Can You Prevent Hair Loss From Chemotherapy?

What the Current Research Says

Hair loss is a side effect of chemotherapy ("chemo") treatment for cancer. Not everyone who undergoes chemo will experience hair loss, but the stress of wondering if you're among the 65% who will can be overwhelming.

To this end, some people take preemptive steps to avoid chemotherapy-induced hair loss (also known as chemotherapy-induced alopecia). This includes non-invasive treatments like scalp cooling and scalp compression as well as hair growth medications like minoxidil.

woman wearing head scarf after chemo
 Fat Camera / Getty Images

This article explores the different methods of hair loss prevention in people undergoing chemotherapy, including the potential benefits, limitations, and risks.

Scalp Cooling

Scalp cooling, also known as scalp hypothermia, involves the placement of ice packs or specialized cooling caps on the scalp while undergoing chemo. Newer cooling caps made of insulated fabrics are worn like helmets and are connected by a tube filled with cold circulating fluids.

Cooling caps are worn for at least 30 minutes before the chemo infusion, during the infusion, and for a certain amount after the infusion (depending on the type and duration of treatment).

The theory behind scalp cooling is that the cold temperatures cause blood vessels in the scalp to narrow (constrict), reducing the amount of chemotherapy drugs able to reach hair follicles.

Benefits

Some studies have found scalp cooling to be effective in reducing chemotherapy-induced hair loss, although the results can vary based on the drugs being used.

For instance, scalp cooling appears most effective when anthracycline-based drugs like Adriamycin (doxorubicin) are used with taxane-based drugs like Taxol (paclitaxel). When these drugs are used on their own, cooling caps are far less effective.

Scalp cooling is also more effective in people with breast cancer and other solid tumor cancers than with blood cancers like leukemia.

According to a 2017 study published in the Journal of the American Medical Association, scalp cooling in people with stage 1 and stage 2 breast cancer reduced the risk of hair loss by the fourth infusion by roughly 50%.

Risks and Limitations

As beneficial as it may be, scalp cooling can be uncomfortable. Headaches, numbness, and shooting pains are common, particularly when the cooling cap is worn for a long time.

More concerning is the fact that cooling caps limit the amount of chemotherapy drugs circulating in the scalp. This can reduce the effectiveness of drugs used to treat leukemia and other blood cancers. Similarly, if a tumor has metastasized (spread), scalp cooling may provide cancer cells with a safe haven in the scalp.

Scalp cooling also adds to the treatment time of each chemo session. It can also add costs of $2,000 or more that many insurance companies will not cover.

Recap

Scalp cooling may reduce the risk of hair loss by reducing the amount of chemotherapy drugs that reach hair follicles. Scalp cooling appears most effective with breast cancer and other solid tumor cancers.

Scalp Compression

Scalp compression is essentially scalp cooling without the cooler. These caps are made of neoprene or similar fabrics that tightly compress the skin of the scalp during chemo. They are put on just before chemo starts and need to be kept on for a period of time after the infusion is completed.

The theory behind scalp compression is that the pressure reduces the blood flow in the scalp in the same way as a tight bandage. It may be a reasonable alternative to someone who cannot afford or tolerate scalp cooling.

Risks and Limitations

The main concern about scalp compression is whether it actually helps. Few studies have been conducted on the effectiveness of scalp compression in preventing chemotherapy-induced hair loss. Most experts have doubts.

As with scalp cooling, there is concern that the reduced circulation in the scalp may reduce the effectiveness of chemo drugs (although this has not been proven).

Scalp compression can also be uncomfortable, particularly if the chemo session is long. Tension headaches may also occur due to the prolonged compression of the scalp.

Recap

Scalp compression is thought to reduce the risk of hair loss by limiting the circulation of chemo drugs in the scalp. The treatment remains largely unproven.

Medications

There are no medications that can prevent hair loss from chemo. But there are some that may speed hair growth after cancer treatment is complete.

The most common products contain minoxidil, the active ingredient in hair growth products like Rogaine. These products are available in topical forms (which you apply to the scalp) and oral forms (which you take by mouth).

Risks and Limitations

It also isn’t clear if using minoxidil after chemo helps hair grow back faster than not using minoxidil. To date, the theory remains largely unproven.

What is known is that minoxidil can cause significant side effects, including:

  • Significant and rapid weight gain
  • Bloating
  • Flushing
  • Peripheral edema (swelling of the ankles and feet)
  • Hirsutism (unintended hair growth, such as on the face or chest)

The risk of side effects is greater with oral minoxidil.

Recap

There are no medications that can prevent hair loss in people undergoing chemotherapy. It is also unclear if hair growth drugs like minoxidil can speed hair growth after chemo compared to letting your hair grow back naturally.

Summary

Chemotherapy-induced hair loss is a common concern among people undergoing cancer treatment. There are methods that may help reduce the risk, some of which are more effective than others.

Scalp cooling reduces blood flow in the scalp and, in turn, the amount of chemotherapy drugs that reach hair follicles. Although studies show it to be effective in many cases, there are concerns that scalp cooling may reduce the effectiveness of chemotherapy in people being treated for blood cancers or those with metastatic disease (cancer that has spread).

Other forms of chemotherapy-induced hair loss prevention remain largely unproven, including scalp compression and hair growth drugs like minoxidil.

A Word From Verywell

Hair loss can be distressing to people already dealing with the rigors of cancer treatment. Pursuing preventive measures like scalp cooling may reduce some of the stress, but it is important to understand that it may not work for everyone.

As such, it is important to seek counseling and support if you are unable to come to terms with the loss of your hair during chemotherapy. By seeking support from others who understand what you are going through, you can avoid feelings of depression or anxiety and focus on the positive goals of treatment.

You can also explore wigs and other head covering to help bolster your self-esteem and feelings of well-being.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Young A, Arif A. The use of scalp cooling for chemotherapy-induced hair loss. Br J Nurs. 2016;25(10):S22-S27. doi:10.12968/bjon.2016.25.10.S22

  5. Rossi A, Caro G, Fortuna MC, Pigliacelli F, D'Arino A, Carlesimo M. Prevention and treatment of chemotherapy-induced alopecia. Dermatol Pract Concept. 2020;10(3):e2020074. doi:10.5826/dpc.1003a74

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By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."