B M Piraccini
- Dermatology Division, IRCCS Policlinico Sant'Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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5
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Santos TS, Hernandéz Galvis K, Vañó Galván S, Saceda-Corralo D. Post-chemotherapy alopecia: what the dermatologist needs to know. Int J Dermatol 2021; 60:1313-1317. [PMID: 34348414 DOI: 10.1111/ijd.15812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
It is estimated that chemotherapy-induced alopecia (CIA) occurs in 65% of chemotherapeutic patients. Forty-seven percent of cancer patients consider hair loss to be the most traumatic aspect of therapy. CIA can be anticipated, depending on the regimen used, and doctors should be aware of the treatments that can minimize it. Careful evaluation before chemotherapy treatment should be performed, and trichoscopy may be useful. Dermatologists do not generally evaluate postchemotherapy alopecia. However, there is an increasing number of reports of permanent chemotherapy-induced alopecia, and these patients require treatment.
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Rossi A, Magri F, Caro G, Michelini S, Di Fraia M, Fortuna MC, Pellacani G, Carlesimo M. Fluorescence advanced videodermoscopy: a new method of hairs and scalp evaluation. Comparison with trichoscopy. J Eur Acad Dermatol Venereol 2021; 35:2317-2323. [PMID: 34314530 DOI: 10.1111/jdv.17558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Non-invasive diagnostic methods in clinical dermatology are widely used to reduce the need for invasive techniques, with great advantages in terms of cost and time. Dermoscopy is the reference test for the in vivo diagnosis of cutaneous lesions, and when it is performed on the scalp region it is named trichoscopy. Fluorescence advanced videodermoscopy (FAV) has been lately proposed as a new non-invasive method for the in vivo skin examination at high magnification, with cell-level resolution. So far, it has shown promising results for the assessment of melanocytic and vascular lesions and for the in vivo diagnosis of parasitosis. OBJECTIVES This observational study aims to perform, for the first time, a morphologic study of healthy scalp and scalp elementary lesions using FAV and to compare it with trichoscopy. METHODS We enrolled 90 healthy individuals for the evaluation of the scalp using FAV. Then, we recruited 53 patients with alopecia and collected images of the elementary lesions using FAV and trichoscopy. RESULTS Three hundred healthy scalp FAV images of different epidermal layers, papillary dermis, follicular ostia and healthy hair shafts were collected. Three hundred and eighty FAV and trichoscopic images of alopecic scalp elementary lesions were collected, showing that FAV provided a more detailed observation than trichoscopy, with higher magnification and cellular resolution. CONCLUSION Fluorescence advanced videodermoscopy may represent a new valid technique of support to trichoscopy, adding further information, increasing chances of diagnosis and decreasing the need of invasive procedures.
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Affiliation(s)
- A Rossi
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - F Magri
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - G Caro
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - S Michelini
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - M Di Fraia
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - M C Fortuna
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - G Pellacani
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - M Carlesimo
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Kaczorowska A, Rudnicka L, Stefanato CM, Waskiel-Burnat A, Warszawik-Hendzel O, Olszewska M, Rakowska A. Diagnostic Accuracy of Trichoscopy in Trichotillomania: A Systematic Review. Acta Derm Venereol 2021; 101:adv00565. [PMID: 34184065 PMCID: PMC9425589 DOI: 10.2340/00015555-3859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Trichotillomania is formally classified as a mental health disorder, but it is commonly diagnosed by dermatologists. The aim of this systematic review is to assess the diagnostic value of trichoscopy in diagnosing trichotillomania. The analysis identified the 7 most specific trichoscopic features in trichotillomania. These features had the following prevalence and specificity: trichoptilosis (57.5%; 73/127 and 97.5%, respectively), v-sign (50.4%; 63/125 and 99%), hook hairs (43.1%; 28/65 and 100%), flame hairs (37.1%; 52/140 and 96.5%), coiled hairs (36.8%; 46/125 and 99.6%), tulip hairs (36.4%; 28/77 and 89.6%), and hair powder (35.6%; 42/118 and 97.9%). The 2 most common, but least specific, features were broken hairs and black dots. In conclusion, trichoscopy is a reliable new diagnostic method for hair loss caused by hair pulling. Trichoscopy should be included as a standard procedure in the differential diagnosis of trichotillomania in clinical practice.
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Rebora A, Guarrera M. Why Do Not All Chemotherapy Patients Lose Their Hair? Answering an Intriguing Question. Skin Appendage Disord 2021; 7:280-285. [PMID: 34307475 PMCID: PMC8280404 DOI: 10.1159/000514342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alfredo Rebora
- Department of Dermatology, University of Genoa, Genoa, Italy
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9
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Gomes TF, Santiago F, Guiote V. Pigtail hairs in syphilitic alopecia. J Eur Acad Dermatol Venereol 2021; 35:e472-e473. [PMID: 33783889 DOI: 10.1111/jdv.17255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/10/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- T F Gomes
- Dermatology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - F Santiago
- Dermatology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - V Guiote
- Dermatology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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Cutaneous T-cell lymphoma in erythrodermic cases may be suspected on the basis of scalp examination with dermoscopy. Sci Rep 2021; 11:282. [PMID: 33431905 PMCID: PMC7801426 DOI: 10.1038/s41598-020-78233-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Erythrodermic variants of cutaneous T-cell lymphoma (CTLC) are one of the case of erythroderma. The aim of the study was to assess the value of scalp dermoscopy in differentiation between erythrodermic CTCL, psoriasis, and atopic dermatitis. A total of 76 patients were included into the study (16 patients with erythrodermic CTCL, 20 patients with psoriatic erythroderma, 20 with erythrodermic atopic dermatitis, and 20 healthy volunteers). The most common trichoscopic features of erythrodermic CTCL were: numerous pili torti, numerous broken hairs, white thick interfollicular bands, and patchy hyperpigmentation of the background. They were observed in 81% (13/16), 75% (12/16), 56% (9/16), and 37.5% (6/16) of patients with CTCL, respectively (p < 0.001). Other specific features of erythrodermic CTCL were 8-shaped hairs (19%; 3/16) and visible anagen bulbs (12.5%; 2/16) (p < 0.05 and p = 0.052, respectively). The most common vascular pattern of erythrodermic CTCL was perifollicular arrangement of glomerular (50%; 8/16; p < 0.001) or linear vessels (31%; 5/16; p < 0.05). Follicular spicules-like scaling was pathognomonic for erythrodermic CTCL (12%, 2/16) although its presence did not reach statistical significance (p = 0.052). In conclusion, the characteristic trichoscopic findings of erythrodermic CTCL are numerous pili torti, eight-shaped hairs, thick white interfollicular bands, color heterogeneity of the background and perifollicular arrangement of vessels.
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Alessandrini A, Bruni F, Piraccini B, Starace M. Common causes of hair loss – clinical manifestations, trichoscopy and therapy. J Eur Acad Dermatol Venereol 2021; 35:629-640. [DOI: 10.1111/jdv.17079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
- A. Alessandrini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - F. Bruni
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - B.M. Piraccini
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
| | - M. Starace
- Dermatology Department of Experimental, Diagnostic and Specialty Medicine University of Bologna Bologna Italy
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12
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Özkur E, Sert C, Kıvanç Altunay İ, Yıldırırmak ZY, Genç DB, Vural S, Erdem Y. Cutaneous manifestations in pediatric oncology patients. Pediatr Dermatol 2021; 38:58-65. [PMID: 33179835 DOI: 10.1111/pde.14375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND/OBJECTIVES Oncology patients present with various skin manifestations related to primary disease and treatments. Although these skin toxicities are well described in adults, studies of pediatric oncology patients are limited. The objective of this study was to evaluate the cutaneous findings in pediatric oncology patients receiving chemotherapy. METHODS In this prospective cohort study conducted from December 2018 to March 2020, all pediatric oncology patients were examined and patients who had a dermatologic finding at any point during their treatments were recorded. Dermatologic examinations were performed by the same dermatologists, and biopsy and microbiologic tests were performed according to clinical need. Patients were grouped according to their oncologic diagnoses and types of chemotherapies. RESULTS A total of 80 patients with a mean age of 9.1 ± 5.0 years were included in the study. Seventy-five (93.7%) of them developed a dermatologic manifestation during the study period. Most of the patients had hematologic malignancies (n = 48, 60%). Antimetabolites were the most frequently used class of chemotherapeutic agents. Anagen effluvium was the most common dermatologic finding (61.3%, n = 49), followed by inflammatory dermatoses (51.2%, n = 41, most commonly diaper dermatitis in 33 patients), xerosis (35%, n = 28), and nail changes (20%, n = 16, most commonly nail pigmentation in seven patients). Mucositis was seen in 13 (16.2%) patients. Five patients (6.2%) had drug-induced cutaneous hyperpigmentation, and five (6.2%) had toxic erythema of chemotherapy. The highest percentage of xerosis (45.4%) was detected in patients using antitumor antibiotics, whereas inflammatory dermatoses were observed more in patients using antimetabolites (48.6% of patients using antimetabolites), and pigmentation changes were more frequently detected in patients using alkylating agents. CONCLUSION Identification, diagnosis, and treatment of these reactions are important to dermatologists and oncologists so that appropriate management may be provided to pediatric oncology patients.
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Affiliation(s)
- Ezgi Özkur
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Cansu Sert
- Department of Pediatrics, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - İlknur Kıvanç Altunay
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Zeynep Yıldız Yıldırırmak
- Department of Pediatric Hematology and Oncology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Dildar Bahar Genç
- Department of Pediatric Hematology and Oncology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sema Vural
- Department of Pediatric Hematology and Oncology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Yasemin Erdem
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
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O'Sullivan JDB, Nicu C, Picard M, Chéret J, Bedogni B, Tobin DJ, Paus R. The biology of human hair greying. Biol Rev Camb Philos Soc 2020; 96:107-128. [PMID: 32965076 DOI: 10.1111/brv.12648] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
Hair greying (canities) is one of the earliest, most visible ageing-associated phenomena, whose modulation by genetic, psychoemotional, oxidative, senescence-associated, metabolic and nutritional factors has long attracted skin biologists, dermatologists, and industry. Greying is of profound psychological and commercial relevance in increasingly ageing populations. In addition, the onset and perpetuation of defective melanin production in the human anagen hair follicle pigmentary unit (HFPU) provides a superb model for interrogating the molecular mechanisms of ageing in a complex human mini-organ, and greying-associated defects in bulge melanocyte stem cells (MSCs) represent an intriguing system of neural crest-derived stem cell senescence. Here, we emphasize that human greying invariably begins with the gradual decline in melanogenesis, including reduced tyrosinase activity, defective melanosome transfer and apoptosis of HFPU melanocytes, and is thus a primary event of the anagen hair bulb, not the bulge. Eventually, the bulge MSC pool becomes depleted as well, at which stage greying becomes largely irreversible. There is still no universally accepted model of human hair greying, and the extent of genetic contributions to greying remains unclear. However, oxidative damage likely is a crucial driver of greying via its disruption of HFPU melanocyte survival, MSC maintenance, and of the enzymatic apparatus of melanogenesis itself. While neuroendocrine factors [e.g. alpha melanocyte-stimulating hormone (α-MSH), adrenocorticotropic hormone (ACTH), ß-endorphin, corticotropin-releasing hormone (CRH), thyrotropin-releasing hormone (TRH)], and micropthalmia-associated transcription factor (MITF) are well-known regulators of human hair follicle melanocytes and melanogenesis, how exactly these and other factors [e.g. thyroid hormones, hepatocyte growth factor (HGF), P-cadherin, peripheral clock activity] modulate greying requires more detailed study. Other important open questions include how HFPU melanocytes age intrinsically, how psychoemotional stress impacts this process, and how current insights into the gerontobiology of the human HFPU can best be translated into retardation or reversal of greying.
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Affiliation(s)
- James D B O'Sullivan
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Carina Nicu
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Martin Picard
- Departments of Psychiatry and Neurology, Columbia University Irving Medical Center, 622 W 168th Street, PH1540N, New York, 10032, U.S.A
| | - Jérémy Chéret
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Barbara Bedogni
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A
| | - Desmond J Tobin
- Charles Institute of Dermatology, University College Dublin, Dublin 4, Ireland
| | - Ralf Paus
- Dr. Philip Frost Department for Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida, 33136, U.S.A.,Monasterium Laboratory, Skin & Hair Research Solutions GmbH, Münster, D-48149, Germany.,Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, M13 9PT, U.K
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14
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Cantelli M, Cappello M, Vastarella M, Patrì A, Scalvenzi M, Fabbrocini G. Vismodegib-Induced Alopecia: Trichoscopic and Confocal Microscopy Evaluation. Skin Appendage Disord 2020; 6:384-388. [PMID: 33313057 DOI: 10.1159/000510121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Vismodegib is the first-in-class inhibitor of the sonic hedgehog pathway useful in the treatment of locally advanced or metastatic basal cell carcinoma (BCC) that is not amenable to surgery and radiation therapy. Common adverse events of vismodegib, probably mechanism related, include alopecia (58%) as a reversible side effect. Case Presentation We report 2 cases of patients receiving vismodegib for the treatment of locally advanced BCCs that developed alopecia during treatment and describe clinical, dermoscopic, and reflectance confocal microscopy (RCM) features of this adverse event. Conclusion Alopecia is one of the most distressing adverse events leading to vismodegib discontinuations. To our knowledge, these are the first descriptions of RCM dermoscopy in vismodegib-induced alopecia. Trichoscopy and confocal microscopy are essential to monitoring vismodegib hair loss and the response to the treatment.
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Affiliation(s)
- Mariateresa Cantelli
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy
| | - Milena Cappello
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy
| | - Maria Vastarella
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy
| | - Angela Patrì
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy
| | - Massimiliano Scalvenzi
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy
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15
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Carlesimo M, Pigliacelli F, D'Arino A, Caro G, Fortuna MC, Rossi A. Dermatologic management of oncotherapy side effects: A proposed algorithm. J Cosmet Dermatol 2020; 20:429-436. [PMID: 32585724 DOI: 10.1111/jocd.13566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 01/20/2023]
Abstract
Since the introduction of the first chemotherapeutic regimens for the treatment of oncological disease, hundreds of drugs have been approved for cancer treatment and many more are under investigation. The development of newer drugs such as target therapies, immuno-oncotherapies, and hormonal therapies has increased in specificity with the development of smaller molecules and more selective targets. Cutaneous side effects are now well known for both standard chemotherapy and targeted therapies. The correct diagnosis and management of these effects are of vital importance both to optimize therapeutic success rates and to reduce the patient's suffering. In fact, the appearance of a cutaneous adverse event can be responsible for a reduction in drug dosage or worse its suspension. In order to achieve this objective, we propose a management algorithm, based on three different steps, before, during, and after the oncological treatments, respectively. Our proposal underlines the importance of correct skin care measures to limit or reduce the severity of side effects.
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Affiliation(s)
- Marta Carlesimo
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, Sapienza University of Rome, Rome, Italy
| | - Flavia Pigliacelli
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, Sapienza University of Rome, Rome, Italy
| | - Andrea D'Arino
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, Sapienza University of Rome, Rome, Italy
| | - Gemma Caro
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, Sapienza University of Rome, Rome, Italy
| | - Maria Caterina Fortuna
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, Sapienza University of Rome, Rome, Italy
| | - Alfredo Rossi
- Department of Internal Medicine and Medical Specialties, UOC Dermatology, Sapienza University of Rome, Rome, Italy
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16
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Rossi A, Caro G, Fortuna MC, Pigliacelli F, D'Arino A, Carlesimo M. Prevention and Treatment of Chemotherapy-Induced Alopecia. Dermatol Pract Concept 2020; 10:e2020074. [PMID: 32642317 DOI: 10.5826/dpc.1003a74] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2020] [Indexed: 10/31/2022] Open
Abstract
Background Chemotherapy-induced alopecia (CIA) is one of the most dramatic side effects of chemotherapy. Currently no guidelines are available for its prevention and treatment. Several devices and drugs are used, but results are often disappointing. Aims Our aim is to analyze drugs and devices proposed in the literature for prevention and treatment of CIA induced by cytotoxic drugs and to discuss the evidenced-based opinion. Methods and Results Scalp cooling is the only agent that has been approved by the US Food and Drug Administration for CIA prevention. Minoxidil and bimatoprost should not be used during chemotherapy administration, but they can be used after chemotherapy discontinuation to obtain greater regrowth. Conclusions Therapy should always be modulated for the patient and no fixed protocol should be used. Trichoscopy and trichogram could be useful tools in supporting this treatment.
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Affiliation(s)
- Alfredo Rossi
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | - Gemma Caro
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | | | - Flavia Pigliacelli
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | - Andrea D'Arino
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
| | - Marta Carlesimo
- Department of Hematology, Oncology and Dermatology, Sapienza University of Rome, Italy
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17
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Silva GDB, Ciccolini K, Donati A, Hurk CVD. Scalp cooling to prevent chemotherapy-induced alopecia. An Bras Dermatol 2020; 95:631-637. [PMID: 32622629 PMCID: PMC7563013 DOI: 10.1016/j.abd.2020.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/20/2020] [Indexed: 02/07/2023] Open
Abstract
Chemotherapy-induced alopecia causes an important impact on cancer patients and its risk of persistence is currently a considerable issue in cancer survivors. Of the various interventions proposed for the prevention of chemotherapy-induced alopecia, scalp cooling has emerged as an effective and safe strategy. This paper aims to provide an overview on scalp cooling and chemotherapy-induced alopecia prevention.
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Affiliation(s)
| | - Kathryn Ciccolini
- Department of Hematology/Oncology, Mount Sinai Hospital, New York, NY, United States of America
| | - Aline Donati
- Department of Dermatology, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil
| | - Corina van den Hurk
- R & D Department, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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18
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Caro G, Fortuna MC, Magri F, Federico A, Carlesimo M, Rossi A. A new treatment of alopecia induced by palbociclib: Topical cetirizine. J Oncol Pharm Pract 2020; 27:460-463. [PMID: 32529951 DOI: 10.1177/1078155220930334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Recently CDK4/6 inhibitors have been introduced for the treatment of hormone positive breast cancer resistant to endocrine therapy. Among their side effects, alopecia is often reported being associated to patients' distress and depressive symptoms. CASE REPORT We report the case of a 70-year-old woman affected by breast cancer in treatment with Palbociclib, who developed alopecia.Management and Outcome: We prescribed a topical solution with cetirizine. Global photography, trichoscopy and trichogram were assessed. All evaluations demonstrated alopecia improvement. DISCUSSION Currently, no treatment options for CDK 4/6 inhibitors induced alopecia have been proposed. Herein, we report the use of topical cetirizine.
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Affiliation(s)
- Gemma Caro
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Maria C Fortuna
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Magri
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Federico
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Marta Carlesimo
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
| | - Alfredo Rossi
- Department of Ematology, Oncology and Dermatology, "Sapienza" University of Rome, Rome, Italy
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19
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Patrì A, Annunziata MC, Cantelli M, Nappa P, Fabbrocini G. Infinity hair: a new trichoscopic finding for chemotherapy-induced alopecia. Br J Dermatol 2020; 183:e62. [PMID: 32338372 DOI: 10.1111/bjd.19062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Patrì
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - M C Annunziata
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - M Cantelli
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - P Nappa
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - G Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
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20
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Franceschini C, Garelli V, Persechino F, Sperduti I, Caro G, Rossi A, Ardigò M. Dermoscopy and confocal microscopy for different chemotherapy‐induced alopecia (CIA) phases characterization: Preliminary study. Skin Res Technol 2019; 26:269-276. [DOI: 10.1111/srt.12790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Chiara Franceschini
- Clinical Dermatology Department San Gallicano Dermatological Institute‐IRCCS Rome Italy
| | - Valentina Garelli
- Department of Plastic and Reconstructive Surgery San Gallicano Dermatological Institute‐IRCCS Rome Italy
| | - Flavia Persechino
- Clinical Dermatology Department San Gallicano Dermatological Institute‐IRCCS Rome Italy
- Department of Clinical and Molecular Medicine “Sapienza” University of Rome Rome Italy
| | - Isabella Sperduti
- Biostatistical Unit Scientific Direction San Gallicano Dermatological Institute‐IRCCS Rome Italy
| | - Gemma Caro
- Department of Internal Medicine and Medical Specialties “Sapienza” University of Rome Rome Italy
| | - Alfredo Rossi
- Department of Internal Medicine and Medical Specialties “Sapienza” University of Rome Rome Italy
| | - Marco Ardigò
- Clinical Dermatology Department San Gallicano Dermatological Institute‐IRCCS Rome Italy
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21
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Haslam IS, Smart E. Chemotherapy-Induced Hair Loss: The Use of Biomarkers for Predicting Alopecic Severity and Treatment Efficacy. Biomark Insights 2019; 14:1177271919842180. [PMID: 31037027 PMCID: PMC6475836 DOI: 10.1177/1177271919842180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 01/08/2023] Open
Abstract
Damage to hair follicles following exposure to toxic chemotherapeutics can cause substantial hair loss, commonly known as chemotherapy-induced alopecia (CIA). Preventive therapies remain limited; however, recent advances in the use of scalp cooling technologies have proved successful in preventing or reducing hair loss in some patients. Further improvements in scalp cooling efficacy and/or development of novel treatments to prevent chemotherapy-induced hair loss are required. To achieve this, post-chemotherapy assessment of hair follicle damage markers, with and without scalp cooling, would provide invaluable mechanistic and prognostic information. At present, the availability of such data is extremely limited. This article describes the potential utility of a combination of biomarkers in assessing drug-induced alopecia and the protective potential of existing or new treatments. A greater understanding of the precise mechanisms of anti-CIA therapies through biomarker analysis would enhance the rationale, use, and development of such treatments.
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Affiliation(s)
- Iain S Haslam
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Eleanor Smart
- Centre for Dermatology Research, University of Manchester, Manchester, UK
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