A 48-year-old woman with advanced-stage epithelial ovarian cancer undergoes surgery and adjuvant therapy with paclitaxel and carboplatin. At a follow-up visit 2 weeks after her first cycle of chemotherapy, the patient reports losing "clumps" of hair in the shower and while brushing her hair that morning. She feels moderately fatigued but has no other symptoms. Examination shows thinning of the hair across the vertex and crown. The skin of the scalp shows no erythema or scaling. Which of the following is the most likely explanation for this patient's hair loss?

Question

A 48-year-old woman with advanced-stage epithelial ovarian cancer undergoes surgery and adjuvant therapy with paclitaxel and carboplatin.  At a follow-up visit 2 weeks after her first cycle of chemotherapy, the patient reports losing "clumps" of hair in the shower and while brushing her hair that morning.  She feels moderately fatigued but has no other symptoms.  Examination shows thinning of the hair across the vertex and crown.  The skin of the scalp shows no erythema or scaling.  Which of the following is the most likely explanation for this patient's hair loss?

Quizplus · Accepted Answer

11ec25c8_d37a_f3b3_bc81_ef632f1a6629_MD0003_00 Hair growth occurs in a cyclical pattern with 3 primary phases: Anagen phase: Linear growth of the hair shaft associated with proliferation of hair follicle cells. At any given time, 80%-90% of follicles are in anagen phase, which lasts up to 5 years.Catagen phase: Transition phase characterized by regression and apoptosis of follicular cells. The hair shaft may continue to be extruded from the follicle but is no longer growing. This phase lasts up to 2 weeks and typically accounts for <1% of follicles.Telogen phase: Resting phase of variable duration. The hair shaft is shed during this phase in preparation for growth of a new hair. Anagen phase: Linear growth of the hair shaft associated with proliferation of hair follicle cells. At any given time, 80%-90% of follicles are in anagen phase, which lasts up to 5 years. Catagen phase: Transition phase characterized by regression and apoptosis of follicular cells. The hair shaft may continue to be extruded from the follicle but is no longer growing. This phase lasts up to 2 weeks and typically accounts for <1% of follicles. Telogen phase: Resting phase of variable duration. The hair shaft is shed during this phase in preparation for growth of a new hair. This patient has acute, widespread hair loss following initiation of cytotoxic chemotherapy. Many chemotherapeutic agents preferentially target rapidly dividing cells, including hair follicle cells in the anagen phase. Impaired cellular reproduction can lead to cessation of hair growth and rapid shedding of hair shafts (anagen effluvium). Chemotherapy-induced hair loss is especially common with antimicrotubule drugs (eg, paclitaxel), alkylators (eg, cyclophosphamide), and antibiotic chemotherapy agents (eg, doxorubicin). The hair loss is usually temporary and can be mitigated in some cases by scalp-cooling devices that reduce blood flow to the follicles. (Choice A) Alopecia areata is a cell-mediated autoimmune disorder affecting hair follicles. It presents with patches of complete hair loss, not diffuse or regional thinning. patches (Choice B) Paclitaxel is associated with drug-induced, subacute cutaneous lupus erythematosus, which can cause hair loss due to deposition of IgG and complement on epidermal keratinocytes. However, the typical lesions are scaly papules and annular plaques that are distributed widely in sun-exposed areas. (Choice C) Female pattern hair loss (ie, thinning at midline and vertex) can occur in patients with androgen-secreting ovarian tumors or a decreased estrogen/androgen ratio due to aromatase inhibitor therapy for breast cancer. However, this change occurs slowly over months, not days. (Choice E) Telogen effluvium is characterized by widespread transition of hair follicles into the telogen phase. It can occur in response to physiologic or emotional stressors (eg, pregnancy, severe illness) but presents with slowly progressive, diffuse hair thinning. Educational objective: Many chemotherapeutic agents preferentially target rapidly dividing cells, including hair follicle cells in the anagen phase. Impaired cellular reproduction in the anagen phase can lead to temporary, reversible cessation of hair growth and rapid shedding of hair shafts (anagen effluvium). References: Anagen effluvium. (http://www.ncbi.nlm.nih.gov/pubmed/23974578)

A 48-Year-Old Woman with Advanced-Stage Epithelial Ovarian Cancer Undergoes Surgery