Presentation, Impact and Prevention of Chemotherapy-induced Hair Loss

Wim PM Breed; Corina JG van den Hurk; Mijke Peerbooms


Expert Rev Dermatol. 2011;6(1):109-125. 

In This Article

Abstract and Introduction


Background: This article provides an overview of the incidence and severity, presentation and impact of chemotherapy-induced alopecia (CIA), one of the most common and distressing side effects of cancer therapy. Furthermore, prevention of CIA by scalp cooling is described, as well as suggestions for improvement of scalp cooling application and clinical research approaches.
Methods: This article focuses on the availability of options to treat CIA and on scalp cooling in particular. It presents an overview of 58 scalp cooling publications and three personal communications, describing its working mechanism, determinants of success rates, side effects and controversies.
Results: CIA occurs in many chemotherapy regimens and is nearly always reversible. Up to now, scalp cooling is by far the best method to reduce CIA. Concerns about the protection of malignant cells in the scalp skin by scalp cooling have been proven to be exaggerated. The majority of patients tolerate scalp cooling very well. Scalp cooling is cost-effective when compared with purchasing wigs and other head covers. A promising method for objective research on CIA is now used in studies to further improve the method of scalp cooling – that is, cooling times and temperatures.
Conclusion: Scalp cooling is effective but not for all chemotherapy patients. Further psychological, clinical and biophysical research is needed to identify the determinants of success. Scalp cooling should be available in every hospital, and every suitable patient should be given the opportunity, after being well informed by their doctor or nurse, to choose for scalp cooling.


Alopecia, bone marrow suppression and gastrointestinal disturbances are the most important and common side effects of chemotherapy. Extensive research resulted in the development of effective drugs to prevent and manage bone marrow suppression and gastrointestinal disturbances. Considerably less attention has been given to the prevention and management of chemotherapy-induced alopecia (CIA), and up to now this has been the domain of some 'interested' oncology nurses and oncologists. In our opinion, this should be the responsibility of all treating physicians and nurses, who have daily experience of the frequency and impact of CIA.

Since the review by Grevelman and Breed,[1] the only review regarding protection against CIA is from Wang et al. in 2006.[2] However, Wang et al. focused on experimental approaches with pharmacological agents in animal models, while up to now the use of scalp cooling is nearly the only method in clinical practice to prevent CIA.

Although scalp cooling technology has been available for more than 40 years, the usage is rather low, even in chemotherapy schedules in which very good hair preservation can be achieved. We will discuss the most important reasons for this rather low usage and suggest solutions. The purpose of this review is to increase awareness of the impact of CIA, to demonstrate the possibilities of the prevention of CIA by scalp cooling and to stimulate application, registration, evaluation and clinical research to improve patient care. The three major parts of this review are: an overview of the incidence and severity, presentation and impact of CIA; prevention of CIA by scalp cooling; and suggestions for solutions of scalp cooling problems and for clinical research approaches.


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