Many people with breast cancer temporarily lose their hair after treatment with chemotherapy, but persistent hair loss is more common in patients who undergo taxane- and cyclophosphamide-based chemotherapy. However, persistent chemotherapy-induced alopecia (pCIA) tends to be underacknowledged by oncologists.

Therefore, a team of researchers embarked upon a study of patients with breast cancer experiencing pCIA after chemotherapy. Their goal: to analyze the clinicopathologic characteristics and response to treatment for pCIA in patients with breast cancer. Their results were recently published in JAMA Dermatology.

The researchers conducted a retrospective analysis of 100 patients whose breast cancer was diagnosed between 2004 and 2017. Most of the patients, who were treated at 4 specialty hair clinics, presented with diffuse alopecia or hair thinning characteristic of female pattern hair loss. Among the 92 patients who were treated with taxane-based chemotherapy, the researchers found no statistical difference between those with hormone receptor-positive breast cancer and those with hormone receptor-negative breast cancer. However, these patients experienced more severe alopecia than the patients who did not receive a taxane-based regimen.

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“In most patients, hair fully regrows after chemotherapy,” the researchers wrote. “However, the persistent hair loss seen in patients with pCIA may be explained by irreversible damage to (hair follicle) stem cells (HFSCs), which are slow-cycling quiescent cells usually resistant to chemotherapy.”

They referenced recent research on a variant in the ABCB1 gene in patients with persistent alopecia after docetaxel-based chemotherapy and added that the data suggest “exposure to a high concentration of taxane in carriers of the risk allele may result in HFSC destruction and, therefore, persistent hair loss.”

However, the researchers found that a significant proportion of patients in this study experienced an improvement in hair density with topical or systemic treatment, suggesting that pCIA may be at least partly reversible. And ultimately, they added, more attention should be placed on preventing hair follicle damage to begin with, although certain hair-protective strategies could be more widely used to curtail the effects on patients’ hair.

The study was limited by the retrospective nature of the research, as well as a relatively small and specific study population. The researchers also cautioned that they did not know if the patients had normal hair densities prior to chemotherapy.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Bhoyrul B, Asfour L, Lutz G, et al. Clinicopathologic characteristics and response to treatment of persistent chemotherapy-induced alopecia in breast cancer survivors. JAMA Dermatol. Published online September 29, 2021. doi:10.1001/jamadermatol.2021.3676