Supportive Care in Cancer

, Volume 11, Issue 6, pp 371–377 | Cite as

Scalp hypothermia to prevent chemotherapy-induced alopecia is effective and safe: A pilot study of a new digitized scalp-cooling system used in 74 patients

  • Mona Ridderheim
  • Maria Bjurberg
  • Anita Gustavsson
Original Article



The aim of this study was to examine the efficacy and safety of a new digitized, controlled, scalp-cooling system to prevent chemotherapy-induced alopecia.


Seventy-four female cancer patients who received 13 varying chemotherapy regimens were included in a nonrandomized pilot study. The Digni 2–3 with Dignicap system consists of a refrigerator unit and a control unit integrated into a mobile cabinet and connected to a tight-fitting cooling cap. This system maintains a constant scalp temperature of +5°C for many hours. In this study, 60 patients were treated for ovarian cancer with either taxane or epirubicin combination chemotherapy. Eight patients with Hodgkin's lymphoma, three with breast cancer, two with endometrial cancer, and one with sarcoma were also included. Photo documentation and patient assessment of hair loss and discomfort were performed.


In anthracycline-treated patients, total prevention of hair loss was observed, whereas hair loss in paclitaxel/docetaxel-treated patients was minimal to none. The combination of anthracycline and taxane resulted in more hair loss, but only three of six patients used a wig. Scalp cooling was generally very well tolerated; only two of 74 patients discontinued use of the cold cap due to discomfort. No scalp metastases occurred over a median follow-up period of 15 months.


The digitized, controlled, scalp-cooling system represents an effective and safe device that should be clinically evaluated in a randomized trial and in studies using other chemotherapy regimens to determine optimal temperatures and durations of cooling for maximal efficacy.


Alopecia Chemotherapy Scalp hypothermia 



The authors acknowledge Yvonne Olofsson, registered nurse, for developing the cooling system and performing the majority of treatments.


  1. 1.
    Adams L, Lawson N, Maxted KJ, et al (1992) The prevention of hair loss from chemotherapy by the use of cold-air scalp cooling. Eur J Cancer Care 1:16–18Google Scholar
  2. 2.
    Bulow J, Friberg L, Gaardsting O, et al (1985) Frontal subcutaneous blood flow, and epi- and subcutaneous temperatures during scalp cooling in normal man. Scand J Clin Lab Invest 45:505–508PubMedGoogle Scholar
  3. 3.
    David J (1987) Scalp cooling to prevent alopecia. Nursing times 83:36–37Google Scholar
  4. 4.
    Dorr VJ (1998) A practitioner's guide to cancer-related alopecia. Semin Oncol 25:562–570Google Scholar
  5. 5.
    Dougherty L (1996) Scalp cooling to prevent hair loss in chemotherapy. Prof Nurse 11:507–509PubMedGoogle Scholar
  6. 6.
    Fairlamb DJ (1988) Hair changes following cytotoxic drug induced alopecia. Postgrad Med J 64:907PubMedGoogle Scholar
  7. 7.
    Freedman TG (1994) Social and cultural dimensions of hair loss in women treated for breast cancer. Cancer Nurs 17:334–341PubMedGoogle Scholar
  8. 8.
    Giaccone G, Di Guilio F, Morandini MP, et al (1988) Scalp hypothermia in the prevention of doxorubicin-induced hair loss. Cancer Nurs 11:170–173PubMedGoogle Scholar
  9. 9.
    Gregory RP, Cooke T, Middleton J, et al (1982) Prevention of doxorubicin-induced alopecia by scalp hypothermia. Br Med J 284:1674Google Scholar
  10. 10.
    Gunnars B (1991) Quality of life during cancer therapy treatment—an analysis of experience of cancer patients. Medical Dissertation ISBN 91–7900–958–1, Lund University, SwedenGoogle Scholar
  11. 11.
    Hillen HFP, Breed WPM, Botman CJ (1990) Scalp cooling by cold air for the prevention of chemotherapy-induced alopecia. Netherlands J Med 37:231–235Google Scholar
  12. 12.
    Joss RA, Kiser J, Weston S, et al (1988) Fighting alopecia in cancer chemotherapy. Recent Res Cancer Res 108:117–126Google Scholar
  13. 13.
    Katsimbri P, Bamias A, Pavlidis N (2000) Prevention of chemotherapy-induced alopecia using an effective scalp cooling system. Eur J Cancer 36:766–771PubMedGoogle Scholar
  14. 14.
    Lemenager M, Lecomte S, Bonneterre ME, et al (1997) Effectiveness of cold cap in the prevention of docetaxel-induced alopecia. Eur J Cancer 33:297–300PubMedGoogle Scholar
  15. 15.
    Luce JC, Rafetto TJ, Bonneterre, et al (1973) Prevention of alopecia by scalp cooling of patients receiving adriamycin. Cancer Chemother Rep 57:108–109Google Scholar
  16. 16.
    Middleton J, Franks D, Buchanan RB, et al (1985) Failure of scalp hypothermia to prevent hair loss when cyclophosphamide is added to doxorubicin and vincristine. Cancer Treat Rep 69:373–375PubMedGoogle Scholar
  17. 17.
    Perry MC (ed) (1996) The chemotherapy source book, 2nd edn. Williams and Wilkins, Baltimore pp 293–555, 595–606Google Scholar
  18. 18.
    Robinson MH, Jones AC, Durrant KD (1987) Effectiveness of scalp cooling in reducing alopecia caused by epirubicin treatment of advanced breast cancer. Cancer Treat Rep 71:913–914PubMedGoogle Scholar
  19. 19.
    Ron IG, Kalmus Y, Kalmus Z, et al (1997) Scalp cooling in the prevention of alopecia in patient receiving depilating therapy. Support Care Cancer 5:136–138PubMedGoogle Scholar
  20. 20.
    Symonds RP, McCormick CV, Maxted KJ, et al (1986) Adriamycin alopecia prevented by cold air scalp cooling. Am J Clin Oncol 9:454–457PubMedGoogle Scholar
  21. 21.
    Toolenaar RA, Liefers GJ, Repelaer van Driel OJ, et al (1994) Scalp cooling has no place in the prevention of alopecia in adjuvant chemotherapy for breast cancer. Eur J Cancer 30A:1448–1453PubMedGoogle Scholar
  22. 22.
    Vendelbo Johansen L (1985) Scalp hypothermia in the prevention of chemotherapy-induced alopecia. Acta Radiol 24:113–116Google Scholar
  23. 23.
    Witman G, Cadman E, Chen M (1981) Misuse of scalp hypothermia. Cancer Treat Rep 65:507–508PubMedGoogle Scholar
  24. 24.
    Villani C, Inghirami P, Pietrangeli D, et al (1986) Prevention by hypothermic cap of antineoplastic induced alopecia. Eur J Gynaecol Oncol 1:15–17Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Mona Ridderheim
    • 1
  • Maria Bjurberg
    • 1
  • Anita Gustavsson
    • 1
  1. 1.Department of OncologyUniversity HospitalLundSweden

Personalised recommendations