Permanent Hair Loss Can Depend Upon The Drugs You Take

Drugs can occasionally cause permanent alopecia by irreversibly destroying hair follicles

. This has been reported from some cytostatic drugs such as in polychemotherapy, retinoids, gold, and busulfan. Severe drug reactions, toxic epidermal necrolysis) can also result in consecutive pseudo-cicatricial alopecia.

Most drugs cause temporary hair loss (alopecia). Permanent complete or partial hair loss is exceptional. I normally see around 5-6 patients per year with permanent hair loss due to drugs and those are almost always cancer related drugs.

The term pathogenesis means step by step development of a disease and the chain of events leading to that disease due to a series of changes in the structure and /or function of a cell/tissue/organ being caused by a microbial, chemical or physical agent. Pathogenesis here is not known, but it is believed that the drugs may lead to depletion of stem cells or the killing of dermal papilla cells.

Many times there is not complete alopecia, but a permanently decreased hair density showing up as sparse, finer, silkier hair. These finer hair can start to grow thicker in future hair cycles under good conditions but they very seldom become as thick as they were before the medication.

There are some different ways for treatment and Minoxidil, topical solution, before and after the use of cytostatic drugs has been shown to delay hair loss and accelerate regrowth in non-permanent alopecia.

Sometimes if treated with laser light (650nm over several months) the fine hair can turn thicker. Also the hair can change colour to the lighter sort due to melanin change in the hair follicle. There should be laser sessions three times per week for 4-6 months in order do benefit from the red laser.

Application of ice-packs has also been a last try and been claimed to reduce the toxic effects of anti-metabolites in the scalp but bears the potential risk of diminished efficacy to treat the malignancy. So for the icing there is a large question mark.

If loss of follicular ostia, atrophy, sclerosis or signs of inflammation are present, a deep biopsy, preferably at the active edge of the lesion, may help to find the underlying specific cause. A thorough examination and a careful history as well as other tests may aid in the diagnosis. In active disease, sufficient and timely treatment may prevent progression of the alopecia and possible systemic involvement. Surgical management, especially hair transplantation, is an option in end stage lesions.

Permanent or scarring alopecia can result from various non-follicular scalp conditions leading to destruction of the pilosebaceous unit. Trauma, deep infections or tumors can be localized on the scalp and often lead to alopecia. Other alopecic lesions may result from an inflammatory or genetic skin condition with a variable frequency of scalp involvement and alopecia. While some are true dermatoses, skin and scalp lesions are a marker for systemic disease in others.

by: Mats Stolt

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