Updated: November 2019 - Cutaneous Lymphoma Foundation’s Medical Advisory Committee
Individuals with cutaneous lymphoma may notice a loss of hair, or alopecia, which can affect any area of the body.
Alopecia has been estimated to occur in approximately 2.5%1 of cutaneous lymphoma patients and can be seen in several variants including mycosis fungoides (MF), the most common form of cutaneous lymphoma, Sézary syndrome and folliculotropic MF (FMF). Alopecia is most common in FMF, where it is estimated to occur in 65% of patients.2
The spectrum of hair loss seen can vary widely from patient to patient and is often associated with the variant of cutaneous lymphoma they have. FMF is variant of MF in which aberrant T-cells more commonly infiltrate the hair follicle. Alopecia occurs as a result of these T-cells interrupting growth of the hair, and appears in a patchy distribution. Hair loss in Sézary syndrome is frequently a generalized loss of hair. Alopecia can be the first sign of cutaneous lymphoma and has been seen a year or more before the other skin findings of cutaneous lymphoma are seen.1
Alopecia due to cutaneous lymphoma can be reversed.
Treatment of the cutaneous lymphoma often leads to re-growth of hair. However, even in patients with seemingly complete resolution of skin disease, hair loss can still persist.1
Alopecia is not only caused by cutaneous lymphoma itself but may also be seen secondarily as a side effect of treatments. Many commonly used treatments including interferons (38%), oral bexarotene (<10%), vorinostat (19%), methotrexate (<10%) and others have been associated with alopecia; the percent of patients who have experienced this side effect is listed in parentheses. Though bexarotene has been associated with causing hair loss, one study found that the gel and oral capsules may also lead to partial re-growth of hair.3 Most of the time treatment-related hair loss is reversible, but the hair may never reach the same level of thickness as before.
Local and total body radiation can also cause hair loss in the areas being treated. In contrast to chemotherapy induced alopecia, hair loss due to radiation is more frequently permanent. Patients who undergo lower doses of radiation therapy have a higher possibility of new hair growth. Re-growth, when it occurs, usually begins 3-6 months after the resolution of chemotherapy or radiation.
Other common treatments for alopecia associated with cutaneous lymphoma include topical or intralesional steroids, Biotin supplementation, topical minoxidil, phototherapy, as well as others. Combining treatment of cutaneous lymphoma itself along with a specific alopecia therapy may provide the best chance at hair re-growth.
(1) Bi MY, Curry JL, Christiano AM, Hordinsky MK, Norris DA, Price VH, Duvic M. The spectrum of hair loss in patients with mycosis fungoides and Sézary syndrome. J Am Acad Dermatol. 2011 Jan;64(1):53-63.
(2) Gerami P, Rosen S, Kuzel T, Boone SL, Guitart J. Folliculotropic mycosis fungoides: an aggressive variant of cutaneous T-cell lymphoma. Arch Dermatol. 2008 Jun;144(6):738-46.
(3) Hanson M, Hill A, Duvic M. Bexarotene reverses alopecia in cutaneous T-cell lymphoma. Br J Dermatol. 2003 Jul;149(1):193-6.