Persistent radiation-induced alopecia (pRIA), or simply alopecia, is a side effect of radiation therapy to the brain. The condition occurs in patches and is characterized by the permanent loss of hair. The assessment, treatment, and management of alopecia have not been systematically documented. This study aims to evaluate the clinical features, associated factors, and treatment response of pRIA.

This cohort study included a total of 71 patients aged 4-75 years with primary central nervous system (CNS) tumors or head and neck sarcoma who were evaluated for pRIA. The primary outcomes of the study were the clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil.

Of 71 patients included in the study, 64 (90%) had a CNS tumor, and 7 (10%) had head and neck sarcoma. The alopecia severity grade was 1 in 40 fo 70 patients (56%), with localized (54%), diffuse (24%), or mixed (22%) patterns. The median escalated scalp radiation dose 39.6, with a higher dose and proton irradiation being associated with greater alopecia severity. Trichoscopic features predominantly included white patches (57%). A total of 28 patients responded to topical minoxidil.

The research concluded that persistent radiation-induced alopecia was associated with a dose-dependent phenomenon with distinctive trichoscopic and clinical features in patients with primary CNS tumors or head and neck sarcomas.