編者按：眾所周知,，化療容易引起脫發(fā),。雖然乳腺癌內(nèi)分泌治療所致脫發(fā)病例已有報(bào)道，但是未被重視,，亦未被系統(tǒng)描述,。米諾地爾為鉀通道開放藥,，具有選擇性血管擴(kuò)張作用，還可以減少或防止脫發(fā),，并且促進(jìn)毛發(fā)再生,，大多用于雄激素型脫發(fā)。那么,，乳腺癌患者內(nèi)分泌治療所致脫發(fā)的臨床特征,、生活質(zhì)量影響、米諾地爾療效如何,？

　　2018年4月11日,，《美國醫(yī)學(xué)會雜志》皮膚病學(xué)分冊在線發(fā)表紐約紀(jì)念醫(yī)院斯隆凱特林癌癥中心、紐約大學(xué)醫(yī)學(xué)院,、康奈爾大學(xué)醫(yī)學(xué)院的隊(duì)列研究報(bào)告,，描述了乳腺癌女性患者內(nèi)分泌治療所致脫發(fā)的臨床特征和生活質(zhì)量，以及米諾地爾的療效,。結(jié)果發(fā)現(xiàn),，該隊(duì)列研究通過標(biāo)準(zhǔn)化臨床照片和毛發(fā)鏡檢圖片確認(rèn)的112例女性患者脫發(fā)形式與雄激素型脫發(fā)相似，雖然大多數(shù)患者脫發(fā)程度輕微,，但是患者認(rèn)為脫發(fā)對情緒有顯著負(fù)面影響,。脫發(fā)改善可見于局部外用米諾地爾的37例患者（80%）。因此,，乳腺癌內(nèi)分泌治療所致脫發(fā)患者可能獲益于米諾地爾,。

　　該隊(duì)列回顧研究于2009年1月1日～2016年12月31日從大型三級醫(yī)院綜合癌癥中心（紐約紀(jì)念醫(yī)院斯隆凱特林癌癥中心）皮膚科入組乳腺癌內(nèi)分泌治療所致脫發(fā)患者112例（年齡34～90歲，中位60歲）,，對乳腺癌內(nèi)分泌治療所致脫發(fā)患者的臨床特征,、脫發(fā)相關(guān)生活質(zhì)量以及米諾地爾療效進(jìn)行評定。該研究利用德國頭發(fā)指數(shù)問卷數(shù)據(jù),，評定脫發(fā)對患者生活質(zhì)量的影響,，評分越高（最高100分）表示生活質(zhì)量越低。研究第3或6個(gè)月時(shí),，由單盲研究者根據(jù)頭皮標(biāo)準(zhǔn)化臨床照片,，對米諾地爾的療效進(jìn)行評判。

　　結(jié)果,，有頭皮標(biāo)準(zhǔn)化臨床照片患者共104例（93%）,，其中：

• 入組接受毛發(fā)鏡檢患者59例（53%）

• 米諾地爾療效評定患者46例（41%）

• 芳香酶抑制劑所致脫發(fā)75例（67%）

• 他莫昔芬所致脫發(fā)患者37例（33%）

• 脫發(fā)嚴(yán)重程度一級患者96例（92%）

　　乳腺癌內(nèi)分泌治療所致脫發(fā)形式與雄激素型脫發(fā)相似，入組時(shí)主要毛發(fā)特征為存在毫毛（細(xì)毛）和毛干末端直徑中到粗,?；颊哒J(rèn)為脫發(fā)對生活質(zhì)量產(chǎn)生負(fù)面影響，根據(jù)頭發(fā)指數(shù)評分（平均41.8±21.3分,，P<0.001）對情緒影響較大,。

　　46例患者局部外用米諾地爾治療后,，其中37例患者（80%）可見脫發(fā)中等或顯著改善。

　　因此,，內(nèi)分泌治療與脫發(fā)相關(guān),，其形式與雄激素型脫發(fā)相似，符合致病因素作用機(jī)制,。雖然大多數(shù)患者脫發(fā)程度輕微,，但是患者認(rèn)為脫發(fā)對情緒等生活質(zhì)量有顯著負(fù)面影響。

　　對此,，瑞士蘇黎世大學(xué)皮膚病學(xué)與毛發(fā)疾病中心專家發(fā)表述評：米諾地爾治療乳腺癌女性內(nèi)分泌治療所致脫發(fā)——圣阿加莎的祝福,？

　　意大利西西里的阿加莎：天主教會最受尊敬的處女烈士之一，也是乳腺癌患者,、殉道者,、乳母、鑄鐘匠,、面包師傅,、火、地震,、埃特納火山噴發(fā)的主保圣人,。阿加莎在眾多畫作中經(jīng)常帶著她被切除的乳房，并放在盤子里,。由伯納迪諾·盧伊尼在羅馬博爾蓋塞美術(shù)館所繪畫出的阿加莎中,，阿加莎在注視著著她手上托盤的乳房。

JAMA Dermatol. 2018 Apr 11. [Epub ahead of print]

Endocrine Therapy-Induced Alopecia in Patients With Breast Cancer.

Freites-Martinez A, Shapiro J, Chan D, Fornier M, Modi S, Gajria D, Dusza S, Goldfarb S, Lacouture ME.

Memorial Sloan Kettering Cancer Center, New York, New York; New York University School of Medicine, New York; Weill Cornell Medical College, New York, New York.

This cohort study describes clinical features, quality of life, and response to minoxidil among female patients with breast cancer who have endocrine therapy-induced alopecia.

QUESTION: What are the clinical features, impact on quality of life, and response to minoxidil of endocrine therapy-induced alopecia in patients with breast cancer?

FINDINGS: In this cohort study of 112 patients, a pattern alopecia similar to androgenetic-type was confirmed by standardized clinical and trichoscopy images, and a significant negative emotional impact was reported by patients, despite most cases being mild. Alopecia improvement was observed in 37 patients (80%) with topical minoxidil.

MEANING: Patients with breast cancer developing alopecia from endocrine therapies may benefit from minoxidil.

IMPORTANCE: Endocrine therapy-induced alopecia (EIA) has been anecdotally reported but not systematically described.

OBJECTIVE: To characterize EIA in patients with breast cancer.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 112 patients with breast cancer, diagnosed with EIA from January 1, 2009, to December 31, 2016, the patients were examined at the dermatology service in a large tertiary care hospital and comprehensive cancer center.

MAIN OUTCOMES AND MEASURES: The clinical features, alopecia-related quality of life (QoL), and response to minoxidil of EIA in patients with breast cancer were assessed. Data from the Hairdex Questionnaire was used to assess the impact of the alopecia on patients QoL. Higher score indicates lower QoL (0-100 score). Efficacy of minoxidil was measured at 3 or 6 months by a single-blinded investigator through standardized clinical photographs of the scalp.

RESULTS: A total of 112 female patients with breast cancer were included (median [range] age, 60 [34-90] years). A total of 104 patients (93%) had standardized clinical photographs; of these, 59 patients (53%) had trichoscopy images available at baseline, and 46 patients (41%) were assessed for response to minoxidil. Alopecia was attributed to aromatase inhibitors in 75 patients (67%) and tamoxifen in 37 (33%). Severity was grade 1 in 96 of 104 patients (92%), and the pattern was similar to androgenetic alopecia. The predominant trichoscopic feature at baseline was the presence of vellus hairs and intermediate- and thick-diameter terminal hair shafts. A negative impact on QoL was reported, with a higher effect in the emotion domain according to the Hairdex score (mean [SD], 41.8 [21.3]; P<.001). After treatment with topical minoxidil, moderate or significant improvement in alopecia was observed in 37 of 46 patients (80%).

CONCLUSIONS AND RELEVANCE: Endocrine therapies are associated with a pattern alopecia similar to androgenetic-type, consistent with the mechanism of action of causal agents. A significant negative impact on QoL was reported by patients, despite mostly mild alopecia severity.

PMID: 29641806

DOI: 10.1001/jamadermatol.2018.0454

JAMA Dermatol. 2018 Apr 11. [Epub ahead of print]

Minoxidil for Endocrine Therapy-Induced Alopecia in Women With Breast Cancer-Saint Agatha's Blessing?

Trüeb RM.

Center for Dermatology and Hair Diseases, University of Zurich, Zurich, Switzerland.

Guard us against breast cancer and other afflictions of women, and inspire us to overcome adversity. From a prayer to St Agatha of Sicily, Patron Saint for women with breast cancer.

PMID: 29641812

DOI: 10.1001/jamadermatol.2018.0453