Presentation, impact and prevention of chemotherapy-induced hair loss: scalp cooling potentials and limitations

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.