Scalp Cooling to Reduce Chemotherapy Associated Hair Loss

Hair loss is one of the most undesirable side effects of cancer treatment and can greatly impact the social and emotional well-being of those taking chemotherapy medications. However, according to a recent clinical trial, there may be hope for people experiencing chemotherapy-induced hair loss.

What Is Scalp Cooling?

Scalp cooling is a technology that has shown encouraging results in preventing hair loss in women undergoing chemotherapy for breast cancer. This device consists of a “cool cap” that is placed on a patient’s head thirty minutes prior to starting a chemotherapy session. The person will continue to wear it during the session and for ninety more minutes afterward. Although new devices are emerging to refine this technology, scalp cooling was first introduced in the 1970s as a way to prevent chemotherapy-induced hair loss.^[1]

The Evidence

In a recent clinical trial, women with breast cancer were divided into the cooling group or the non-cooling group. After four chemotherapy cycles, 50.5% of the cooling group retained the hair on their head.^[2] Another study used scalp cooling in people with lung and breast cancer and achieved successful prevention of hair loss in 81% of patients.^[3] Other clinical studies in both the United States and Europe have shown similar results with over 50% of patients retaining their hair due to scalp-cooling technology.^[4,5] To date, scalp cooling has been deemed safe in patients with breast cancer.^[6]

How Does Scalp Cooling Work?

It is not yet entirely known how scalp cooling has achieved such successful results in preventing chemotherapy-induced hair loss. One theory is that cooling the scalp in the window of time before, during, and after a chemotherapy session constricts the blood vessels supplying the hair follicles, thereby delivering less of the medication to the hair follicles. Additionally, cooler temperatures may decrease the cellular uptake and metabolism of the hair follicular cells, preventing the hair loss inducing effects of the chemotherapy drugs.^[7,8]

There are a few scalp cooling systems currently on the market that are approved for prevention of chemotherapy-induced hair loss. One system uses a “cool cap” before, during, and immediately after each chemotherapy system. This system is described to work by reducing blood flow to the hair follicle.^[2] Another similar scalp cooling system on the market uses a tight-fitting silicone cap with an outer insulating neoprene cap to cool the scalp before, during, and after chemotherapy sessions.^[9] While in session, coolants circulate throughout the cap and sensors within the cap monitor temperatures and autoregulate to keep the temperature low enough, but never below 0 degrees Celsius. 

Future Questions

Further questions remain when considering the use of scalp cooling to prevent chemotherapy-induced hair loss. For instance, what specific temperature should cooling devices be set to and how cold is too cold? Are the patient’s baseline body temperatures taken into account when setting the machine in order to achieve an optimal cooling effect? Hopefully encouraging results from well-designed clinical studies will continue to emerge and more doctors will offer scalp-cooling treatments to all patients undergoing chemotherapy.