F14 CICATRICIAL ALOPECIA AFTER CHEMOTHERAPY/RADIOTHERAPY
Misciali C, Tosti A, Vincenzi C, Iorizzo M, Fanti PA
Department of Dermatology, University of Bologna, Italy

We report here the cases of 3 women and 1 man, aged between 16 and 35 years, with permanent alopecia due to chemotherapy/radiotherapy. Two women and 1 man had a clinical history of acute myeloproliferative syndrome and multiple myeloma. They underwent autologous bone marrow transplantation one year before our observation. Conditioning regimen included busulphan, cyclophosphamide and melphalan. Hair loss started 10-15 days after transplantation and rapidly progressed to total alopecia in a few days. Hair regrowth started 1 month after transplantation but the new hair was thinner than the original and the hair density was greatly reduced. Hair was short, brittle and soft. Scalp biopsy revealed a reduced hair follicle density in the absence of inflammation and fibrosis. The hair count in horizontal sections showed a reduced number of follicular units, total hairs, terminal follicles and slight high percentage of vellus hairs. Some follicular fibrotic stelae were observed. The 3rd woman was diagnosed intracranial ependymoma and was treated with surgery and postoperative radiation therapy. Clinical history revealed that hair loss started after radiation therapy and provoked a total alopecia in a few days. Hair regrowth started 1 month after the therapy, but the hair density was reduced. Scalp biopsy showed reduced hair follicle density with fibrosis and slight inflammation. The counts obtained by horizontal sections demonstrated few vellus hair follicles, a reduced number of follicular units, total hairs, terminal follicles. Follicular stelae were fibrotic. Fibrosis and almost complete absence of sebaceous glands were detected. Systemic chemotherapy is a well known cause of reversible hair loss. Busulphan chemotherapy, however, is responsible for a permanent alopecia that usually occurs in patients submitted to bone marrow transplantation. The pathology showed a reduced follicular density in the absence of fibrosis, suggesting that alopecia may results either from hair follicle stem cell destruction or from acute damage of the keratinocytes of the lower portion of some follicles caused by the drug. Pre- and postoperative radiation for the treatment of brain cancer ranges from 2000 to 5000 rad in different doses according to individual protocol. It induces normally a temporary alopecia. High doses of radiation induce marked inhibition of matrix cell proliferation and develop a permanent alopecia. The hair will not regrow completely or will regrow thin and short with fibrosis and marked reduction of hair density.