A Clinical and Biological Guide for Understanding Chemotherapy-Induced Alopecia and Its Prevention
Open accessAbstract
Chemotherapy-induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self-esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration-cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50%. This is despite different types of chemotherapy regimens, patient-specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available. Implications for Practice: Chemotherapy-induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately low temperature to the scalp and patient-specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively, and biological evidence-based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality-of-life.
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The hair follicle matrix is often targeted because it is more proliferatively active than malignant cells.
“The hair follicle matrix is often targeted because it is more proliferatively active than malignant cells46.”
From Morphological characteristics and notes of the skin in preclinical toxicity assessment (2023) · cites this paper as [46]
Section 3.3 (p. 10) says hair-follicle matrix keratinocytes can divide faster than malignant cells, making them susceptible to chemotherapy. It does not establish that they are generally more proliferative or that the matrix is often targeted for that reason. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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- Authors
- Dunnill, C. J., Al-Tameemi, W., Collett, A., Haslam, I. S., & Georgopoulos, N. T.
- Affiliations
- University of Huddersfield (GB)
- Corresponding author
- Georgopoulos, Nikolaos Theodoros
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-09-26
- Volume
- 23
- Issue
- 1
- Pages
- 84-96
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC5759815
- OpenAlex
- W2755791619
- Cited by
- 96
- References
- 134
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 15 · 2023: 10 · 2022: 13 · 2021: 12 · 2020: 13 · 2019: 5 · 2018: 3 · 2014: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Huddersfield Repository (University of Huddersfield) (acceptedVersion)
- SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
- Keele Research Repository (Keele University) (submittedVersion, cc-by)
- Huddersfield Research Portal (University of Huddersfield) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Dermatology › Chemotherapy-related skin toxicity
- Health Sciences › Medicine › Urology › Hair Growth and Disorders
- Health Sciences › Medicine › Oncology › Cancer Treatment and Pharmacology
- Keywords
- chemotherapy-induced alopecia, scalp cooling, hair follicle, anticancer drug toxicity, alopecia prevention, psychological burden, quality of life, cap design, hair loss
- MeSH terms
- Alopecia, Antineoplastic Agents, Humans, Hypothermia, Induced, Neoplasms, Prognosis
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