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Gradual thinning at the parting and crown that builds over months on tamoxifen, an aromatase inhibitor or ovarian suppression. It is not the sudden shedding of chemotherapy, it lasts as long as the treatment does, and it is often dismissed because it is mild on a clinician's scale and not on the patient's.
In the series that first described it systematically, 112 women with breast cancer seen at a dermatology service for hair loss on endocrine therapy (Freites-Martinez et al., JAMA Dermatology 2018), the alopecia was attributed to an aromatase inhibitor in 75 (67 per cent) and to tamoxifen in 37 (33 per cent). The pattern was that of androgenetic alopecia: widening of the parting, thinning at the crown, miniaturised hairs on trichoscopy, rather than the diffuse shedding of chemotherapy. Severity was graded 1, the mildest band, in 96 of 104 patients (92 per cent). The quality-of-life measurement is the point of the paper: despite that mildness the Hairdex emotion score was 41.8 (standard deviation 21.3), a significant negative effect, which is the gap between how the problem is scored in clinic and how it is lived.
After topical minoxidil, moderate or significant improvement was observed in 37 of 46 patients (80 per cent). In the later three-centre cohort (JAMA Dermatology 2019), 32 of 42 women with endocrine-therapy alopecia (76 per cent) improved moderately or significantly on topical minoxidil or spironolactone. These are uncontrolled series in people who sought dermatological help, not randomised trials, and some improvement over months would be expected without treatment.
The decision that matters more than any of this is adherence. Five years of adjuvant endocrine therapy substantially reduces recurrence and death from hormone-receptor-positive breast cancer, and stopping it to protect hair trades a visible problem for an invisible one. Switching between tamoxifen and an aromatase inhibitor, or between aromatase inhibitors, is a conversation to have with the oncologist rather than a decision to make alone. Scalp cooling has no role here: the drug is taken daily for years, not infused over hours.
Showing the molecule this term concerns: Tamoxifen.
Shares Platelet-rich plasma for hair after cancer treatment, Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss.
Shares Anagen effluvium (chemotherapy hair loss), Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss.
Shares Anagen effluvium (chemotherapy hair loss), Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss.
Shares Anagen effluvium (chemotherapy hair loss), Persistent chemotherapy-induced alopecia, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss.
Shares Anastrozole, Exemestane, Letrozole (and other aromatase inhibitors), Tamoxifen.
Shares Exemestane, Tamoxifen, Endocrine therapy (SERMs, AIs, SERDs).
Shares Anastrozole, Exemestane, Letrozole (and other aromatase inhibitors).
Shares Exemestane, Tamoxifen, Endocrine therapy (SERMs, AIs, SERDs).