Hair loss is undoubtedly a dominant concern among patients when they are told they should  have chemotherapy. This probably applies equally to men as much as women. The most obvious concern is the loss of scalp hair as the most visible evidence that a patient is receiving chemotherapy. However eyebrow and eyelash hair loss can also be distressing and can cause eye soreness due to loss of protection against dust as well having obvious cosmetic effects.

Although it is not permanent hair loss is very distressing.

Not all chemotherapy drugs actually cause noticeable hair loss but many do, especially those drugs used to treat breast cancer after surgery. Most cytotoxic hair loss is seen after the first cycle of drugs and it can appear rather quickly, typically during the second or third week.

These drugs cause hair loss by damaging the cells in the hair follicles that are responsible for producing and maintaining the hair. These are actively dividing cells that (like the blood-forming cells) are therefore very susceptible to damage by most cytotoxic drugs.

There have been many attempts to minimise hair loss, at least of scalp hair nearly all concentrated on cooling the scalp during the period of chemotherapy being infused into the body. The aim, in theory, is to shrink the many small blood vessels of the scalp so that less drug reaches the hair follicles. A second effect of cooling may be to slow the metabolism of the hair follicle so that the cells are less susceptible to cytotoxic drug effects.

For most of the last 40 years, the only treatments available have been based on ice-caps of various designs. It has been standard practice to advise patients to keep the hair short (piling up long hair underneath an ice cap could provide a barrier to cooling the skin) and to soak the hair before applying the cap to improve the conduction of heat from the scalp skin. An ice cap is both heavy and uncomfortable and the icy cold itself can be problematic. Also it is not possible to control or measure the scalp temperature or whether the cooling is evenly distributed over the whole scalp.

In recent years, devices that blow cold air over the scalp under a lightweight cap have been developed and are being increasingly used. They certainly appear to be better tolerated, in that they are much less heavy and don’t need the hair to be soaked. They are also capable of having the air temperature varied which gives the possibility of controlling the scalp temperature. This may not need to be as uncomfortably cold as the temperature with the wet ice-cap technique. It may also allow the patient to wear the cap for longer and therefore with better effect.

However, the optimum duration of cooling, how long to start before the chemotherapy and how long to cool after the infusion has finished is also uncertain and probably differs with different drugs.

There have been many studies looking at the issues raised above but, sadly, there is no clear evidence as to what is the best technique or how effective it is for given types of chemotherapy. The best we can say is that cooling definitely does seem to benefit some patients, allowing them to avoid needing a wig or scarf to cover the hair loss. But we need better and bigger studies to clarify the best way to scalp-cool and how likely an individual patient is to benefit.

PRACTICAL TIP Give cooling a try for the first cycle. Is it tolerable and was there much hair loss?

REMEMBER Even total hair loss is not for ever. Nearly everyone gets total re-growth of hair over the months following chemotherapy.

Remember, if you are after a Cancer Second Opinion, we work at Queen Anne Medical Centre. The number there is+44 207 0343 301 – ask for Jane Gunter.

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