Cancer-Related Alopecia Risk and Treatment.

Opinion statement: Cancer-related alopecia (CRA) presents a significant challenge for many patients undergoing cancer treatment, often affecting their psychological well-being and sense of identity. In my opinion, the optimal management of CRA requires a proactive, personalized approach that prioritizes both prevention and regrowth, while taking into account the type of cancer therapy, patient goals, and overall clinical context. For patients receiving chemotherapy, especially taxane- or anthracycline-based regimens, scalp cooling should be offered as a first-line preventative option whenever feasible. Its demonstrated effectiveness, particularly when appropriately sequenced with chemotherapy agents, makes it a valuable tool in preserving hair and quality of life. For patients with contraindications to scalp cooling or limited access to this intervention, early counseling and support around hair loss expectations and coping strategies remain critical. In terms of regrowth, topical minoxidil remains the most evidence-based pharmacologic option and should be recommended, especially for patients with endocrine therapy- or chemotherapy-induced alopecia. While oral minoxidil shows promise, it should be used with caution until more robust safety data are available in oncology settings. Spironolactone, tretinoin, prostaglandin analogs, and red light therapy may be considered in select cases, especially when standard options are insufficient, though patients should be counseled on the limitations of available evidence. Ultimately, a patient-centered, multidisciplinary approach is key to optimizing outcomes in CRA care.