Scalp Cooling to Prevent Chemotherapy-Induced Alopecia

June 2020 in “ Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia ”

Giselle de Barros Silva, Kathryn Ciccolini, Aline Donati, Corina van den Hurk

chemotherapy-induced alopecia scalp cooling chemotherapy CIA

Studysummary This paper provides an overview of scalp cooling as an effective and safe intervention for preventing chemotherapy-induced alopecia, addressing its impact on cancer patients and survivors.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The document reviewed the effectiveness of scalp cooling in preventing chemotherapy-induced alopecia (CIA) and concluded that it significantly reduced hair loss in patients undergoing chemotherapy, particularly with drugs like anthracyclines and taxanes. Scalp cooling worked by lowering scalp temperature, reducing follicular drug uptake, and protecting hair follicles. The procedure was generally well-tolerated, with common adverse effects including headaches, nausea, and coldness, and did not increase the risk of scalp metastases. However, it was not recommended for patients with hematologic malignancies or cold-precipitated diseases. The findings supported scalp cooling as a viable method to improve the quality of life for cancer patients by mitigating hair loss, though long-term follow-up studies were needed.

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Research cited in this study

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43 citations , March 2019 in “JAMA Dermatology”

This study found that persistent chemotherapy-induced alopecia is often more severe and diffuse than alopecia from endocrine therapy, with both conditions negatively impacting patients' emotional wellbeing, and moderate to significant improvement was observed with dermatologic therapy.

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4 citations , February 2019 in “Breast Cancer Research and Treatment”

This study found that applying a 1% sodium N-(dihydrolipoyl)-l-histidinate zinc complex lotion to the scalp did not prevent chemotherapy-induced alopecia in breast cancer patients, but it may aid recovery.

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9 citations , February 2019 in “BMC cancer”

This study found that M30 may protect against cyclophosphamide-induced alopecia in mice by enhancing hair growth and preventing abnormal hair, suggesting its potential as a treatment.

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59 citations , August 2018 in “The oncologist”

This study found that permanent chemotherapy-induced alopecia was relatively common three years after treatment among breast cancer patients receiving adjuvant chemotherapy, particularly those on taxane-based regimens.

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23 citations , July 2018 in “Journal of Cosmetic Dermatology”

This study describes a distinct pattern of trichoscopic features associated with chemotherapy-induced alopecia and how these features evolve through different phases of chemotherapy treatment.

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53 citations , April 2018 in “Journal of The American Academy of Dermatology”

This article reviews therapy-related hair disorders in oncology patients, detailing underlying mechanisms and potential management strategies, but reports no new clinical findings.

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34 citations , January 2018 in “International Journal of Dermatology”

This review discusses chemotherapy-induced alopecia, highlighting its pathogenesis, clinical patterns, and current therapeutic approaches, with no new clinical results reported.

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37 citations , October 2017 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This literature review reported that scalp hypothermia significantly decreases the occurrence of chemotherapy-induced alopecia, increasing effectiveness by 2.7-fold in controlled clinical trials and 3.9-fold in randomized trials, and highlighted a need for standard guidelines for its use.

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38 citations , September 2017 in “Oncologist”

This source reports that scalp cooling is currently the only safe and FDA-cleared method to potentially reduce chemotherapy-induced hair loss, with about a 50% chance of maintaining sufficient hair to avoid needing a wig.

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48 citations , February 2017 in “Journal of Cosmetic Dermatology”

This proposal reviews current knowledge and suggests actions for managing chemotherapy‐induced alopecia but reports no new clinical results, highlighting the need for evidence‐based guidelines.

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21 citations , September 2016 in “Breast”

This study investigated scalp cooling in breast cancer patients undergoing chemotherapy, finding that those who reached a lower mean scalp skin temperature of 18 °C during cooling were less likely to require a wig or head covering compared to those with higher temperatures.

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22 citations , May 2016 in “Breast cancer research and treatment”

This study reported cold thermal injuries on the scalp in four patients using cold caps to prevent chemotherapy-induced alopecia, suggesting improper application can lead to adverse events.

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15 citations , January 2015 in “Skin Pharmacology and Physiology”

This study indicates that targeting the PTH/PTHrP receptor may potentially stimulate hair growth, particularly for chemotherapy-induced alopecia, as observed in hairless and cyclophosphamide-treated mice.

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This study found that scalp cooling significantly reduced the risk of chemotherapy-induced alopecia in breast cancer patients, while topical minoxidil and other interventions did not show significant efficacy.

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52 citations , November 2013 in “Journal of Pain and Symptom Management”

This narrative review evaluates evidence that regional hypothermia can reduce oral, hair, eye, and nail complications from chemotherapy, but highlights the need for more research to address study limitations.

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218 citations , January 2013 in “The Lancet Oncology”

This review discusses the pathobiology of chemotherapy-induced alopecia and highlights challenges in managing it, reporting no new clinical results and emphasizing the need for well-designed preclinical models to develop effective treatments.

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This study describes permanent scalp alopecia in patients receiving chemotherapy, radiation, or both, and highlights the need for further research to identify causative factors and mitigation strategies.

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103 citations , December 2011 in “Journal of the American Academy of Dermatology”

This review discusses current knowledge and management strategies for chemotherapy-induced alopecia, highlighting the need for better research prioritization and providing patient support materials, but reports no new clinical results.

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64 citations , July 2011 in “Dermatologic Therapy”

This review discusses treatments for chemotherapy-induced alopecia, highlighting scalp cooling for hair loss prevention and 2% topical minoxidil for regrowth acceleration as effective options, but reports a need for more rigorous trials to validate promising new therapies.

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44 citations , November 2010 in “Current Opinion in Supportive and Palliative Care”

This review discusses interventions for chemotherapy-induced hair loss and reports no new clinical results; scalp cooling and nutritional support are considered potential strategies but not yet substantiated.

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This study found that in women undergoing chemotherapy after breast surgery, topical minoxidil significantly shortened the duration of hair loss compared to a placebo without significant side effects.

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In this study, AS101 combined with chemotherapy significantly reduced the severity of chemotherapy-induced alopecia in non-small-cell-lung-cancer patients and may involve immune mechanisms related to IL-1 and PGE2.

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In this study, scalp hypothermia with the Theracool™ cooling machine was largely ineffective for preventing alopecia in breast cancer patients undergoing a chemotherapeutic regimen including cyclophosphamide and anthracyclines.

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26 citations , January 1992 in “Cancer investigation”

This study found that N-acetylcysteine effectively prevented cyclophosphamide-induced alopecia in rats, and ImuVert plus N-acetylcysteine prevented alopecia from a cyclophosphamide-cytarabine combination.

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53 citations , June 1982 in “The BMJ”

Cooling the scalp below 22°C before and during chemotherapy can help prevent hair loss.