LETTER
Tamoxifen-Induced Female Androgenetic Alopecia in a Patient with Breast Cancer
Jean-Pierre M. Ayoub, MD;
Vicente Valero, MD; and
Gabriel N. Hortobagyi, MD
1 May 1997 | Volume 126 Issue 9 | Pages 745-746
TO THE EDITOR:
Tamoxifen is widely used in the management of postmenopausal women with hormonally responsive early and metastatic breast cancer. We describe a case of female androgenetic alopecia in a patient receiving adjuvant tamoxifen therapy for stage II breast cancer.
While receiving tamoxifen, the patient reported hot flashes, headaches, and depression. Soon after initiating tamoxifen therapy, she had noticed diffuse thinning of the hair on her head that was worse in the frontal area. Examination revealed diffuse thinning of the hair with moderate receding of the frontal hair line. Distribution of hair on the remainder of the body was normal. Complete blood count and results of routine chemistry analyses were normal. Thyroid function tests revealed a mildly elevated thyroid stimulating hormone level (4.6 µU/mL; reference range, 0.012 to 4.0 micro IU) with a normal thyroxine level (8.0 µg/dL; reference range, 5 to 15 µg/dL), and the patient began receiving L-thyroxine. Despite normalization of the results of thyroid function tests, the patient continued to have diffuse thinning of scalp hair on her most recent follow-up visit and wears a wig.
Female androgenetic alopecia is thought to develop by the increased action of androgens on hair follicles with menopause. Although some controlled studies have shown subtle alterations in androgen levels, others have found no significant differences in sex hormone levels between patients and controls [1]. Tamoxifen completely binds to cytosol estrogen receptors, competing with the binding of estradiol in hormone-dependent cells [2] and enhancing the estrogen deficiency of the target cell. It is conceivable that this state would allow androgens to act on hair follicles and cause alopecia in genetically susceptible persons. Although it has been described in frank clinical hypothyroidism [4], alopecia would not have been expected in our patient solely on the basis of a mildly elevated level of serum thyroid stimulating hormone. Tamoxifen has been reported to induce changes in hair color[5] but, to our knowledge, this is the first reported case of alopecia associated with tamoxifen therapy.
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Author and Article Information
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The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
1. Callan AW, Montalto J. Female androgenetic alopecia: an update. Australas J Dermatol. 1995; 36:51-5.
2. Jaiyesimi IA, Buzdar AU, Decker DA, Hortobagyi GA. Use of tamoxifen for breast cancer: twenty-eight years later. J Clin Oncol. 1995; 13:513-29.
3. Signore RJ, von Weiss J. Alopecia of myxedema: clinical response to levothyroxine. J Am Acad Derm. 1991; 25:902-4.
4. Hampson JP, Donnelly A, Lewis-Jones MS, Pye JK. Tamoxifen-induced hair colour change [Letter]. Br J Dermatol. 1995; 132:483-4.
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