Permanent Chemotherapy-Induced Nonscarring Alopecia and Premature Ovarian Failure

A 22-year-old woman developed permanent chemotherapy-induced nonscarring alopecia and premature ovarian failure after receiving myeloablative treatment for acute myeloid leukemia, which included busulfan, fludarabine, thiotepa, and anti-thymocyte globulin. Despite some initial hair regrowth post-treatment, she experienced continued hair loss and ceased menstruation. Physical examination and blood tests confirmed the alopecia and premature ovarian failure, with high levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Scalp biopsies showed a reduced number of hair follicles and presence of miniaturized hairs without significant inflammation, consistent with permanent alopecia. The patient now requires hormone replacement therapy (HRT) and uses a scalp prosthesis. The document highlights that while postchemotherapy alopecia is usually reversible, there are increasing reports of permanent cases, often associated with busulfan and other cytotoxic agents. Histological findings typically show a reduction in terminal hairs and increased miniaturization without fibrosis. The document also notes that endocrine dysfunction may play a role in such alopecia, as evidenced by a study of 20 female patients with PCIA, all of whom displayed biological menopause. The need for further research on the potential role of diminished estrogens and chemotherapeutic effects on hair follicle stem cells in PCIA is emphasized.