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- Hair Loss Side Effect With Interferon
Hair Thinning and Interferon
Why Does Interferon Cause Hair Thinning and Hair Loss?
I was wondering about the effects that an Interferon course had on the head hair thinning and loss and came across this explanation and recommendation for hair care. I can’t remember where I found it originally, just that I stored it on my hard drive… I think the source is in the references at the bottom.
“Interferon affects the hair follicles and changes the texture of the hair, thereby making it more sensitive to breakage. Hair loss, which has been described as a possible side effect of treatment with interferons,(1) occurs by one of two mechanisms. First, loss via a shearing or friction effect at the scalp level (often during sleep as the hair moves across a pillow) is caused by the weak, brittle nature of hair changes. ”
“Second, loss can occur via a spontaneous release of the hair from the follicle, leaving the follicle empty, which is usually seen with vigorous shampooing or brushing. Alopecia is frequently observed when therapy is continued for longer than 3 to 4 months, and is characterized by thinning and slight-to-mild hair loss. It appears to be the most common cutaneous reaction associated with interferon alfa treatment.(2) Alopecia may become more pronounced when interferon is discontinued and may continue for 1 to 3 months.(3) In general, alopecia associated with interferon is reversible. In some patients, hair regrowth occurs during treatment continuation.(1)”
“Total revealed alopecia is seen more often with high-dose interferon or long-term interferon maintenance therapy. Thinning, often noticeable to others, is usually seen during combination therapy with ribavirin or low-dose, short-course interferon. Patches of loss occur unpredictably in some patients.”
PREVENTIVE STRATEGIES
Providers should:
1. Educate patients regarding the risk of alopecia, its causes, and management. Inform patients that hair usually regrows, although the new growth may be a different texture; however, in rare cases, hair loss may be permanent.
2. Rule out other etiologies, including a history of alopecia areata, thyroid dysfunction,and other medical conditions, treatment, or medications (eg, chemotherapy, radiation therapy) that may predispose the patient to alopecia.
Patients should be instructed to:
1. Use a wide-toothed comb and/or natural bristle brush; gently comb/brush only once or twice daily.
2. Shampoo less frequently (1–3 times/wk); use conditioner or detangler.
3. Use Nioxin™ or selenium sulfide (Selsun Blue®) shampoo, or Centrum® Complete multivitamin with zinc and selenium.
4. Use vegetable-based henna or vegetable-based hair color (eg, Aveda™, Matrix™) if intent on coloring hair. Avoid use of peroxide-based hair dye or permanent wave solutions while on therapy; their use is not contraindicated, but can accelerate hair loss and hair damage.
5. Pin a silk scarf on pillowcase or buy a satin pillowcase to avoid hair loss through friction or shearing effect.
6. Avoid pressure-based hair items: caps, barrettes, ponytail clips, hair bands.
7. Avoid pulsating showerheads (eg, Waterpik™); these exert too high a PSI and facilitate loss.
8. Avoid/limit use of gels, freezing sprays, mousse; these make hair difficult to comb through.
TREATMENT STRATEGIES
Symptomatic patients should be advised to:
1. Cut hair length to decrease hair weight and rate of loss (for progressive thinning in longer, heavier hair).
2. Purchase scarves, wigs, turbans, or caps when total revealed alopecia is anticipated.
3. Complete any hair transplant procedures prior to therapy or continue them after completion of treatment to avoid delayed healing and risk of infection (for patients with pre-existing male pattern baldness).
Providers should, as needed:
1. Provide a prescription for scalp prosthesis or cranial prosthesis (wig) due to treatment-induced alopecia to facilitate insurance/Medicare reimbursement.
2. Refer patients for psychosocial support, such as support groups, and recommend consultation with a cosmetologist or dermatologist (if appropriate) for changed bodyimage issues.
3. Note that drug therapy (minoxidil [Rogaine®]) for hair loss is not efficacious for interferon-related hair loss.
REFERENCES
(1). Tosti A, Misciali C, Bardazzi F, Fanti PA, Varotti C. Telogen effluvium due to recombinant interferon a-2b. Dermatology. 1992;184:124-125.
(2). Stafford-Fox V, Guindon KM. Cutaneous reactions associated with alpha interferon therapy.Clin J Oncol Nurs. 2000;4:164-168.
(3). Vial T, Descotes J. Clinical toxicity of the interferons. Drug Safety. 1994;10:115-150.
Side Effects Management Handbook • V. Cutaneous: Skin, Hair, Nails • p. 2
Side Effects Management Handbook • V. Cutaneous: Skin, Hair, Nails • p. 3
Tags: hair thinning, interferon, male pattern baldness, total revealed alopecia