Patterns of hair loss and regrowth after autologous hematopoietic stem cell transplantation: a trichoscopic perspective

Background Chemotherapy-induced alopecia is a distressing adverse effect of cancer therapy. Autologous hematopoietic stem cell transplantation (AHSCT) is widely used for hematological malignancies, yet limited data exist on longitudinal trichoscopic changes post-AHSCT. Objective To assess the severity, progression, and trichoscopic characteristics of hair changes following AHSCT and to evaluate correlations with chemotherapy regimen and clinical factors. Patients and methods A 6-month prospective observational study was conducted on 81 patients post-AHSCT. Scalp hair loss was quantified using the Severity of Alopecia Tool score. Trichoscopy was performed monthly using a handheld dermoscope (DermLite DL5). Patients were followed up monthly for 6 months. Results Black dots decreased significantly from 39.5 to 16.0% ( P =0.001). Terminal hairs increased from 75.3 to 98.8% ( P =0.001), and vellus hairs increased from 86.4 to 98.8% ( P =0.002). Scalp hair loss improved progressively, with 92.6% of patients showing less than 25% loss at month 6 compared with 63% at baseline ( P <0.001). Younger age was significantly associated with faster improvement ( P =0.04). Conclusion AHSCT‑related alopecia demonstrates a predictable pattern of clinical and trichoscopic improvement. Younger age may predict faster recovery. These findings aid in patient counseling and monitoring post-AHSCT.