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Hair that has not returned to its old density six months or more after chemotherapy ended. It is the effect patients are least often warned about beforehand, it is commonest after taxanes and after transplant conditioning, and it is usually thinning rather than baldness.
Persistent, sometimes called permanent, chemotherapy-induced alopecia is incomplete regrowth that lasts beyond six months after the last dose. In a prospective Korean cohort of 61 women with breast cancer whose hair density and thickness were measured before chemotherapy and who were followed for three years (Kang et al., The Oncologist 2019), 39.5 per cent met the definition at six months and 42.3 per cent at three years; those who had a taxane-based regimen were more likely to be affected, and at three years the problems participants reported were hair thinning (75.0 per cent), reduced hair volume (53.9 per cent), hair loss (34.6 per cent) and grey hair (34.6 per cent). That figure comes from a single-centre cohort of 61 people and should be read as what careful measurement finds rather than as a population rate; clinic series that count only those who seek help report far less.
In the largest treated series, a retrospective cohort of 192 women across three centres (Freites-Martinez et al., JAMA Dermatology 2019), 98 had persistent chemotherapy-induced alopecia and taxanes were the agent involved in 80 of them (82 per cent). Compared with women whose thinning came from endocrine therapy, their alopecia was more often diffuse (41 per cent versus 25 per cent) and more often graded moderate (39 per cent versus 13 per cent). After treatment with topical minoxidil or spironolactone, moderate to significant improvement was seen in 36 of 54 patients (67 per cent). High-dose conditioning for stem cell transplantation, particularly busulfan-containing regimens, is the other recognised cause.
What to do about it is well enough established to be worth asking for and not well enough established to promise: a dermatology referral to exclude iron deficiency, thyroid disease and the pattern hair loss that many people would have developed anyway; topical minoxidil, with the series above behind it; and camouflage. Scalp cooling, which reduces the dose reaching the follicle, is being examined as a way of reducing the risk, but no trial has yet reported persistent alopecia as a primary endpoint.
Ball-and-stick model from PubChem 2D record (no 3D conformer available). PubChem record
Showing the molecule this term concerns: Docetaxel.
Shares Regrowth after chemotherapy (chemo curls), Camouflage and restoration: fibres, micropigmentation, transplantation, Persistent radiation-induced alopecia, Anagen effluvium (chemotherapy hair loss).
Shares Anagen effluvium (chemotherapy hair loss), Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss, Scalp cooling (cold caps: DigniCap, Paxman), Docetaxel.
Shares Regrowth after chemotherapy (chemo curls), Anagen effluvium (chemotherapy hair loss), Docetaxel, Paclitaxel / nab-paclitaxel.
Shares Regrowth after chemotherapy (chemo curls), Camouflage and restoration: fibres, micropigmentation, transplantation, Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss, Scalp cooling (cold caps: DigniCap, Paxman).
Shares Scalp cooling (cold caps: DigniCap, Paxman), Late effects and survivorship toxicity, Docetaxel, Paclitaxel / nab-paclitaxel.
Shares Scalp cooling (cold caps: DigniCap, Paxman), Docetaxel, Cyclophosphamide, Paclitaxel / nab-paclitaxel.
Shares Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss, Scalp cooling (cold caps: DigniCap, Paxman), Docetaxel, Paclitaxel / nab-paclitaxel.
Shares Docetaxel, Cyclophosphamide, Paclitaxel / nab-paclitaxel, Cytotoxic chemotherapy.