For a number of people, the hair loss (the medical term for hair loss is alopecia) associated with breast cancer treatment is the worst side effect because it is so visible. Hair loss happens because most chemotherapy medicines and some targeted therapy medicines target all rapidly dividing cells — healthy cells as well as cancer cells. Hair follicles, the structures in the skin filled with tiny blood vessels that make hair, are some of the fastest-growing cells in the body. The cells that make up your nails and skin also rapidly divide, so are also affected by chemotherapy.
Research has shown that up to 89% of people treated with taxane chemotherapy have hair loss and/or skin and nail side effects.
A meta-analysis suggests that cold therapy — including cold caps, frozen gloves, and frozen socks — can help prevent some of the hair loss, as well as skin and nail side effects caused by taxane chemotherapy.
The research was published online on Oct. 31, 2018, by the journal JAMA Dermatology. Read the abstract of “Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events: A Systematic Review.”
There are three taxane chemotherapy medicines used to treat breast cancer:
- Taxol (chemical name: paclitaxel)
- Taxotere (chemical name: docetaxel)
- Abraxane (chemical name: albumin-bound or nab-paclitaxel)
All the taxanes are given intravenously, and all can cause hair loss, nail changes, mouth sores, and other skin side effects.
A meta-analysis is a study that combines and analyzes the results of a number of earlier studies. In this case, the results from 5,647 people in 34 studies published between 1980 and 2018 were analyzed. All the people were being treated with taxane chemotherapy:
- 22 of the studies were on preventing hair loss
- 12 studies were on preventing skin and nail side effects
It’s not clear how many of the people in the studies had been diagnosed with breast cancer.
Scalp cooling systems and cold caps
The meta-analysis found 95% of the studies on hair loss showed that either a cold cap or a scalp cooling system could help reduce hair loss. Still, the studies found big differences in how effective the systems and caps were depending on the chemotherapy regimen.
Scalp cooling was considered safe by all the studies, even though there was one report of a skin metastasis on the scalp. This means that some cancer cells had spread to the scalp.
Cold caps and scalp cooling systems are tightly fitting, strap-on, helmet-type hats filled with a gel coolant that’s chilled to between −15 to −40 degrees Fahrenheit. Cold caps and scalp cooling systems work by narrowing the blood vessels beneath the skin of the scalp, reducing the amount of chemotherapy medicine that reaches the hair follicles. With less chemotherapy medicine in the follicles, the hair may be less likely to fall out. The cold also decreases the activity of the hair follicles, which slows down cell division and makes the follicles less affected by the chemotherapy medicine.
Cold caps and scalp cooling systems are slightly different. Cold caps are similar to ice packs. Kept in a special freezer before they’re worn, cold caps thaw out during a chemotherapy infusion session and need to be replaced with a new cap about every 30 minutes. People usually rent the caps and the special freezer. Penguin, Chemo Cold Caps, and ElastoGel are some cold cap brand names.
With scalp cooling systems, the cap is attached to a small refrigeration machine that circulates coolant, so the cap only has to be fitted once and doesn’t need to be changed during chemotherapy. Scalp cooling systems, such as the DigniCap System and the Paxman System, are purchased by a cancer treatment center, and people are charged to use the system while receiving chemotherapy.
Because the caps are so cold, some people get a headache while wearing the cap. Most people get very cold, so people are advised to dress warmly and bring warm blankets with them.
Frozen gloves and socks
The analysis found:
- Four of six studies (67%) on nail side effects showed that frozen gloves helped prevent nail side effects.
- Three of five studies (60%) on skin side effects found frozen gloves helped prevent skin side effects.
- Seven of eight studies (88%) found frozen gloves and socks to be safe to use.
Still, discomfort was common among people using frozen gloves and socks, and one person developed frostbite.
While not specifically mentioned in this meta-analysis, other studies have suggested that frozen gloves and socks may help prevent peripheral neuropathy, the pain and/or tingling caused by damage to the peripheral nervous system. Your peripheral nervous system is made up of the many nerves that bring signals from the brain and spinal cord to other — or peripheral — parts of the body, such as the hands and feet. Damage to those nerves can affect the way the body sends signals to muscles, joints, skin, and internal organs. This can cause pain, numbness, loss of sensation, tingling, and other symptoms, such as loss of balance.
"Most of the studies we looked at support the use of cold caps or scalp cooling systems to reduce hair loss," said senior author Adam Friedman, M.D., director of the Supportive Oncodermatology Clinic at the George Washington University Cancer Center and professor of dermatology in the School of Medicine and Health Sciences. "These seem to be the most effective in preventing taxane-induced alopecia, and there is even evidence supporting their ability to prevent toxic events affecting both the skin of the hands/feet and the nails."
If you want to try cold therapy
The DigniCap and Paxman scalp cooling systems have received U.S. Food and Drug Administration (FDA) clearance to be marketed in the United States to reduce hair loss associated with chemotherapy. No frozen gloves or frozen socks have received FDA clearance.
If you’d like to try frozen gloves and/or socks to help prevent skin and nail side effects from chemotherapy, you’ll probably be on your own. As this meta-analysis shows, much less research has been done on frozen gloves and socks. So, it’s not clear how cold the gloves or socks should be or how long before and after a chemotherapy infusion they should be worn. It’s not clear how many treatment centers may offer frozen gloves and/or socks to people having chemotherapy, but it’s likely far fewer than offer scalp cooling options. You’ll probably have to purchase your own cooling gloves and socks.
Much more research is needed to figure out the best way to use frozen gloves and socks to prevent nail and skin side effects associated with chemotherapy.
If you’re interested in trying a cooling system to preserve your hair during chemotherapy, talk to your doctor about all the factors that need to be taken into account, including your chemotherapy regimen and any other health issues you may have.
Women who use cold caps or scalp cooling systems during chemotherapy are advised to baby their hair during treatment:
- no blow drying, hot rollers, or straightening irons
- shampoo only every third day with cool water and a gentle shampoo
- no coloring until 3 months after chemotherapy is done
- gentle combing and brushing
The Rapunzel Project is a nonprofit organization dedicated to helping women and men undergoing chemotherapy access and use scalp-cooling technology to help keep their hair. Visit the Rapunzel Project site for more information. Also, the Hair to Stay Foundation offers grants to pay for scalp cooling costs.
For more information on cold therapy to preserve hair during chemotherapy, visit the Breastcancer.org pages on Cold Caps and Scalp Cooling Systems.
To discuss chemotherapy side effects and cooling systems with others, join the Breastcancer.org Discussion Board forum Chemotherapy - Before, During, and After.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser