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Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia

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Abstract

Introduction

The use of scalp cooling for the prevention of chemotherapy-induced alopecia (CIA) is increasing. Cold caps are placed onto the hair-bearing areas of the scalp for varying time periods before, during, and after cytotoxic chemotherapy. Although not yet reported, improper application procedures could result in adverse events (AEs). At present, there are no evidence-based scalp cooling protocols, and there is no regulatory oversight of their use.

Objective

To report the occurrence of cold thermal injury (frostbite) on the scalp, following the use of cold caps for the prevention of CIA.

Materials and methods

We identified four patients who developed cold thermal injuries on the scalp following the application of cold caps. Medical records were analyzed to retrieve the demographic and clinical characteristics.

Results

The cold thermal injuries in our patients were grade 1/2 in severity and improved with topical interventions and interruption of cold cap use, although grade 1 persistent alopecia ensued in 3 patients. The true incidence of such injuries in this setting, however, remains unknown.

Conclusions

Cold thermal injuries are likely infrequent and preventable AEs that may result from improper device application procedures during cold cap use. Although these untoward events are usually mild to moderate in severity, the potential occurrence of long-term sequelae (e.g., permanent alopecia and scarring) or the need to discontinue cold cap use, are not known. Prospective studies are needed to further elucidate the risk and standardize healthcare delivery methods, and to improve patient/supportive/healthcare provider education.

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Abbreviations

AC-T:

Adriamycin + cyclophosphamide + paclitaxel

AE:

Adverse event

CIA:

Chemotherapy-induced alopecia

CMF:

Cyclophosphamide + methotrexate + fluorouracil

MSKCC:

Memorial Sloan Kettering Cancer Center

PH:

Pertuzumab + trastuzumab

TCHP:

Docetaxel + carboplatin + trastuzumab + pertuzumab

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Acknowledgments

We thank Ms. Bernadette Murphy for the clinical photography. M.E.L. and V.R.B are supported by the RJR Oncodermatology Fund at Memorial Sloan Kettering Cancer Center. This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA

    Viswanath Reddy Belum, Kathryn Ciccolini & Mario E. Lacouture

  2. Centro Paulista de Oncologia, Sao Paulo, Brazil

    Giselle de Barros Silva & Mariana Tosello Laloni

  3. Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Shari B. Goldfarb, Larry Norton & Nancy T. Sklarin

Authors
  1. Viswanath Reddy Belum
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  2. Giselle de Barros Silva
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  3. Mariana Tosello Laloni
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  4. Kathryn Ciccolini
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  5. Shari B. Goldfarb
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  6. Larry Norton
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  7. Nancy T. Sklarin
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  8. Mario E. Lacouture
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Corresponding author

Correspondence to Mario E. Lacouture.

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Conflict of interest

MEL has consulting agreements with Dignitana and Paxman and receives research funding from Berg pharmaceuticals, KC has consulting agreements with Roche, Amgen, and PER. The other authors declare that they have no conflicts of interest.

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Belum, V.R., de Barros Silva, G., Laloni, M.T. et al. Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia. Breast Cancer Res Treat 157, 395–400 (2016). https://doi.org/10.1007/s10549-016-3799-7

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  • DOI: https://doi.org/10.1007/s10549-016-3799-7

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