Treatment Options for Chemotherapy-Induced Hair Loss

Scalp cooling is the only proven method to prevent chemotherapy-induced hair loss, with success rates of 50-65% in randomized clinical trials. 1

Understanding Chemotherapy-Induced Alopecia (CIA)

CIA affects approximately 65% of patients receiving chemotherapy and typically starts 1-3 weeks after initiating therapy 1
Hair loss patterns depend on chemotherapy type, dose, administration method, and interval between infusions 1
CIA usually results in diffuse grade 2 alopecia (>50% hair loss) across the entire scalp, and may include eyebrows, eyelashes, and body hair 1
Hair typically begins regrowing 2-3 months after completing chemotherapy at a rate of approximately 1 cm/month 1
About 65% of patients experience changes in color and texture in newly grown hair 1

Scalp cooling is the most effective preventive intervention with response rates ranging from 50-65% 1, 2
Works by inducing vasoconstriction and reducing biochemical activity in the scalp and hair follicles 1
Protocol involves:
- Starting cooling 20-45 minutes before chemotherapy infusion
- Continuing during infusion
- Maintaining cooling for 20-150 minutes after infusion (shorter times may be sufficient for certain regimens) 1
More effective with taxane-based regimens; less effective when anthracyclines are combined with taxanes or cyclophosphamide 1, 3
The NCCN guidelines specifically recommend considering scalp cooling to reduce incidence of chemotherapy-induced alopecia, noting results may be less effective with anthracycline-containing regimens 1

Topical minoxidil has shown some benefit in reducing the duration of chemotherapy-induced alopecia 4
- While it doesn't prevent hair loss, it can shorten the period of baldness by approximately 50 days 4
- No significant side effects were reported in clinical trials 4

Adaptive devices such as wigs, breast prostheses, and other accessories can help patients cope with appearance changes 1
Most insurance plans cover mastectomy prostheses and specialty bras; wigs may also be covered with a prescription 1
Psychosocial support is important as 47% of female patients consider hair loss to be the most traumatic aspect of chemotherapy 5

For endocrine therapy-induced alopecia (EIA), which differs from CIA:
- Characterized by grade 1 alopecia primarily on the crown with recession of frontal and bitemporal hairline
- More frequent in post-menopausal women receiving aromatase inhibitors
- Typically develops between 6-18 months after therapy initiation
- Rule out other causes with laboratory testing (thyroid function, iron stores, vitamin D, zinc levels) 1

CIA is usually reversible, though some patients may experience permanent changes in hair color, texture, or density 5
Hair regrowth typically begins 2-3 months after completing chemotherapy 1
Appropriate hair and scalp care along with temporary use of wigs represents an effective coping strategy 5

Don't assume all hair loss is temporary; increasing reports show some patients experience permanent hair loss after chemotherapy 2
Don't overlook the psychological impact of hair loss, which can significantly affect quality of life and treatment adherence 1, 5
Don't use scalp cooling in patients with hematological malignancies or when chemotherapy is given with curative intent in patients with generalized hematogenic metastases 6