Expert Consensus for Prevention, Diagnosis and Management of Persistent Chemotherapy-Induced Alopecia

September 2025 in “ PubMed ”

Azael Freites‐Martínez, Zoé Apalla, Jerry Shapiro, Matilde Iorizzo, Lidia Rudnicka, Kristen Lo Sicco, Vasiliki Nikolaou, Rodrigo Pirmez, Anita Takwale, Davide Fattore, Brittany Dulmage, Bianca Maria Piraccini, Sergio Vañó‐Galván, Mario E. Lacouture, V. Sibaud, Michela Starace

persistent chemotherapy-induced alopecia pCIA non-scarring alopecia hair follicle stem cells taxanes thiotepa anthracyclines scalp cooling devices topical minoxidil low-dose oral minoxidil bicalutamide oral finasteride dutasteride minoxidil Propecia Avodart

TLDR Prevent persistent hair loss after chemotherapy with scalp cooling and early minoxidil use.

Persistent chemotherapy-induced alopecia (pCIA) is a significant psychological burden for cancer survivors, yet lacks standardized guidelines. A Delphi study with 15 international experts achieved strong consensus on 47 statements, defining pCIA as non-scarring alopecia persisting beyond 6 months post-chemotherapy, primarily caused by the destruction of hair follicle stem cells due to agents like taxanes, thiotepa, and anthracyclines. Prevention through scalp cooling devices and early intervention with topical or low-dose oral minoxidil is recommended, while bicalutamide, oral finasteride, and dutasteride are not advised for breast cancer patients due to safety concerns. The study provides a framework for diagnosis and treatment, emphasizing prevention and early intervention, with further research needed on new treatments and long-term effects.

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