This document discusses permanent chemotherapy induced alopecia (PCIA), which is hair loss that does not regrow more than 6 months after chemotherapy treatment. It provides an overview of potential causes and treatments that have shown promise, including topical minoxidil, oral minoxidil, AS101, CG428 spray, and bimatoprost for eyelashes. Case studies demonstrate regrowth of hair for some using these treatments, though results vary. Further research is still needed to determine the most effective treatments for PCIA.

1. Permanent Chemotherapy Induced
Alopecia (PCIA)
By: Armand DeSollar and
Sarah Saint

2. Chemotherapy induced alopecia
• Many chemotherapy drugs can cause hair loss
• The incidence rate of alopecia due to chemotherapy is around 65%
• The exact mechanism by which chemotherapy causes alopecia is still up for
debate
• However, one hypothesis is that the toxins in the chemotherapy destroy the
hair follicle, which is the site of hair growth
• Most of the time, hair growth will continue once the chemotherapy is stopped
• But, the incident rate for permanent hair loss after chemotherapy is around
3%

3. Treatment of chemotherapy induced
alopecia
1. 2% Topical Minoxidil: is the pharmacologic intervention that has shown the most promise in
regrowing hair after chemotherapy
• In a double-blind randomized trial of 22 participants, 2% minoxidil shortened the amount
of time it took hair to regrow by 50.2 days compare to the control group
2. 1,25-dihydroxyVitamin D: has shown promise in regrowing hair in murine models
• Did cause dermatitis on the applied spot
3. AS101: significantly reduced CIA in humans and provided complete protection in animals
4. Scalp cooling: early data shows it has success rates around 50%, but it is only for the prevention
of alopecia and does not treat hair loss after chemotherapy

4. Hair Cycle
3 Stages
• Anagen Phase (Growing stage) -
Lasts 2-6 years and determines
hair length
• Catagen (Transition stage) - Lasts
about 1 to 2 weeks; hair is cut off
from blood supply and from cells
that produce new hair
• Telogen (Resting phase) - Lasts 3-
4 months. Old hair is “resting” and
not growing.

5. Permanent chemotherapy induced
alopecia (PCIA)
• PCIA is the absence of or incomplete hair regrowth lasting longer than 6
months after chemotherapy
• Exact reason for PCIA is still being debated
• Researchers believe PCIA occurs due to permanent damage to the stem cells
in the hair bulge but it could occur due to interference with active signaling
pathways that trigger hair growth.
• Hair follicles of individuals with PCIA histologically have similar characteristics
• The majority show a reduction in anagen (growing) phase hair follicles,
increase in telogen (resting) phase hair follicles, and miniaturization of hair
follicles.

6. Treatments for PCIA
• Lose Dose Oral Minoxidil
– Case report of 39 year old woman treated with cytotoxic
chemotherapy drugs (cyclophosphamide and busulfan) for
myeloid leukemia.
– She was clinically diagnosed with PCIA and was 16 months out
from treatment with little to no hair regrowth.
– Histologically, she had an increase in telogen (resting) phase hair
follicles and miniaturization of hair follicles.
– Treatment: Took 1 mg of oral minoxidil daily for one year.

7. Treatments for PCIA
Results for low dose oral minoxidil:
• She regrew significant amounts of
hair after one year which continued
into the second year of treatment
• Histologically, she had an
increased number of anagen
(growing) phase hair follicles, a
decrease in telogen (resting) phase
hair follicles, and reversal of follicle
miniaturization.

8. Treatments for PCIA
• 5% Topical Minoxidil
–Case Report # 1
• 58 year old female treated with taxane
chemotherapy (docetaxel) for breast cancer. No
hair regrowth after 7 years.
• Applied 5% topical minoxidil twice daily to scalp.
• Results: Increase volume of persisting hair, but no
response to rest of scalp after 6 months.

9. Treatments for PCIA
• 5% Topical Minoxidil
–Case Report #2
• 55 year old woman treated with taxane chemotherapy
(pacitaxel) for breast cancer. No significant hair
regrowth after 3 years.
• Applied 5% topical minoxidil twice daily for 6 months.
• Results: Increased volume of persisting hair, but no
response for the rest of the scalp

10. Treatments for PCIA
• AS101
– An immunomodulator: ammonium
trichloro[dioxoethylene-O,O’)tellurate
– 3 case reports for a 26, 18, and 11 year old treated
with cytotoxic chemotherapy for medulloblastoma. All
have incomplete or no hair growth 1-2 years after
treatment
– All 3 individuals applied a .01% spray form of AS101 to
their scalps once daily for 3 months

11. Treatments for PCIA
• AS101 Results:
–11 year old- Mild hair regrowth; less than 25%
of hair coverage
–18 year old- Moderate hair regrowth; 25%-50%
of hair coverage
–26 year old- Significant hair regrowth; More
than 50% of hair coverage

12. Treatments for PCIA
• CG428
– Botanical spray containing a blend of citrus, onion,
cocoa, and guarana.
– Researchers believe CG428 may reduce inflammation
in the scalp, improve hair regrowth, and restore the
natural hair cycle.
– 21 subjects suffering from persistent hair issues after
chemotherapy enrolled in a study to look at the
effectiveness of CG428

13. Treatments for PCIA
• CG428
–All study participants used the topical spray
twice per day.
–First improvement was observed:
• In 33% of participants after 1 month
• In 52% of participants after 2 months
• In 76% of participants after 3 months

14. CG428

15. Treatments for PCIA
• Bimatoprost
– Has not been studied for scalp hair loss
– Mainly used for eyelash loss due to
chemotherapy, but not permanent eyelash loss
due to chemotherapy
– Studies show that .03% topical bimatoprost
solution resulted in quicker eyelash regrowth
compared to normal eyelash regrowth following
chemotherapy

16. Treatments for PCIA
• Micro-Needling
–Uses a motorized pen with a needle at the end
to superficially penetrate skin to stimulate
collagen and elastin production and encourage
skin to regenerate.
–Inject platelet-rich plasma into patients’ scalps
to kick start growth
–Not proven, but may have potential

17. Support Group
• Aheadofourtime.org
– “world-wide organization of cancer patients who have banded together to
share emotional support, compare medical research and educate our
health care providers. If you are tired of the stares and the dismissive
suggestions to “wear a wig”, you will find understanding and, indeed,
empowerment among us”

18. References
Ahluwalia, G. S. (2013). Safety and Efficacy of Bimatoprost Solution 0.03% Topical Application in Patients with Chemotherapy-Induced Eyelash Loss. Journal of Investigative Dermatology Symposium Proceedings, 16(1).
CG428. (2014). Retrieved April 04, 2016, from http://cg428.com/
Kluger, N., Jacot, W., Frouin, E., Rigau, V., Poujol, S., Dereure, O., Guillot, B., Romieu, G., Bessis, D. (2012). Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide
(FEC) and docetaxel: A prospective study of 20 patients. Annals of Oncology, 23(11), 2879-2884. Retrieved March 25, 2016, from http://annonc.oxfordjournals.org/content/23/11/2879.long
Miteva, M., Misciali, C., Fanti, P. A., Vincenzi, C., Romanelli, P., & Tosti, A. (2011). Permanent Alopecia After Systemic Chemotherapy: A Clinicopathological Study of 10 Cases. The American Journal of Dermatopathology, 33(4),
345-350.
Morris, C., Woodward, J., & Stinnett, S. (2011). The role of bimatoprost eyelash gel in chemotherapy-induced madarosis: An analysis of efficacy and safety. Int J Trichol International Journal of Trichology, 3(2), 84. Retrieved
March 25, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250027/
Payne, A. S. (2015, February 4). Chemotherapy-induced alopecia. Retrieved March 25, 2016, from http://www.uptodate.com/contents/chemotherapy-induced-alopecia
Prevezas, C., Matard, B., Pinquier, L., & Reygagne, P. (2009). Irreversible and severe alopecia following docetaxel or paclitaxel cytotoxic therapy for breast cancer. British Journal of Dermatology, 160(4), 883-885. Retrieved April
1, 2016, from http://www.academia.edu/17545181/Irreversible_and_severe_alopecia_following_docetaxel_or_paclitaxel_cytotoxic_therapy_for_breast_cancer
Tallon, B., Blanchard, E., & Goldberg, L. J. (2010). Permanent chemotherapy-induced alopecia: Case report and review of the literature. Journal of the American Academy of Dermatology, 63(2), 333-336. Retrieved March 31, 2016,
from https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0190962209008238
Yang, X., & Thai, K. (2015). Treatment of permanent chemotherapy-induced alopecia with low dose oral minoxidil. Australasian Journal of Dermatology.
Yeager, C. E., & Olsen, E. A. (2011). Treatment of chemotherapy-induced alopecia. Dermatologic Therapy, 24(4), 432-442.