Research has shown that scalp cooling can help some people keep some or quite a bit of their hair during chemotherapy. But how scalp cooling works hasn’t been clearly understood.
Now, a study offers a first peek at the biology behind scalp cooling therapy by finding it dramatically reduces the amount of chemotherapy medicine absorbed by the hair follicles.
The research was published on Oct. 15, 2020, by the journal PLOS One. Read “Cooling-mediated protection from chemotherapy drug-induced cytotoxicity in human keratinocytes by inhibition of cellular drug uptake.”
About hair loss from chemotherapy and scalp cooling
For many people, the hair loss (called alopecia by doctors) associated with breast cancer chemotherapy treatment is the worst side effect because it is so visible. Hair loss happens because most chemotherapy 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, contain some of the fastest-growing cells in the body.
Scalp cooling systems and cold caps are tightly fitting, helmet-type hats filled with a cold gel or liquid coolant. During each chemotherapy infusion, you wear the caps or scalp cooling system hat:
- for 30 to 50 minutes before the infusion
- during the infusion
- after the infusion
How long you wear the hat after the chemotherapy session depends on the type of chemotherapy you’re getting and the type of cold caps or scalp cooling system you use.
It’s been assumed that scalp cooling works by narrowing the blood vessels beneath the skin of the scalp, which reduces the amount of chemotherapy medicine that reaches the hair follicles. With less chemotherapy medicine reaching the follicles, the hair is less likely to fall out. It also was thought that the cold decreased the activity in the cells of the hair follicles, slowing down cell division and making the follicles less likely to be affected by the chemotherapy medicine.
The effectiveness of scalp cooling for preserving hair seems to depend heavily on the type of chemotherapy regimen used. Studies suggest that scalp cooling is more effective for taxane chemotherapy regimens than for anthracycline chemotherapy regimens.
Taxane chemotherapy medicines used to treat breast cancer are:
- Taxol (chemical name: paclitaxel)
- Abraxane (chemical name: nab-paclitaxel)
- Taxotere (chemical name: docetaxel)
Anthracycline chemotherapy medicines used to treat breast cancer are:
- Adriamycin (chemical name: doxorubicin)
- Ellence (chemical name: epirubicin)
- Doxil (chemical name: liposomal doxorubicin)
- daunorubicin (brand names: Cerubidine, DaunoXome)
- mitoxantrone (brand name: Novantrone)
About the study
This study investigated the biological mechanism of how scalp cooling works.
The researchers used three types of keratinocyte cells, the cells that make up the outermost skin layer. One of the keratinocyte cell types came from human hair follicles.
To ensure the cells were actually affected by chemotherapy medicines, the researchers exposed the cells to Adriamycin and Ellence at room temperature. The more medicine the cells were exposed to, the more cells died.
The researchers then exposed the cells to Adriamycin and Ellence at temperatures similar to those produced by scalp cooling. The cooler temperatures protected the cells from the chemotherapy medicines.
The researchers then used special instruments to measure how much of the chemotherapy medicines the cells were absorbing. They found that cooling the cells caused the cells to take up less of the medicine.
“…[T]his is a really exciting discovery because our research now shows it is not as simple as [cooling narrowing scalp blood vessels and reducing the amount of medicine reaching the follicles],” said lead researcher Nik Georgopoulos, Ph.D., of the Scalp Cooling Research Centre of the University of Huddersfield, in a statement. “We were able to measure how much chemotherapy drug goes into the cultured cells from hair follicles and what we have found is that cooling actually dramatically reduces the amount of chemotherapy drug being absorbed by the [rapidly dividing] cells of the hair follicle.
“Our results provide evidence that attenuation of cellular drug uptake represents at least one of the mechanisms underpinning the ability of cooling to rescue human keratinocytes from chemotherapy drug-cytotoxicity, thus supporting the clinical efficacy of scalp cooling,” he added.
The researchers also said that one of their goals is to provide better evidence on how scalp cooling works so companies that make scalp cooling systems can design better-fitting caps that can lead to more effective cooling and more hair preservation.
What this means for you
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.
If you’re interested in trying a scalp 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.
Because the hats are so cold, some people get a headache while wearing them. Most people get very cold, so people are advised to dress warmly and bring warm blankets for their chemotherapy treatment sessions.
People who use scalp cooling systems during chemotherapy are advised to baby their hair during treatment by:
- not blow drying or using hot rollers or straightening irons
- shampooing only every third day with cool water and a gentle shampoo
- not coloring until 3 months after chemotherapy is done
- gently 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.
Read more about preventing hair loss from chemotherapy with 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
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