Chemotherapy-Induced Hair Loss
Chemotherapy can be used to cure or control the spread of cancer1. Chemotherapy treatments are commonly associated with side effects as cytotoxic drugs can have a damaging impact on healthy cells2. Hair loss can be a distressing side effect of chemotherapy treatments, influencing a patient’s body image and self-esteem3,4.The extent of chemotherapy-induced hair loss is dependent on the drug, dose and hair care practices used throughout treatment5. This type of hair loss is usually reversible as hair growth typically occurs 3 to 6 months posttreatment6.
Scalp Cooling Systems
To help prevent chemotherapy-induced hair loss, scalp cooling systems can be used during treatment. Scalp cooling can help reduce chemotherapy-induced hair loss in two ways. First, the cooling effect created by these systems can decrease blood flow to the scalp thereby reducing the amount of cytotoxic agents that reach follicular cells7. Minimizing the amount of cytotoxic exposure can decrease the amount of follicular damage. Secondly, scalp cooling can also slow down hair follicle activity, reducing cell division. This can also help to reduce the amount of follicle damage caused by chemotherapy8.
Scalp cooling systems can come in all shapes and sizes. Some, such as ice or gel cap systems, don’t restrict patients to a seated position and are quite affordable as they only require space in the freezer to maintain their cold temperature. Despite their simplicity, these systems do come with drawbacks. Caps can be quite heavy and replacement of ice/gel may need to occur mid-way through the application period in order to maintain low enough temperatures8.
The benefits of using scalp cooling systems do outweigh their disadvantages9. Across 6 randomized studies, a significant advantage of using the scalp cooling in chemotherapy-induced hair loss patients was found10–15. In these studies, over 25% of participants were able to maintain good hair preservation with the use of scalp cooling systems during chemotherapy treatments10–15. Additionally, in a survey of chemotherapy patients, the majority of patients treated with a scalp cooling system were found to be satisfied with their results16.
A relatively new cooling system that has become available for use is the DigniCap® scalp cooling system17. The DigniCap® scalp cooling system consists of two caps; an inner cooling silicone cap and an outer neoprene cap17. The inner cooling cap is connected to the cooling and control unit, controlling the release and temperature of a liquid coolant. This liquid coolant circulates throughout the cooling cap, providing the desired cooling effect17. The outer neoprene cap is used to insulate and secure the inner cooling cap to the patient’s scalp17. This cap system is FDA approved to ‘reduce hair loss in breast cancer patients undergoing chemotherapy’18.
This new cooling system has shown to be effective in clinical trials. In a study using 122 breast cancer patients, over 66% of patients treated with the DigniCap® scalp cooling system found that less than half of their hair was lost18. This is a great result as hair loss is typically only noticed when more than 50% of scalp hair is lost6. These results were reported 1 month after their last chemotherapy cycle, showing that, with this cooling system, patients did not have to wait for 3 to 6 months for hair to grow back18. Side effects found with this system include; headaches, chills, neck and shoulder discomfort18.
It has been noted that the effect of the DigniCap® scalp cooling system could be influenced by the type of chemotherapy used. The effectiveness of the DigniCap® scalp cooling system in 74 cancer patients who received 13 different chemotherapy regimens were evaluated in a nonrandomized study19. Treatment with the cooling system completely prevented hair loss in patients treated with anthracycline whereas a minimal amount of hair loss was found in patients treated with paclitaxel/docetaxel. Since this is one study, firm conclusions about the DigniCap’s effectiveness with specific chemotherapy treatments are premature. However, evidence discussed above demonstrates that scalp cooling systems, including the DigniCap, may reduce hair loss in cancer patients. If you have any questions about scalp cooling systems speak to a Sure Hair representative today.
Article by: Sarah Versteeg MSc, Mediprobe Research Inc.
- How is Chemotherapy Used to Treat Cancer? [Internet]. American Cancer Society. 2016 [cited 2016 Dec 23]. Available from: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/ chemotherapy/how-is-chemotherapy-used-to-treat-cancer
- Chemotherapy Side Effects [Internet]. American Cancer Society. 2016 [cited 2016 Dec 23]. Available from: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/ chemotherapy/chemotherapy-side-effects
- McGarvey EL, Baum LD, Pinkerton RC, Rogers LM. Psychological sequelae and alopecia among women with cancer. Cancer Pract. 2001 Dec;9(6):283–9.
- Münstedt K, Manthey N, Sachsse S, Vahrson H. Changes in self-concept and body image during alopecia induced cancer chemotherapy. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 1997 Mar;5(2):139–43.
- Batchelor D. Hair and cancer chemotherapy: consequences and nursing care–a literature study. Eur J Cancer Care (Engl). 2001 Sep;10(3):147–63.
- Trueb RM. Chemotherapy-Induced Anagen Effluvium: Diffuse or Patterned? Dermatology. 2007;215(1):1–2.
- Bülow J, Friberg L, Gaardsting O, Hansen M. Frontal subcutaneous blood flow, and epi- and subcutaneous temperatures during scalp cooling in normal man. Scand J Clin Lab Invest. 1985 Oct;45(6):505–8.
- Betticher DC, Delmore G, Breitenstein U, Anchisi S, Zimmerli-Schwab B, Müller A, et al. Efficacy and tolerability of two scalp cooling systems for the prevention of alopecia associated with docetaxel treatment. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2013 Sep;21(9):2565–73.
- Grevelman EG, Breed WPM. Prevention of chemotherapy-induced hair loss by scalp cooling. Ann Oncol Off J Eur Soc Med Oncol. 2005 Mar;16(3):352–8.
- Edelstyn GA, MacDonald M, MacRae KD. Doxorubicin-induced hair loss and possible modification by scalp cooling. Lancet Lond Engl. 1977 Jul 30;2(8031):253–4.
- Giaccone G, Di Giulio F, Morandini MP, Calciati A. Scalp hypothermia in the prevention of doxorubicin-induced hair loss. Cancer Nurs. 1988 Jun;11(3):170–3.
- Macduff C, Mackenzie T, Hutcheon A, Melville L, Archibald H. The effectiveness of scalp cooling in preventing alopecia for patients receiving epirubicin and docetaxel. Eur J Cancer Care (Engl). 2003 Jun;12(2):154–61.
- Parker R. The effectiveness of scalp hypothermia in preventing cyclophosphamide-induced alopecia. Oncol Nurs Forum. 1987 Dec;14(6):49–53.
- Ron IG, Kalmus Y, Kalmus Z, Inbar M, Chaitchik S. Scalp cooling in the prevention of alopecia in patients receiving depilating chemotherapy. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 1997 Mar;5(2):136–8.
- Satterwhite B, Zimm S. The use of scalp hypothermia in the prevention of doxorubicin-induced hair loss. Cancer. 1984 Jul 1;54(1):34–7.
- Peerbooms M, van den Hurk CJ, Breed WP. Familiarity, opinions, experiences and knowledge about scalp cooling: a Dutch survey among breast cancer patients and oncological professionals. Asia-Pac J Oncol Nurs. 2015 Mar;2(1):35–41.
- Mount Sinai Health System Launches DigniCap Scalp Cooling System for Women with Breast Cancer [Internet]. Mount Sinai Hospital. 2016 [cited 2016 Dec 23]. Available from: http://www.mountsinai.org/about-us/newsroom/press-releases/mount-sinai-health-system-launches-dignicap-scalp-cooling-system-for-women-with-breast-cancer
- FDA allows marketing of cooling cap to reduce hair loss during chemotherapy [Internet]. FDA U.S. Food and Drug Administration. 2015 [cited 2016 Dec 23]. Available from: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm476216.htm
- Ridderheim M, Bjurberg M, Gustavsson A. Scalp hypothermia to prevent chemotherapy-induced alopecia is effective and safe: a pilot study of a new digitized scalp-cooling system used in 74 patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2003 Jun;11(6):371–7.