Scalp hypothermia as a preventative measure for chemotherapy‐induced alopecia: a review of controlled clinical trials

Abstract

Chemotherapy-induced alopecia (CIA) is a temporary, yet psychologically devastating form of hair loss that affects 65% of patients receiving cancer chemotherapy. In the 1970s, scalp hypothermia was introduced as a preventative measure against the development of CIA. Numerous studies provide evidence for the effectiveness of scalp cooling to prevent CIA, although results varied because of differences in chemotherapy regimen, cooling technique, mode of administration and patient factors. However, many of the existing studies are uncontrolled or consist of small sample sizes, and data from randomized, randomized studies are limited. To date, no clear guidelines have been established for optimum scalp cooling use as a treatment modality and its efficacy remain unknown. Nonetheless, scalp cooling remains the most widely utilized method for the prevention of CIA, and in December 2015, the United States Food and Drug Administration (FDA) cleared the DigniCap Scalp Cooling System (Dignitana AB, Sweden) for marketing and the Orbis from Paxman Coolers Ltd. received clearance in 2017. This literature review is one of the first to provide up-to-date review and side-by-side comparisons of controlled and randomized clinical trials (CCTs and RCTs) evaluating scalp hypothermia for the prevention of CIA. Our analyses of CCTs and RCTs to date show that scalp hypothermia is effective in reducing the occurrence rate of CIA, by 2.7-fold in the CCTs and 3.9-fold in the RCTs. These results suggest that scalp hypothermia represents an effective preventative measure for CIA, and provide guidance for management of anticipated alopecia following chemotherapy and for future investigations.

Extracellular fraction of adipose tissue as an innovative regenerative approach for vitiligo treatment

“…In vitiligo, dissatisfaction to therapies is due to complexity of a multifactorial disease whose precise aetiology is still unclear even if T cell-mediated autoimmunity trigged by oxidative stress is recognized as the prevalent mechanism for the onset of white patches. [48] Permanent oxidative disequilibrium caused by an intrinsic defect as in vitiligo skin may also prevent melanocyte regeneration and lead to a vicious circle. In fact, even if several studies revealed the presence of some melanocytes in depigmented skin, [49][50][51] it is conceivable that the persistence of a hostile environment does not allow the complete return of functional melanocytes.…”

Scalp cooling to prevent chemotherapy-induced alopecia

“…There were 18 trials included in the review, with different scalp cooling techniques – ranging from older and less complex cooling caps to digitally controlled machines. 49 Scalp cooling machines from Paxman and Dignitana have been approved by the Food and Drug Administration (FDA), and have been incorporated into the NCCN guidelines for breast cancer patients.…”

“…Those with intradermal scalp temperature lower than 18 °C are more likely to have better hair protection with scalp cooling. 49 , 52 …”

Chemotherapy‐induced alopecia – the urgent need for treatment options

“…Shah et al 1 provide a careful analysis of clinical trials with the highest level of evidence. Authors confirmed the efficacy of scalp hypothermia in reducing the rate of CIA, but it depends on therapeutic agents and dosage schedules.…”

“…To the editor, We read with great interest the guideline for the treatment of cutaneous lupus erythematosus (CLE) elaborated by the European Dermatology Forum in cooperation with the European Academy of Dermatology and Venereology published in the Journal of the European Academy of Dermatology and Venereology in March 2017. 1 A therapeutic guide for CLE is absolutely necessary to decide the best management of our patients. Nevertheless, we would like to point out important aspects regarding the role of laser therapy in patients with CLE.…”