10.5826/dpc.1303a152
text/xml
2160-9381
2917
en
Michela Starace
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
oral minoxidil
Persistent Chemotherapy-Induced Alopecia Treated With Low Dose Oral Minoxidil: A Multicenter Retrospective Case Series of 15 Patients 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-07-31
2022-10-17
2023-07-31
2023-08-24
e2023152
Dermatol Pract Concept
Michela Starace
2023/07/31
10.5826/dpc.1303a152
e2023152
Dermatology Unit - IRCCS Policlinico Sant’Orsola - Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
2160-9381
oral minoxidil
en
e2023152
Kang J, Lee JW, Kwon O. Efficacy of low-dose oral minoxidil in the management of anticancer therapy-induced alopecia in patients with breast cancer: A retrospective cohort study. J Am Acad Dermatol. 2023;88(5):1170-1173. DOI: 10.1016/j.jaad.2022.12.005. PMID: 36526083.
Persistent Chemotherapy-Induced Alopecia Treated With Low Dose Oral Minoxidil: A Multicenter Retrospective Case Series of 15 Patients 
https://dpcj.org/index.php/dpc/article/download/2917/2242
 Persistent Chemotherapy-Induced Alopecia Treated
    With Low Dose Oral Minoxidil: A Multicenter
       Retrospective Case Series of 15 Patients
       Matilde Iorizzo1, Anna Waśkiel-Burnat2, Jasmine Anedda3, Bianca Maria Piraccini4,
                         Zoe Apalla5, Lidia Rudnicka2, Michela Starace4


1 Private Dermatology Practice, Bellinzona/Lugano, Switzerland
2 Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
3 Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
4 Dermatology Unit - IRCCS Policlinico Sant’Orsola - Department of Specialized, Experimental and Diagnostic Medicine, University of
  Bologna, Bologna, Italy
5 Second Dermatology Department, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece



Key words: persistent chemotherapy induced alopecia, permanent chemotherapy induced alopecia, cancer survivors, cancer patients,
oral minoxidil
Citation: Iorizzo M, Waśkiel-Burnat A, Anedda J, et al. Persistent Chemotherapy-Induced Alopecia Treated With Oral Minoxidil: A
Multicenter Retrospective Case Series of 15 Patients. Dermatol Pract Concept. 2023;13(3):e2023152.
DOI: https://doi.org/10.5826/dpc.1303a152
Accepted: February 3, 2023; Published: July 2023
Copyright: ©2023 Iorizzo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Michela Starace, Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of
Bologna, V. Massarenti 1, 40138, Bologna, Italy. Tel +39051-6364867; Fax +39-0516364867; E-mail: michela.starace2@unibo.it




Introduction                                                             Case Presentation
Persistent chemotherapy-induced alopecia (PCIA) is de-                   A retrospective analysis of case series of 15 patients treated
fined as the absence of hair regrowth after more than                    with LDOM for PCIA (Table 1) was performed. All patients
6 months of treatment discontinuation [1]. Topical minoxi-               with biopsy-proven PCIA with no efficacy from topical
dil has been considered as the drug of choice in prevention              ­minoxidil used for at least one year were included. Patients
or treatment of CIA. In a case of PCIA the efficacy of topi-             with diagnosis of other form of hair loss or using other, than
cal minoxidil may be limited [2,3]. Moreover, it may cause               oral minoxidil, drug for alopecia were excluded.
scalp irritation with itching, dryness and scaling. The use of                All patients presented with thinned and sparse hair, with
low-dose oral minoxidil (LDOM) for the treatment of var-                 more or less pronounced areas of bare scalp. Trichoscopy
ious forms of hair loss has demonstrated great efficacy [4].             showed a reduction of follicular units with an increase in
To date, data considering efficacy of LDOM in PCIA are                   vellus hair formation in the absence of inflammation and
limited [2,5].                                                           scarring. LDOM was used at a daily dose of 1.5 mg in less



Research Letter | Dermatol Pract Concept. 2023;13(3):e2023152                                                                         1
     Table 1. Characteristics of patients with                   necessary, at the three months follow up, in three females due
    persistent chemotherapy-induced alopecia                     to non-acceptable facial hypertrichosis. No other, including
      treated with low dose oral minoxidil.                      cardiological, side effects were reported. No cardiological
                                                                 tests were needed during and after the therapy. All patients
    Patients numbers                                15
                                                                 refused a post-treatment scalp biopsy.
    females                                         13
                                                                     The results of the present study is consistent with the
    males                                            2
                                                                 study conducted by Kang et al. (5) who observed efficacy
    Age (years), mean (range)                   49 (35-71)
                                                                 of combination of LDOM and topical minoxidil in patients
    Disease
                                                                 with PCIA. In our study, LDOM used in monotherapy was
    breast adenocarcinoma                           12
                                                                 effective.
    lung adenocarcinoma                              1
                                                                     The limitation of the study is a small group of the pa-
    myelodysplasia                                   1
                                                                 tients included into analysis and the lack of post-treatment
    Hodgkin lymphoma                                 1
                                                                 histology which would allow to define improvement on pa-
    Taxane-based therapy
                                                                 thology grounds. Further studies are needed to better clar-
    docetaxel                                        3
                                                                 ify the mechanism of action of LDOM in patients affected
    paclitaxel                                       7
                                                                 by PCIA and to draw conclusions concerning optimal drug
    Non-taxane based therapy
                                                                 dosages.
    carboplatin                                      3
    cisplatin                                        1
    cyclophosphamide                                10           Conclusions
    dacarbazine                                      1
                                                                 To conclude, we believe that LDOM is a promising ther-
    doxorubicin                                      2
                                                                 apeutic option for patients with PCIA who do not benefit
    epirubicin                                       3
                                                                 from the topical solution or report disadvantages related to
    etoposide                                        3
                                                                 friction on a delicate scalp with thin hair.
    5-fluorouracil                                   1
    vincristine                                      1
    vinorelbine                                      1           References
    Targeted therapy
                                                                 1. Freites-Martinez A, Shapiro J, van den Hurk C, et al. Hair
    pertuzumab                                       3
                                                                    disorders in cancer survivors. J Am Acad Dermatol. 2019;80(5):
    trastuzumab                                      4              1199-1213. DOI: 10.1016/j.jaad.2018.03.056. PMID: 29660423.
    Alopecia grade                                                  PMCID: PMC6186205.
    grade 1                                          7           2. Yang X, Thai KE. Treatment of permanent chemotherapy-
    grade 2                                          8              induced alopecia with low dose oral minoxidil. Australas J
                                                                    ­Dermatol. 2016;57(4):e130-e132. DOI: 10.1111/ajd.12350.
    Trichoscopy
                                                                     PMID: 25966934
    circle hairs / yellow dots                       3           3. Bhoyrul B, Asfour L, Lutz G, et al. Clinicopathologic
    hair thinning / empty follicules                15               Characteristics and Response to Treatment of Persistent
                                                                     Chemotherapy-Induced Alopecia in Breast Cancer Survivors.
                                                                     JAMA Dermatol. 2021;157(11):1335-1342. DOI: 10.1001
severe cases (seven cases with grade 1 alopecia according to
                                                                     /jamadermatol.2021.3676.      PMID:    34586345.     PMCID:
­CTCAEv5.0) and 2.5 mg in more severe ones (eight cases              PMC8482302.
with grade 2 alopecia). Efficacy of LDOM was assessed based      4. Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, et al. Safety of
on clinical and trichoscopic pictures. After six to 12 months,       low-dose oral minoxidil for hair loss: A multicenter study of
clinical improvement was observed in seven (100%) patients           1404 patients. J Am Acad Dermatol. 2021;84(6):1644-1651.
                                                                     DOI: 10.1016/j.jaad.2021.02.054. PMID: 33639244.
with grade 1 and in six (75%) patients with grade 2 alopecia.
                                                                 5. Kang J, Lee JW, Kwon O. Efficacy of low-dose oral minoxi-
Trichoscopy revealed an increased hair thickness and growth
                                                                     dil in the management of anticancer therapy-induced alopecia
of new hair (Figure 1). Two out of eight patients affected           in patients with breast cancer: A retrospective cohort study.
by grade 2 alopecia were not able to abandon the wig, but            J Am Acad Dermatol. 2023;88(5):1170-1173. DOI: 10.1016/j
partial hair regrowth and increased thickness made them feel         .jaad.2022.12.005. PMID: 36526083.
more confident. Dose reduction from 2.5 mg to 1.5 mg was




2                                                                    Research Letter | Dermatol Pract Concept. 2023;13(3):e2023152
Figure 1. Clinical and trichoscopy images of a patient with persistent chemotherapy-induced alopecia (A,B) before treatment. (C,D) after
6 months of treatment with oral minoxidil 1.5 mg/day.




Research Letter | Dermatol Pract Concept. 2023;13(3):e2023152                                                                         3
