Most chemotherapy drugs cause a degree of hair loss, or alopecia, because the powerful chemicals involved don’t just target cancerous cells, but all rapidly-dividing cells in the human body. Since the cells that make up a hair follicle divide very quickly, it’s not surprising that chemotherapy hair loss is one of treatment’s most consistent, and distressing, side effects.
In this guide, we’ll cover some of the common treatments that cancer patients try out to prevent the hair loss that chemotherapy can cause, including cold caps and Rogaine, with an eye to whether or not they actually work.
You’ll also find information specific to the breast cancer drug Taxotere, which has been linked to a risk of permanent hair loss.
Is There A Cure For Chemotherapy-Induced Alopecia?
Many of us come to identify strongly with our own outward appearance. It’s only natural to see ourselves as others see us. Inundated by advertisements that stress a youthful, “healthy” appearance, many women come to see their own hair, and how they choose to style their hair, as a direct embodiment of personal identity. Losing that symbol of identity can be devastating, and surprisingly so, for many chemotherapy patients.
Potential “cures” for chemo-induced hair loss, however, are in no short supply. But do any of them actually work?
Where hair loss is concerned, most research has focused on “camouflage” methods, like wearing wigs and scarves, and the potential psycho-social benefits associated with their use. Unfortunately, scientists haven’t spent much time looking into the efficacy of potential treatment methods, and even less time trying to develop innovative new techniques.
Of the two methods you’ll see referenced most often, “scalp cooling” and minoxidil, scalp cooling is supported by the most robust medical evidence. Research on minoxidil, on the other hand, the active ingredient in Rogaine, is mainly limited to patients with forms of alopecia not caused by chemotherapy.
Do Chemo Cold Caps Really Work?
Chemo cold caps are hats, either filled with a cooling gel or dry ice, that can be worn prior to, during and shortly after a chemo drug is administered. Cold temperatures constrict the blood vessels under a patient’s scalp, preventing some of the chemo agent from reaching hair follicles. Theoretically, less chemo agent kills fewer follicles, reducing the amount of overall hair loss. Plus, it seems to work.
In Europe, scalp cooling has been used by chemo patients for more than 40 years. Research out of the Netherlands, like this 2013 study published in the European Journal of Oncology Nursing, has found that while patients who wear cold caps during chemotherapy still experience some hair loss, it’s less severe than in patients who don’t use a scalp cooling product. Those patients are also less likely to purchase wigs, and among those who do buy some sort of “camouflage,” are less likely to use it.
Similar results have been observed by other teams. In fact, the latest review of studies on scalp cooling, which looked over 32 different papers on the subject, went on to advocate in no uncertain terms that “scalp cooling should […] be available in every hospital and health care professionals should offer the possibility of scalp cooling to all eligible patients.”
Despite these glowing reports, cold caps appear to be more effective for male patients, younger patients and patients with classically “Caucasian” hair. The benefits of scalp cooling seem to decrease at higher doses of chemotherapy, and the technique may be more effective for patients undergoing anthracycline chemotherapy and those who receive only taxanes, like Taxotere.
Is Scalp Cooling Dangerous?
While some women experience headaches while using cold caps, studies have found that this particular side effect is rarely so severe that a patient would choose to stop scalp cooling altogether. More troubling is the idea that preventing a chemotherapy agent from reaching the scalp will allow tumor cells to metastasize there.
This worry, although possible, has been shown to be largely unfounded in reality. For one, breast cancers rarely metastasize to the scalp in the first place. Second, studies have found that patients with breast cancer are at the same risk for scalp metastasis, whether or not they use a cold cap. In a 2013 paper, published by the journal The Breast, German researchers used autopsy reports and observational studies to estimate how often breast cancers actually metastasized to the scalp, and whether or not that number changed for patients who wore cold caps. It didn’t. For women who used scalp cooling, cancer cells reached the scalp in between 0.04% and 1% of patients. In women who did not use cold caps, the range was almost exactly the same, between 0.03% and 3%.
Can Rogaine (Minoxidil) Prevent Chemo Hair Loss?
Probably not. Unlike scalp cooling, minoxidil doesn’t seem to prevent hair loss during chemotherapy treatments. But it may be able to cut down on the amount of time it takes for hair to grow back after chemotherapy is over.
Dermatologists often suggest trying Rogaine to help hair grow back after chemo treatments, including Taxotere. Doctors usually recommend a maximum strength formulation of minoxidil, the active ingredient in Rogaine, which is marketed to men. But Rogaine comes with a really big drawback. You have to use it twice a day, every day, for the rest of your life. Stop using the drug and your hair will fall out.
No one quite understands how minoxidil works. The going theory is that this topical drug opens blood vessels in the scalp, allowing more blood, oxygen and nutrients to reach hair follicles.
Medical Studies On Rogaine & Chemo Hair Loss
Unfortunately, there’s very little actual research on whether Rogaine can help cancer patients regrow their hair. The studies that have been conducted have found conflicting results:
- In a 1992 study for the European Journal of Gynaecological Oncology, scientists in Providence, Rhode Island evaluated the potential benefits of twice-daily minoxidil in ten female patients who were being treated for gynecological cancers. Each patient served as her own control group, by applying Rogaine only to one portion of the scalp – but unfortunately, four of the ten patients were eliminated because they didn’t use minoxidil twice-daily during the study. Of the six patients who completed their minoxidil treatments, five experienced “complete or severe” hair loss across the entire scalp. Only one patient kept her hair throughout chemotherapy. In short, Rogaine “showed no benefit in the prevention of chemotherapy-induced alopecia.”
- In 1994, a group in Argentina provided 24 female cancer patients, all of whom were being treated with doxorubicin-based chemotherapy regimens, with a topical solution of 2% minoxidil. A similar group of 24 patients was provided with a placebo solution. In both groups, between 88% and 92% of patients experienced severe alopecia – regardless of Rogaine treatments. A summary of the study is available here.
- In this 1996 study, researchers at the University of Texas found that women who used minoxidil after receiving adjuvant chemo for breast cancer stayed bald for a shorter period of time than women who had been given a placebo.
While few of the studies on Rogaine have found any positive benefits for chemotherapy patients, none have found that minoxidil is especially toxic when given to people with cancer. The side effects of Rogaine are well documented; you can find a full list at Drugs.com.
Can Rogaine Cause Permanent Hair Loss?
That’s a tricky question. Many people experience an increase in thinning when they first start using Rogaine. That might seem paradoxical, but in most cases, this initial “shedding” of hairs is actually a sign that the treatment is working. The problem appears in the minority of patients for whom Rogaine doesn’t work in the first place, a category in which we can place most chemotherapy patients. Minoxidil forces these people to “shed” their existing hairs, but doesn’t help them grow any new hair back.
That’s not quite the same as saying Rogaine causes permanent hair loss, but it can be an issue for some patients. Of course, in patients on chemotherapy, there’s no evidence that minoxidil works at all.
Rogaine And Taxotere
Taxotere causes hair loss in around 3 out of every 4 patients, and some women never regrow their hair after receiving the drug. Some women regrow only the hair on their scalp, but never regrow their eyebrows or eyelashes. Could Rogaine hold some benefit for patients taking Taxotere?
Currently, we don’t have adequate scientific evidence to give a firm answer on that topic. To our knowledge, only one group of researchers have looked into the specific benefits Rogaine use may (or may not) pose for Taxotere patients who have lost their hair.
In a 2012 study published by the Annals of Oncology, French researchers reviewed 20 cases of permanent hair loss in breast cancer patients, all of whom had received a cocktail of fluorouracil, epirubicin and cyclophosphamide, followed by Taxotere. Fourteen of the patients tried Rogaine, in formulations of either 2% or 5% minoxidil, but the treatment was “always unsuccessful” after more than three months.
Anecdotal Evidence Isn’t Promising
We’ve seen isolated reports of women who received Taxotere and experienced significant hair regrowth after using Rogaine. But we’ve also seen reports from women who found Rogaine completely ineffective. For his part, Dr. Scot Sedlacek, an oncologist in Colorado who has studied the side effects of Taxotere extensively, isn’t particularly hopeful.
In an interview with A Head Of Our Time, a support group for women who have suffered permanent hair loss after receiving Taxotere, Sedlacek was asked what current Taxotere patients could do to increase their chances of hair regrowth. “Nothing really,” he answered, “you can try Rogaine,” but then pointed out that patients will need to apply the drug every 12 hours for the rest of their lives. “If you stop using Rogaine, your hair will fall out,” he told patients.
In his 20 years of prescribing Taxotere to breast cancer patients, Sedlacek could recall only one patient who had agreed to try Rogaine. While the drug helped to increase her hair growth, that benefit only applied to existing hairs. “Rogaine did not help the patchy thin areas at all,” the doctor said, “Rogaine didn’t grow new hair in the dormant / dead follicles – it only helped continue growing the already-growing hairs.” Sedlacek wouldn’t try Rogaine himself if he were a breast cancer patient facing the prospect of hair loss.
In sum, the jury is still out on the question of Rogaine and Taxotere. Taking the treatment’s lackluster results for other chemo drugs into account, the benefits some women have seen are likely the result of chance.
Are There Treatments For Permanent Hair Loss?
Currently, there is no known method of regrowing a patient’s hair after their follicles have been damaged past the point at which the body itself could repair them.
But chemotherapy-induced hair loss is almost always temporary – at least, that’s the line patients have been hearing for decades. Recent studies, however, suggests that one drug in particular, Taxotere, may actually cause permanent hair loss. Far from being a side effect confined to a small minority of patients, this permanent alopecia has been found to affect up to 15% of breast cancer patients treated with Taxotere.