Limitations of Treatment-Induced Alopecia Grading Instruments in Evaluating Therapeutic Response
Abstract
BACKGROUND: The Common Terminology Criteria for Adverse Events (CTCAE) is one of the numerous instruments for grading hair loss through clinical estimation of hair density and subsequent categorization of alopecia severity that is widely used in oncology clinical trials. However, there is a paucity of literature investigating the comparative diagnostic performance of recommended granular severity grading instruments and the CTCAE for anticancer therapy-induced alopecia. The aim of this retrospective observational study is to evaluate the ability of the Dean Scale to accurately capture clinician reported therapeutic response to minoxidil in patients with anticancer therapy-induced alopecia.
RESULTS: A ROC curve was generated to determine the diagnostic accuracy of the Dean Scale and CTCAE scale. Comparatively, the area under the ROC curve was 0.74 (95%CI: 0.62-0.83) for the Dean Scale and 0.55 (95% CI: 0.48-0.61) for the CTCAE scale (Chi-square AUC comparison, p=0.0005). These results suggest that the CTCAE scale was not responsive to change in hair density and no better than random at assessing clinician-reported moderate to significant improvement of hair loss. Despite the superior diagnostic performance observed with the Dean scale, regrowth was not captured in 45.8% (n=11) of patients with moderate-to-significant clinical response.
CONCLUSIONS: The results of this study highlight the limitations of the classification methods commonly used for anticancer therapy-induced alopecia, which may lack the precision to capture clinically significant hair regrowth. To accurately track disease progression, dermatologists should consider wide adoption of the SALT II severity classification and/or the addition of objective trichoscopic evaluations to commonly used alopecia grading scales for treatment-related alopecia.
Keywords: Alopecia, Common Terminology Criteria for Adverse Events (CTCAE), Dean Scale, severity, grading
How to Cite:
Minta, A., Ueltschi, O., Rose, L., Kaffenberger, B. H., Trovato, S. & Dulmage, B., (2026) “Limitations of Treatment-Induced Alopecia Grading Instruments in Evaluating Therapeutic Response”, Academic Dermatology 4(1), 1-5. doi: https://doi.org/10.18061/ad.5790
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