Scalp Cooling to Prevent Hair Loss

Scalp cooling can be an effective, easily tolerated method to prevent chemotherapy-induced hair loss chemotherapy-induced hair loss in some patients. Using a variety of different methods, basically scalp cooling is done by a cap placed on the head that is kept continuously cool (either by machine or cap changes). The caps contain either fluid or air. Used while chemotherapy is being administered, scalp cooling works by constricting the blood vessels and blood flow to the hair follicles during the time of peak concentration of the specific drug, reducing the amount of drug the follicles are exposed to.⁽⁴⁾

The type of chemotherapy drug used as well as the dosage and number of treatments required generally influence the effectiveness of scalp cooling in preventing alopecia. Typically success rates are higher with lower dosages, and the highest success rates were found in those using taxane (e.g., paclitaxel) chemotherapy drugs.⁽⁴⁾

Study results indicate that an average of 67% of patients using scalp cooling successfully preserved their hair. Besides drug type and amount of drug used, research suggests that certain factors may influence the success of scalp cooling. These include:⁽⁴⁾

• Lower temperatures produce dramatically better results.
• Wetting the hair is advised by some experts.
• Proper cap fitting that maintains contact with all areas of the scalp.
• Longer cooling times are associated with better outcomes in some studies, but not in others.
• Previous chemotherapy may reduce success rates.
• Ethnic hair texture differences (less successful in Afro-American hair types).
• Impaired liver function may reduce success rates (because the chemotherapy drug takes longer to peak and clear the system).

Is Scalp Cooling Safe to Use?

Some experts suggest that scalp cooling should also be avoided in any cancer that may be disseminated (based on a single case of scalp metastasis in a study involving 61 patients with disseminated breast cancer). Certainly there was some concern raised by the medical community that inhibiting the effects of chemotherapy drugs might cause metastasis of the original cancer to the scalp. However, analyses of thousands of cases have found the risk to be extremely unlikely. The fear of brain metastasis as a result of scalp cooling is thought to be unfounded since the procedure does not decrease brain temperature to any significant extent.^(4, 163)

Still, because of the potential for metastasis to the scalp skin, experts concur that scalp cooling should not be used in certain types of cancer because they are either blood-borne (and thus disseminated throughout the body) or cutaneous (occurring in the skin):^(4, 163)

• Leukemia
• Multiple myeloma
• Non-Hodgkin’s and other lymphomas
• Melanoma (when treated with adjuvant or curative chemotherapy)