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IMPORTANCE Chemotherapy-induced alopecia as well as nail and cutaneous changes occur in up to 89% of patients receiving taxane-based chemotherapy and are associated with cosmetic concerns, psychosocial distress, and overall morbidity.OBJECTIVE To review the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse events.EVIDENCE REVIEW PubMed and Scopus databases were systematically reviewed for studies published in the English language from January 1, 1980, to August 13, 2018. Specific search terms included but were not limited to taxane, docetaxel, paclitaxel, prevent, nail, skin, hair, alopecia, and onycholysis. Primary clinical studies that detailed preventive interventions for taxane-induced dermatologic adverse events and that classified results according to a taxane-specific chemotherapy regimen were reviewed and graded according to a 5-point scale, modified from the Oxford Centre for Evidence-based Medicine.FINDINGS The 34 original reports that met the inclusion criteria consisted of 6 randomized clinical trials, 4 nonrandomized clinical trials, 18 cohort studies, 3 case-control studies, 1 cross-sectional study, and 2 case reports and involved a total of 5647 unique participants. A total of 22 studies addressed preventive interventions for alopecia associated with taxane use, whereas 12 studies focused on taxane-induced skin and nail changes. Specifically, 20 (95%) of 21 studies supported the use of either a cold cap or a scalp cooling system to reduce alopecia but reported substantial differences in efficacy depending on the chemotherapy regimen. Scalp cooling was generally considered safe by all pertinent studies despite a single report of scalp skin metastasis. Similarly, use of frozen gloves and frozen socks in the prevention of nail and cutaneous hand and foot toxic effects was considered safe in 7 (88%) of 8 studies, although discomfort was common and frostbite was noted in 1 patient. Overall, use of frozen gloves was endorsed by 4 (67%) of 6 studies to prevent nail toxic effects and by 3 (60%) of 5 studies to prevent cutaneous hand changes.CONCLUSIONS AND RELEVANCE Scalp hypothermia with cold caps or scalp cooling systems has demonstrated efficacy as a monotherapy in preventing taxane-induced alopecia, and use of frozen gloves and socks has been associated with reduced nail and skin changes. Future studies should establish the routine usage protocols, standard outcome measures, and long-term efficacy and safety for these interventions.

Background In gender minority patients, electrolysis and laser hair removal may be necessary to reduce facial and body hair in individuals seeking a more feminine appearance and/or modified gender expression. These procedures may also be required preoperatively for some gender‐affirming surgeries. Aims To identify (a) the frequency of unwanted facial and body hair, (b) the use of various hair removal methods, and (c) associated barriers to care in gender minority patients. Methods An online‐based patient survey was distributed via social media on Facebook®, YouTube®, and Instagram® in fall 2018. Respondents were at least 18 years old and self‐identified as a gender minority. Results In total, 991 responses were recorded with a completion rate of 77%. Considering excess hair, 84% of transwomen on feminizing hormone therapy (FHT: estrogen and anti‐androgen therapy), 100% of transwomen not on FHT, and 100% of nonbinary individuals on FHT reported excess facial/body hair. Laser hair removal (18%) and electrolysis (17%) had similar rates of use in this cohort and were more commonly reported for nonsurgical gender‐affirming purposes than preoperative preparation. Cost was the most frequently cited barrier to care. Conclusion As the majority of transwomen and nonbinary people on feminizing hormone therapy had persistent excess facial/body hair, routine use of gender‐affirming hormones is not sufficient to fully eliminate unwanted hair. There remains a critical need to advocate for more comprehensive insurance coverage for laser hair removal and electrolysis in gender minority patients.