Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients

In a prospective study of 20 white Caucasian female patients treated between 2007 and 2011, permanent alopecia was identified as a complication following breast cancer chemotherapy with a sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel regimen. The patients developed a moderate or intense androgenetic-like pattern of scalp alopecia, with 19 out of 20 experiencing permanent diffuse scalp alopecia and body hair loss. Biopsy specimens showed normal or androgenetic-like patterns, with reduced hair follicle density and/or an increased amount of vellus hair in 53% of cases, and a mild lymphocytic infiltrate in 67% of cases. Laboratory tests ruled out other potential causes such as iron or zinc deficiency, thyroid disorders, and hyperandrogenism. The mean Dermatology Life Quality Index (DLQI) score was 8.66, reflecting significant psychological distress, and 70% of patients used hair prostheses or scarves due to the hair loss. No effective treatments were found, including vitamins, minoxidil, psoralen plus ultraviolet A therapy, and spironolactone. The study estimated the incidence of this side effect to be around 2% among patients treated with this regimen at the institution during the study period.