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HairTransptantForumInternational

September/October2010

Successfultreatment of chemotherapy-inducedalopecia w:th Lasercapt": a casereport

Tseng-KuoShiao,MD,Ting-KuoShiao,JessicaC.ShiaolverlandPark, (anscs,' I-SenShiao,MDTaipei,Taiwonuhr@ott,net

Case repart: The patientis a 46-year- old male of Chinese decent diagnosed with stage IV colon cancerwith l0 + me- tastasesto the liver on October12,2009 (Figure l). His CEA at the time of discov-

Figurel. MRIof theliverat thetimeofdiagnosis. efy

WaS 4,030ng/ml.

FOLFOX (s-FU, folinicacid,oxaloplatin)chemotherapyevery two weeks was started on October 28, 2OO9.Alternative therapy includedfermentedwheat germ extract (Avemar) and high-doseIV VitaminC (3,0OOmg IV 3 timesperweek) beginningin the samemonth and 8glday of fucoidanfrom Fucusvesiculosisbeginningin early December2009.The patienthad minimalsideeffectsfrom the FOLFOXchemo- therapy regimen,reportedno GI discomforts,and had no noticeablehair lossduringhis l2 weeksof FOLFOX. Unfortunately,the patient's tumors did not respondto the chemo regimen,and his CEA reached7,9oong/mlby fanuary 2010.Hisoncologistswitchedhischemoregimento cetuximab+ FOLFIRI (5-FU, folinicacid,irinotecan)while hisalternativetherapiesremainedthesame.Underthisnew regimen,he experiencedsignificantside effectsincluding diarrhea,nausea,skineruptions,and',within severalweeks, significanthair loss. His colon cancerrespondedto the new chemo regimen, and hisCEAdroppedto 396ng/mlin 4 weeks (February 2010) and 359n9/mlin 2 months (March 2010).The patient'sCT after 3 months of chemo (April 2010)showed significant reductionof tumor size ( < |/ lOof the volumeat the timeof discovery)and widespreadcalcification.His fucoidanregi- men was changedto a 50/50 mix of Fucusvesiculousand Undaria pinnatifidaat the end of March 2010.The same chemoprotocolcontinuedand hisCEAdroppedto l2.4Oby f uly 2010and his CT at the end of July alsoshowedreduc- tionsin tumorsizeandcount.Asof f uly 3l ,2OlO, thepatient is stillon the sameprotocol.

LaserCap Treatment

Hopingto stopthe patient'shair loss,in April 2010Drs. Tseng-Kuoand I-SenShiaohad startedthe patienton Laser- Captreatment.LaserCapis a portablelow levellasertherapy devicecontainin 9224-65Onm 5mw laserdiodes.Thepatient received30-minuteLaserCaptreatments2-3 timesa week. By lune 2OlO,after23 sessions (about 9 weeksof LaserCap therapy),the patient'shairlosshadcompletelystopped.He had alsoregainedhis lost hair and may havehad a higher hair densitythan he did prior to chemotherapy (Figure 2). The patientdid not use minoxidil,becauseit irritatedhis alreadycompromisedskin (from cetuximab).

Figure 2. Pictures in the top row were taken l0 days (3 treatment sessions)after initiation of LaserCaptherapy.Note the significanthair lossin thesepictures.Pictures in the bottom row were taken about 9 weeks (23 treatment sessions)after initiation of LaserCaptherapy.Not only did the patient's hair loss stop, his hair also grew back while he was under active chemotherapy (note the skin eruption on left forehead due to cetuximab).

Discussion

Few dermatologicconditionscarry as much emotional distressaschemotherapy-inducedalopecia.lt ispsychologi- cally dauntingas it constantlyremindsthe patientof the disease,and patientshaveevenrefusedpossiblypalliative or lifesavingdrugsbecausethey could not acceptthe tem- porary or prolongedbaldness.In this patient'scase,once his hair lossceased,his family membersnoticeda change in his mood from beingdepressedto beingmuch more re- laxed.In his words,"lt was very depressingto seehair all over my pillow when I got up everymorning and to watch gobs of hair falling off each time I combed my hair. Now I feelbad for other cheinorecipientswho do not haveaccess to the LaserCap." As far as we know, this is the first reportedcaseof suc- cessfultreatmentof hair loss induced by chemotherapy while the patientis undergoingactivechemotherapyunder the same regimen.However,this is an anecdotalcaseand controlledstudiesmustbedoneto determineif low levellaser therapyis reallyusefulin chemotherapy-inducedalopecia, or if such successis only possibleagainstcertainchemo- therapeuticagentsor influencedby thepatient'sage,gender, and degreeof hair loss.We mustalsodetermineif low level Iasertherapywas solelyresponsiblefor the successor if any alternativetherapiesthispatientreceived,suchasfucoidan, fermentedwheatgermextract,and IV VitaminC,alsoplayed a role.Nevertheless,we hopethis casereportwill leadto a newdirectionin findingtreatmentfor chemotherapy-induced alopeciaand bring hopeto the millionssufferingfrom this heart-wrenchingcondition.*