1. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients 
Athina Fonia, MRCP, Carlo Cota, MD, Jane F. Setterfield, FRCP, Lynne J. Goldberg, MD, David A. Fenton, FRCP, Catherine M. Stefanato, MD, FRCPath 
Journal of the American Academy of Dermatology 
Volume 76, Issue 5, Pages (May 2017)
DOI: /j.jaad
Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

2. Fig 1
Patient 1, type A clinical pattern of alopecia. Diffuse scalp hair loss involving the (A) occiput, (B) vertex, and (C) temporal areas.
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
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3. Fig 2
Patient 1. Histopathology of type A clinical pattern of alopecia. A, Isthmus. Note the preservation of the follicular units with diffuse “shift out of anagen” and “follicular inertia” of miniaturized telogen and intermediate/vellus-sized hair follicles. B, Higher power showing a stellate morphology of the miniaturized telogen hair follicles. C, Subisthmus. Numerous end-stage fibrous tracts. D, Detail showing loss of vascularity and a characteristic solar elastosis–like appearance with obliteration. (Hematoxylin–eosin stain; original magnification: A and C, ×40; B and D, ×200.)
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

4. Fig 3
Patient 3, type B clinical pattern of alopecia. A and B, Hair regrowth after minoxidil 5% treatment in this patient who presented with diffuse scalp alopecia with accentuation on the vertex of the scalp. Note thinning of the temporal area. C, Biopsy specimen obtained from the vertex of the scalp before hair regrowth (clinically involved area). Isthmus: histopathology showing preservation of the follicular units with increased telogen hair follicles and miniaturization. D, Miniaturization with variation of hair follicle size, consistent with female pattern hair loss. E, A dysmorphic telogen hair follicle at 6 o'clock and an anagen hair follicle at 12 o'clock. (Hematoxylin–eosin stain; original magnification: C, ×40; D and E, ×200.)
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions

5. Fig 4
Patient 3, histopathology of type B clinical pattern of alopecia. Biopsy specimen obtained from the occiput of the scalp before hair regrowth (clinically uninvolved area). A, Subisthmus. Miniaturization with variation in hair follicle size of anagen hair follicles. B and C, Peribulbar lymphoid cell infiltrate involving also the inferior follicular segments of miniaturized hair follicles. D, Isthmus. A dysmorphic telogen hair follicle (at 9 o'clock) with an anagen terminal hair follicle (middle) and an anagen vellus hair follicle (at 1 o'clock). (Hematoxylin–eosin stain; original magnification: A, ×40; B and C, ×400; D, ×200.)
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
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6. Fig 5
Patient 10, type C clinical pattern of alopecia. A, Patchy hair loss on a background of a diffuse hair loss with (B) occipital involvement in an ophiasis-like pattern. C, Biopsy specimen obtained from the vertex of the scalp. Histopathology of vertical sections shows an atrophic epidermis with miniaturized hair follicles in the dermis and subcutaneous tissue with numerous end-stage fibrous tracts and a dysmophic telogen hair follicle (inset). D, Detail of the end-stage avascular obliterated fibrous tracts with solar elastosis–like appearance. (Hematoylin–eosin stain; original magnification: C, ×40; inset and D, ×200.)
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
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7. Fig 6
Patient 10. Histopathology of type C clinical pattern of alopecia. Biopsy specimen obtained from the vertex of the scalp. A, Isthmus. Histopathology of horizontal sections showing preservation of the follicular units with diffuse miniaturization and (B) numerous vellus hair follicles. C, Subisthmus. Peribulbar lymphoid cell infiltrate involving also the inferior follicular segment. D, Another inferior segment of a hair follicle with lymphoid cell infiltrate and pigment casts. (Hematoxylin–eosin stain; original magnification: A, ×40; B, ×100; C, ×200; D, ×400.)
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
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8. Fig 7
Chemoinflammatory and hormonal hair follicle cycle disruption steps. A, Taxane attacking the hair bulb of an anagen hair follicle inducing an anagen effluvium. B, Disrupted peribulbar area of immune privilege loss with bulbar antigen exposure triggering alopecia areata–like features, including peribulbar lymphoid cell infiltrate, shift out of anagen with “inflammatory” telogen effluvium, and miniaturization. C, The residual hair follicles with underlying obliterated end-stage fibrous tracts cannot recycle and are “arrested” in a status of “follicular inertia.” D, Further miniaturization caused by adjuvant antiestrogen hormonal therapy imparting features of female pattern hair loss (FPHL).
Journal of the American Academy of Dermatology  , DOI: ( /j.jaad )
Copyright © 2016 American Academy of Dermatology, Inc. Terms and Conditions