Defining Predictive Factors for Permanent Chemotherapy-Induced Alopecia: Trichoscopy, Reflectance Confocal Microscopy and Histopathology Study on 77 Patients

Introduction: Literature about trichoscopy of permanent chemotherapy-induced alopecia (pCIA) is still scarce, while no data were published regarding reflectance confocal microscopy (RCM). The aim of our study is to monitor the different phases of chemotherapy-induced alopecia development with trichoscopy and RCM, in order to identify predictor factors for permanent alopecia. Methods: This multicentre, prospective, observational study evaluated patients with cancer who were candidates for chemotherapy with a drug implicated in pCIA development. Patients were followed for the next 2 years after recruitment. Results: A total of 77 patients were enrolled. Six months after the discontinuation of chemotherapy in all patients with pCIA, trichoscopic examination revealed a diffuse presence of multiple yellow dots, the persistence of regrowing hairs, and an increase degree of miniaturization in comparison to baseline. RCM detected the permanence of inflammatory cells over time, especially around the adnexal structures, which led to the appearance of fibrosis and alteration of the normal rimming. Conclusions: Trichoscopy and RCM allowed one to detect the different phases of chemotherapy-induced alopecia development. The following predictor factors for pCIA were identified: a positive history of cyclophosphamide- and taxane-based chemotherapy; a diffuse presence of multiple yellow dots at trichoscopy; onset and persistence of a diffuse inflammatory infiltrate at RCM.