Topical minoxidil and procedural interventions benefits in P
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Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma a study was conducted. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA.

The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Of the 71 patients included , 90% had a CNS tumor and 10% had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients, with localized (29 of 54), diffuse (13 of 54), or mixed (12 of 54) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose and proton irradiation were associated with greater alopecia severity, and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy.

Predominant trichoscopic features included white patches (16 of 28); in 15 patients, hair-shaft caliber negatively correlated with scalp dose. The association between hair density and scalp radiation dose was not statistically significant. Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% ; 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction.

Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.

Source:https://jamanetwork.com/journals/jamadermatology/article-abstract/2768761
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