Anticipating an altered appearance: Women undergoing chemotherapy treatment for breast cancer

Chemotherapy treatment for cancer can have a profound impact on appearance, and is often experienced as distressing. Few qualitative studies explore experiences of chemotherapy, and seldom focus on the process of anticipation and preparation for an altered appearance. We report findings from an interview study of 19 women which explored their expectations of chemotherapy-induced hair loss, their anticipated reactions to hair loss and how women intend to prepare for an altered appearance. The results demonstrate that women are active in anticipating hair loss and adopt a range of different strategies to manage their alopecia--even before it has occurred. Four key themes were identified: (a) anticipating hair loss, (b) coming to terms with the inevitability of hair loss, (c) becoming ready, and (d) taking control. We argue that this can be seen as a form of anticipatory coping, which involves affective and behavioural rehearsal so that women can feel more in control of their experience of the side effects of chemotherapy treatment for cancer. We suggest seeing these activities as a form of anticipatory coping, and understanding the psychological reasons why women engage in these activities, may help nursing professionals to better support women through this often traumatic time.     

Anticipatory coping: taking control of hair loss

Many women consider hair loss to be one of the most difficult and feared side effects of chemotherapy treatments. On learning they will likely lose their hair, women immediately begin anticipating the event and its impact on themselves and others. Anticipation of an unwanted event can lead to greater anxiety, fear, or depression, particularly if women see or find no options for gaining some sense of control. Anticipatory coping is the process of anticipation and preparation for an expected altered appearance. By researching options, making deliberate choices, and taking specific actions to determine their appearance without hair, women gain a greater sense of control of their changing appearance. This greater sense of control may ease or lessen feelings of fear and depression and help women to take control of other aspects of their lives that contribute to a greater quality of life during cancer treatment. Oncology nurses are in a unique position to help women turn their anxiety about hair loss into an anticipatory coping process, one that increases women's sense of control over some of the outward changes taking place in their bodies and empowers them to make proactive choices regarding their overall response to cancer.     

Locks of love.

Locks of Love is a nonprofit organization that provides custom hairpieces to financially disadvantaged children under age 18 across the United States who are suffering from long-term medical hair loss. This article will provide information to those readers who wish to cut their long hair and donate it to a needy child or to those who may simply be interested in learning more about this organization.     

Hair loss. Common congenital and acquired causes

Hair loss is a common problem likely to be encountered by a clinical practitioner. The most frequent causes of hair loss in pediatric patients include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. In the adult population, causes to be considered are alopecia areata and hair loss associated with systemic disease and hormonal influence. The clinician must be able to separate the types and causes of hair loss into those that reflect primary dermatologic conditions and those that represent reaction to systemic disease.     

Can stress make you lose your hair?

Many individuals are frightened by hair loss and are hesitant to speak about it. Many are unaware that stressors can causes hair loss and that hair care practices and habits can aggravate a hair loss situation. Intervention by the nurse in encouraging a person to have an adequate assessment and work-up can facilitate an accurate diagnosis. Supportive and appropriate therapy can then be arranged. The hair tells a story and can be associated with good health.     

Diffuse hair loss in women

The complaint "Doctor, I am losing my hair" represents a particular challenge to the physician, and involves making a specific diagnosis, selecting an appropriate therapy, and expressing empathy for the patient's anxiety. Diffuse hair loss in women was formerly classified as an entity of its own. Since the identification of female pattern hair loss, most cases have been recognized to be due to androgenetic alopecia, often during phases of life characterized by fluctuations of sexual hormone levels or in connection with intake or cessation of hormonal therapy. The most difficult differential diagnosis includes androgenetic alopecia, chronic telogen effluvium, and psychogenic pseudo efflvuium. Androgenetic alopecia is due to androgen-induced, non-synchronized, progressive shortening of the hair growth cycle and gradually leads to thinning of the central scalp area. Idiopathic chronic telogen effluvium typically occurs in women, starting abruptly without a recognizable initiating factor, and involves the entire scalp area with increased shedding of telogen hair. It is believed to be due to synchronization phenomena of the cyclic hair growth. Psychogenic pseudo effluvium affects fashion-oriented, self-conscious women suffering of a discrepancy between the actual state of their hair and idealized expectations. Later the problem of age-related hair thinning oft becomes a surrogate for the more generalized problem of senescence. Rational therapy of androgenetic alopecia aims at blocking the androgen effect on hair follicles with estrogens and antiandrogens or at pharmacologically reversing vellus hair transformation with topical minoxidil. In contrast, women with idiopathic chronic telogen effluvium should be reassured that their problem is rather a state of exaggerated "hair shedding" than of actual "hair loss".     

Hirsutism

Hirsutism is defined as the excessive growth of terminal hair on the face and body of a female in a typical male pattern distribution. Hirsutism is a common clinical problem in women and the treatment depends on the cause of hirsutism. Untreated hirsutism can be associated with considerable loss of self-esteem and psychological morbidity. Hyperandrogenemia is the key trigger for excess hair growth. Polycystic ovary syndrome and idiopathic hirsutism are the most common cause of hirsutism. As with all medical problems, investigation begins with a careful history, examination and then investigation directed at the possible cause. A raised serum testosterone level of > 150 ng/dl (5.2 nmol/l) should prompt further investigations to exclude an underlying androgen-secreting tumour. The treatment of hirsutism is most effective using combination therapy, including lifestyle therapies, androgen suppression, peripheral androgen blockage and cosmetic treatments. Women should be warned not to expect improvement or at least 3-6 months after therapy is begun and lifelong therapy may be needed to prevent recurrence. The current review discusses definition, pathogenesis, differential diagnosis, diagnostic strategies, management, guidelines and the authors' recommendations about hirsutism.     

Common hair loss disorders

Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, dose attention to the appearance of the hair loss, and a few simple studies can quickly narrow the potential diagnoses. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women. The U.S. Food and Drug Administration has approved topical minoxidil to treat men and women, with the addition of finasteride for men. Telogen effluvium is characterized by the loss of "handfuls" of hair, often following emotional or physical stressors. Alopecia areata, trichotillomania, traction alopecia, and tinea capitis have unique features on examination that aid in diagnosis. Treatment for these disorders and telogen effluvium focuses on resolution of the underlying cause.     

干细胞在听觉损伤治疗中的运用前景

目的:总结近年来国内外有关干细胞在修复毛细胞丢失和损伤的研究近况,探讨干细胞替代疗法在听觉损伤方面的研究进展。资料来源:应用计算机检索Elsevier数据库1990-01/2005-05相关听觉损伤及干细胞修复的文献,检索词“stemcellsandhearingcellregeneration”。资料选择:对搜集的文献进行筛选。纳入标准:①毛细胞损伤与丢失。②听觉损伤与修复。③干细胞替代疗法治疗听觉损伤。排除标准:①干细胞的致瘤性。②综述文献、重复研究。资料提炼:共收集54篇关于听觉损伤修复文献,纳入17篇符合标准的文献,9篇文献对干细胞运用进行分析评价。资料综合:内耳细胞尤其是毛细胞及相关的神经元损伤丢失可导致听觉损伤和平衡觉失调。由于哺乳动物前庭和耳蜗毛细胞的再生修复能力非常有限,因此通常认为毛细胞的损伤丢失是导致感音神经性聋的主要成因,并且靠自身是无法再生与修复。细胞替代疗法在治疗耳聋性疾病方面具有广阔的运用前景,是近年来听觉研究领域十分关注的热点。移植治疗耳聋的最佳方法是利用耳源性干细胞。最近,研究者分别从刚出生大鼠的柯蒂氏器和成年小鼠的前庭椭圆囊分离出胚胎样多分化潜能的干细胞,内耳干细胞将是重塑毛细胞再生和恢复听觉功能的重要细胞源。结论:干细胞在治疗毛细胞丢失引发的听觉损伤方面具有重要价值,随着研究的深入细胞替代疗法必然呈现诱人的前景。     

Atoh1 gene therapy in the cochlea for hair cell regeneration

Introduction: The sensory epithelium of the cochlea is a complex structure containing hair cells, supporting cells and auditory nerve endings, all of which degenerate after hearing loss in mammals. Biological approaches are being considered to preserve and restore the sensory epithelium after hearing loss. Of particular note is the ectopic expression of the Atoh1 gene, which has been shown to convert residual supporting cells into hair cells with restoration of function in some cases.

Areas covered: In this review, hair cell development, spontaneous regeneration and hair cell regeneration mediated by Atoh1 gene therapy in the cochlea are discussed.

Expert opinion: Gene therapy can be safely delivered locally to the inner ear and can be targeted to the sensory epithelium of the cochlea. Expression of the Atoh1 gene in supporting cells results in their transformation into cells with the appearance and function of immature hair cells but with the resulting loss of the original supporting cell. While the feasibility of Atoh1 gene therapy in the cochlea is largely dependent on the severity of the hearing loss, hearing restoration can be achieved in some situations. With further advances in Atoh1 gene therapy, hearing loss may not be as permanent as once thought.     

Removal of unwanted facial hair

Unwanted facial hair is a common problem that is seldom discussed in the primary care setting. Although men occasionally request removal of unwanted facial hair, women most often seek help with this condition. Physicians generally neglect to address the problem if the patient does not first request help. The condition may be caused by androgen overproduction, increased sensitivity to circulating androgens, or other metabolic and endocrine disorders, and should be properly evaluated. Options for hair removal vary in efficacy, degree of discomfort, and cost. Clinical studies on the efficacy of many therapies are lacking. Short of surgical removal of the hair follicle, the only permanent treatment is electrolysis. However, the practice of electrolysis lacks standardization, and regulation of the procedure varies from state to state. Shaving, epilation, and depilation are the most commonly attempted initial options for facial hair removal. Although these methods are less expensive, they are only temporary. Laser hair removal, although better studied than most methods and more strictly regulated, has yet to be proved permanent in all patients. Eflornithine, a topical treatment, is simple to apply and has minimal side effects. By the time most patients consult a physician, they have tried several methods of hair removal. Family physicians can properly educate patients and recommend treatment for this common condition if they are armed with basic knowledge about the treatment options.     

Noise-induced hearing loss: the family physician's role

Noise is an environmental health problem that has not received sufficient attention. Physicians should become knowledgeable about the medical consequences of excessive noise, support legislation to reduce the problem and promote programs aimed at noise control and prevention of hearing loss. Questions about noise and hearing should be incorporated into the medical history, and pure-tone audiometry should be a part of periodic physical evaluations.     

Idiopathic hirsutism: excessive bodily and facial hair in women

Hirsutism is the excessive and increased bodily and facial hair growth in women in locations where hair is normally minimal or absent. It refers to the growth of hair in a pattern normally occurring only in men, and therefore primarily raises psychological, cosmetic and social concerns. Idiopathic hirsutism (IH), where the cause of excessive hair growth is unknown, is considered to be the most common form of hirsutism. It is suspected that this type of hirsutism may be familial, as there is often a family history of the condition. Women with IH will generally have normal menses and normal levels of testosterone. There are many treatment modalities that fall into two broad groups: medical and mechanical treatment. An example of a medical treatment is when an agent is used, which interferes with the synthesis of androgen at the ovarian or adrenal level, or by inhibiting the effect of androgen at the receptor level. An example of a mechanical treatment is laser hair removal, where the hair follicle is destroyed; however, much depends on the on the skill of the treating practitioner, laser type, laser spot size, skin type, hair colour, and the stage at which the hair follicles were during their hair growth cycle, and the delivered wavelength. Laser offers the fastest method of hair loss. Other mechanical treatments include electrolysis, depilatory creams, plucking and waxing. This article presents a general overview of IH, including a definition, diagnostic measures, clinical manifestations, normal and abnormal physiology, and treatment options.     

Progress and prospects: gene therapy for performance and appearance enhancement

While medical therapies aim at reversing, reducing or eliminating diseases, the goal of enhancements is to improve performance or appearance beyond normal levels. Distinction between the two interventions is not always clear as they often present as a continuum. Gene therapy typically aims at treating or preventing disease, but the technology can theoretically be employed for enhancement. Some of the gene therapy enhancement strategies include improving performance by increasing muscle mass, endurance, memory, and cognition and bettering appearance by controlling weight, height and hair growth. In addition to the technical challenges of making enhancement strategies safe and effective, genetic enhancement presents significant ethical/societal questions that must be addressed.     

Unusual loss of body hair in childhood: Trichotillomania or alopecia

Hair loss (alopecia) is a relatively common problem in childhood and the underlying pathophysiology and manifestations are diverse. We report four cases of hair loss with unusual distributions and discuss the outcome of their management.One child had alopecia with unilateral loss of hair over the eyebrow. He received topical corticosteroids and tacrolimus and his condition resolved. A girl had scalp alopecia which evolved to alopecia universalis. The mother and the child were non-compliant with treatment. A boy had alopecia totalis not responsive to Western or alternative treatment. The fourth child had trichotillomania and bizarre loss of scalp hair. Mother and child received psychological counselling and the child's hair loss improved. It is important to differentiate between alopecia and trichotillomania as the management is very different. Diagnosis and treatment are based on clinical assessment, evaluation of coexisting psychosocial factors and exclusion of autoimmune and other underlying disorders. In alopecia totalis or universalis, alternative therapy is often sought and tried for prolonged periods but efficacy has remained unproven. These cases serve to illustrate the principles of management of children with unusual patterns of hair loss.     

Psychological effect, pathophysiology, and management of androgenetic alopecia in men

Androgenetic alopecia In men, or male pattern baldness, is recognized increasingly as a physically and psychologically harmful medical condition that can be managed effectively by generalist clinicians. This article discusses the clinical manifestations, epidemiology, physical and psychosocial importance, pathophysiology, diagnosis, and management of androgenetic alopecia in men. Androgenetic alopecia affects at least half of white men by the age of 50 years. Although androgenetic alopecia does not appear to cause direct physical harm, hair loss can result in physical harm because hair protects against sunburn, cold, mechanical injury, and ultraviolet light. Hair loss also can psychologically affect the balding individual and can Influence others' perceptions of him. A progressive condition, male pattern baldness is known to depend on the presence of the androgen dihydrotestosterone and on a genetic predisposition for this condition, but its pathophysiology has not been elucidated fully. Pharmacotherapy, hair transplantation, and cosmetic aids have been used to manage male pattern baldness. Two US Food and Drug Administration-approved hair-loss pharmacotherapies-the potassium channel opener minoxidil and the dihydrotestosterone synthesis inhibitor finasteride--are safe and effective for controlling male pattern baldness with long-term daily use. Regardless of which treatment modality is chosen for male pattern baldness, defining and addressing the patient's expectations regarding therapy are paramount in determining outcome.     

Hair loss. What causes it and what can be done about it

Although both men and women throughout history have seen hair as an important aspect of appearance, it is especially important today, in light of the great emphasis on youthfulness. A new interest in preventing baldness has been stimulated recently by the publicity given to certain products now under investigation that have shown an ability to retard or reverse male pattern baldness in certain individuals. Hair loss has many possible causes, such as systemic diseases, infections, toxic agents, and hormone imbalances. Treatment of the underlying disorder alleviates the shedding of hair. Balding may also be a normal physiologic occurrence in women taking oral contraceptives or after parturition and in men with male pattern baldness. The latter can be treated topically with progesterone or minoxidil. Minoxidil has been studied extensively and has been shown to improve balding at the vertex of the scalp, particularly in young men who have only begun to lose hair. Cases of more extensive male pattern baldness and baldness secondary to scarring can be treated effectively with surgical procedures.     

头部冷疗装置在乳腺癌患者化疗所致脱发中的应用效果

目的 探讨头部冷疗装置在乳腺癌患者化疗所致脱发中的应用效果.方法 选取2018年10月至2019年5月在我院普外科住院的60例乳腺癌患者为研究对象,将2018年10月至2019年1月住院的30例乳腺癌患者作为对照组,2019年2月至5月住院的30例乳腺癌患者作为观察组,其中对照组3例脱落,观察组2例脱落,最终对照组共纳...     

The impact of cancer and chemotherapy: Perceptual similarities and differences between cancer patients, nurses and physicians

BACKGROUND: An essential condition to provide optimal care to cancer patients is a thorough understanding of the worries and needs of these patients. PURPOSE: To assess and compare perceptions about the impact of cancer and chemotherapy of health-care providers and patients. METHODS: Breast cancer survivors (N=80), oncology nurses (N=41) and physicians (N=49) with oncology experience completed a psychophysical scaling method with items tapping both the physical and psychosocial effects of cancer and chemotherapy. RESULTS: The following five issues ranked highest among patients: fear of metastases, fatigue, consciousness of one's own vulnerability, hair loss and nausea. Whereas there was a strong correspondence between the ratings of nurses and physicians, both groups grossly overestimated and underestimated various issues. For example, the effects on relationships with partners and children were greatly overestimated by nurses, while physicians underestimated hair loss the most. CONCLUSIONS: There was a considerable discrepancy on various issues between perceptions of patients and medical professionals. CLINICAL IMPLICATION: The observed lack of correspondence between patients and health-care providers may result in inappropriate provision of attention and health care. Methods have to be developed to assess easily the main needs and worries of individual patients, which is an essential condition to be able to provide optimal care.