Few dermatologic conditions carry as much emotional distress as chemotherapy-induced
alopecia (CIA). The prerequisite for successful development of strategies for CIA prevention is
the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable
and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as
acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with
different clinical patterns of hair loss. When an arrest of mitotic activity occurs, obviously
numerous and interacting factors influence the shedding pattern. The major approach to
minimize CIA is by scalp cooling. Unfortunately, most published data on scalp cooling are of
poor quality. Several experimental approaches to the development of pharmacologic agents are
under evaluation and include drug-specific antibodies, hair growth cycle modifiers, cytokines
and growth factors, antioxidants, inhibitors of apoptosis, and cell-cycle and proliferation modifiers.
Ultimately, the protection should be selective to the hair follicle; for example, topical
application, such that the anticancer efficacy of chemotherapy is not hampered. Among the few
agents that have been evaluated so far in humans, AS101 and minoxidil were able to reduce the
severity or shorten the duration of CIA, but could not prevent CIA.
Semin Cutan Med Surg 28:11-14 © 2009 Published by Elsevier Inc.

Few dermatologic conditions carry as much emotional distress as chemotherapy-induced
alopecia (CIA). The prerequisite for successful development of strategies for CIA prevention is
the understanding of the pathobiology of CIA. The incidence and severity of CIA are variable
and related to the particular chemotherapeutic protocol. CIA is traditionally categorized as
acute diffuse hair loss caused by dystrophic anagen effluvium; however, CIA presents with
different clinical patterns of hair loss. When an arrest of mitotic activity occurs, obviously
numerous and interacting factors influence the shedding pattern. The major approach to
minimize CIA is by scalp cooling. Unfortunately, most published data on scalp cooling are of
poor quality. Several experimental approaches to the development of pharmacologic agents are
under evaluation and include drug-specific antibodies, hair growth cycle modifiers, cytokines
and growth factors, antioxidants, inhibitors of apoptosis, and cell-cycle and proliferation modifiers.
Ultimately, the protection should be selective to the hair follicle; for example, topical
application, such that the anticancer efficacy of chemotherapy is not hampered. Among the few
agents that have been evaluated so far in humans, AS101 and minoxidil were able to reduce the
severity or shorten the duration of CIA, but could not prevent CIA.
Semin Cutan Med Surg 28:11-14 © 2009 Published by Elsevier Inc.