[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]

Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse EventsA Systematic Review

Educational Objective
To describe the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse events.
1 Credit CME
Key Points

Question  Are the interventions to prevent taxane-induced dermatologic adverse events in patients undergoing chemotherapy safe and effective?

Findings  In this systematic review of 34 reports, most studies of taxane-induced alopecia supported the use of cold caps or scalp cooling systems to reduce hair loss. Relevant evidence also indicated that use of frozen gloves and socks was associated with the prevention of taxane-induced nail and skin changes.

Meaning  Use of cold caps or scalp cooling systems and frozen gloves and socks may be effective in the prevention of taxane-induced alopecia as well as nail and cutaneous hand toxic effects; further investigation is needed to establish the routine usage protocols, standard outcome measures, and long-term efficacy and safety for these interventions.


Importance  Chemotherapy-induced alopecia as well as nail and cutaneous changes occur in up to 89% of patients receiving taxane-based chemotherapy and are associated with cosmetic concerns, psychosocial distress, and overall morbidity.

Objective  To review the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse events.

Evidence Review  PubMed and Scopus databases were systematically reviewed for studies published in the English language from January 1, 1980, to August 13, 2018. Specific search terms included but were not limited to taxane, docetaxel, paclitaxel, prevent, nail, skin, hair, alopecia, and onycholysis. Primary clinical studies that detailed preventive interventions for taxane-induced dermatologic adverse events and that classified results according to a taxane-specific chemotherapy regimen were reviewed and graded according to a 5-point scale, modified from the Oxford Centre for Evidence-based Medicine.

Findings  The 34 original reports that met the inclusion criteria consisted of 6 randomized clinical trials, 4 nonrandomized clinical trials, 18 cohort studies, 3 case-control studies, 1 cross-sectional study, and 2 case reports and involved a total of 5647 unique participants. A total of 22 studies addressed preventive interventions for alopecia associated with taxane use, whereas 12 studies focused on taxane-induced skin and nail changes. Specifically, 20 (95%) of 21 studies supported the use of either a cold cap or a scalp cooling system to reduce alopecia but reported substantial differences in efficacy depending on the chemotherapy regimen. Scalp cooling was generally considered safe by all pertinent studies despite a single report of scalp skin metastasis. Similarly, use of frozen gloves and frozen socks in the prevention of nail and cutaneous hand and foot toxic effects was considered safe in 7 (88%) of 8 studies, although discomfort was common and frostbite was noted in 1 patient. Overall, use of frozen gloves was endorsed by 4 (67%) of 6 studies to prevent nail toxic effects and by 3 (60%) of 5 studies to prevent cutaneous hand changes.

Conclusions and Relevance  Scalp hypothermia with cold caps or scalp cooling systems has demonstrated efficacy as a monotherapy in preventing taxane-induced alopecia, and use of frozen gloves and socks has been associated with reduced nail and skin changes. Future studies should establish the routine usage protocols, standard outcome measures, and long-term efficacy and safety for these interventions.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: August 16, 2018.

Corresponding Author: Adam Friedman, MD, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave, NW, Second Floor, Washington, DC 20037 (ajfriedman@mfa.gwu.edu).

Published Online: October 31, 2018. doi:10.1001/jamadermatol.2018.3465

Author Contributions: Dr Friedman and Mr Marks had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Marks, Qureshi.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Marks.

Supervision: Marks, Friedman.

Conflict of Interest Disclosures: Dr Friedman reported serving as a consultant to Dermira, Eli Lilly and Company, Encore Dermatology Inc, Exeltis, Galderma, IntraDerm, Johnson and Johnson, Oculus Innovative Sciences, Pfizer Inc, and Sanovaworks as well as receiving honoraria from Allergan, Amgen, Bayer, Biogen, Janssen Biotech, La Roche-Posay Laboratorie Pharmaceutique, Medscape, Menlo Therapeutics, Novartis, Orlando Dermatology Aesthetic & Clinical, Promius Pharma, Regeneron, Sanovaworks, and Valeant Pharmaceuticals. No other disclosures were reported.

Yared  JA, Tkaczuk  KHR.  Update on taxane development: new analogs and new formulations.  Drug Des Dev Ther. 2012;6:371-384. doi:10.2147/DDDT.S28997PubMedGoogle Scholar
Sibaud  V, Lebœuf  NR, Roche  H,  et al.  Dermatological adverse events with taxane chemotherapy.  Eur J Dermatol. 2016;26(5):427-443. doi:10.1684/ejd.2016.2833PubMedGoogle Scholar
Goldspiel  BR.  Clinical overview of the taxanes.  Pharmacotherapy. 1997;17(5, pt 2):110S-125S.Google Scholar
Winther  D, Saunte  DM, Knap  M, Haahr  V, Jensen  AB.  Nail changes due to docetaxel–a neglected side effect and nuisance for the patient.  Support Care Cancer. 2007;15(10):1191-1197. doi:10.1007/s00520-007-0232-0PubMedGoogle ScholarCrossref
Rubio-Gonzalez  B, Juhász  M, Fortman  J, Mesinkovska  NA.  Pathogenesis and treatment options for chemotherapy-induced alopecia: a systematic review  [published online January 29, 2018].  Int J Dermatol. doi:10.1111/ijd.13906PubMedGoogle Scholar
Gilbar  P, Hain  A, Peereboom  V-M.  Nail toxicity induced by cancer chemotherapy.  J Oncol Pharm Pract. 2009;15(3):143-155. doi:10.1177/1078155208100450PubMedGoogle ScholarCrossref
Robert  C, Sibaud  V, Mateus  C,  et al.  Nail toxicities induced by systemic anticancer treatments.  Lancet Oncol. 2015;16(4):e181-e189. doi:10.1016/S1470-2045(14)71133-7PubMedGoogle ScholarCrossref
Capriotti  K, Capriotti  JA, Lessin  S,  et al.  The risk of nail changes with taxane chemotherapy: a systematic review of the literature and meta-analysis.  Br J Dermatol. 2015;173(3):842-845. doi:10.1111/bjd.13743PubMedGoogle ScholarCrossref
Taxol (Paclitaxel) Injection [package insert]. Princeton, NJ: Bristol-Myers Squibb Co; 2011.
McGarvey  EL, Baum  LD, Pinkerton  RC, Rogers  LM.  Psychological sequelae and alopecia among women with cancer.  Cancer Pract. 2001;9(6):283-289.Google ScholarCrossref
Münstedt  K, Manthey  N, Sachsse  S, Vahrson  H.  Changes in self-concept and body image during alopecia induced cancer chemotherapy.  Support Care Cancer. 1997;5(2):139-143. doi:10.1007/BF01262572PubMedGoogle ScholarCrossref
Paus  R, Haslam  IS, Sharov  AA, Botchkarev  VA.  Pathobiology of chemotherapy-induced hair loss.  Lancet Oncol. 2013;14(2):e50-e59. doi:10.1016/S1470-2045(12)70553-3PubMedGoogle ScholarCrossref
Prevezas  C, Matard  B, Pinquier  L, Reygagne  P.  Irreversible and severe alopecia following docetaxel or paclitaxel cytotoxic therapy for breast cancer.  Br J Dermatol. 2009;160(4):883-885. doi:10.1111/j.1365-2133.2009.09043.xPubMedGoogle ScholarCrossref
Martín  M, de la Torre-Montero  JC, López-Tarruella  S,  et al.  Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling.  Breast Cancer Res Treat. 2018;171(3):627-634. doi:10.1007/s10549-018-4855-2PubMedGoogle ScholarCrossref
Palamaras  I, Misciali  C, Vincenzi  C, Robles  WS, Tosti  A.  Permanent chemotherapy-induced alopecia: a review.  J Am Acad Dermatol. 2011;64(3):604-606. doi:10.1016/j.jaad.2010.03.020PubMedGoogle ScholarCrossref
Scotté  F, Tourani  JM, Banu  E,  et al.  Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand.  J Clin Oncol. 2005;23(19):4424-4429. doi:10.1200/JCO.2005.15.651PubMedGoogle ScholarCrossref
Battegay  EJ.  Angiogenesis: mechanistic insights, neovascular diseases, and therapeutic prospects.  J Mol Med (Berl). 1995;73(7):333-346. doi:10.1007/BF00192885PubMedGoogle ScholarCrossref
Wasner  G, Hilpert  F, Schattschneider  J, Binder  A, Pfisterer  J, Baron  R.  Docetaxel-induced nail changes–a neurogenic mechanism: a case report.  J Neurooncol. 2002;58(2):167-174. doi:10.1023/A:1016002329546PubMedGoogle ScholarCrossref
Schepisi  G, Conteduca  V, Lolli  C, Medri  M, De Giorgi  U.  Taxane-related nail toxicity.  Lancet Oncol. 2015;16(7):e310-e311. doi:10.1016/S1470-2045(15)00019-4PubMedGoogle ScholarCrossref
Bolognia  JL, Cooper  DL, Glusac  EJ.  Toxic erythema of chemotherapy: a useful clinical term.  J Am Acad Dermatol. 2008;59(3):524-529. doi:10.1016/j.jaad.2008.05.018PubMedGoogle ScholarCrossref
Stravodimou  A, Voutsadakis  IA.  Hand and foot syndrome associated with docetaxel treatment.  Acta Oncol. 2012;51(4):554-556. doi:10.3109/0284186X.2011.636755PubMedGoogle ScholarCrossref
Harris  CS, Wang  D, Carulli  A.  Docetaxel-associated palmar-plantar erythrodysesthesia: a case report and review of the literature.  J Oncol Pharm Pract. 2014;20(1):73-80. doi:10.1177/1078155213475466PubMedGoogle ScholarCrossref
Sparano  JA, Wang  M, Martino  S,  et al.  Weekly paclitaxel in the adjuvant treatment of breast cancer.  N Engl J Med. 2008;358(16):1663-1671. doi:10.1056/NEJMoa0707056PubMedGoogle ScholarCrossref
Childress  J, Lokich  J.  Cutaneous hand and foot toxicity associated with cancer chemotherapy.  Am J Clin Oncol. 2003;26(5):435-436. doi:10.1097/01.coc.0000026486.56886.18PubMedGoogle ScholarCrossref
Rodríguez-Lomba  E, Molina-López  I, Suárez-Fernández  R, Baniandrés-Rodríguez  O.  Periarticular thenar erythema and onycholysis syndrome: a manifestation of taxane-induced cutaneous toxicity  [in Spanish].  Actas Dermosifiliogr. 2017;108(6):595-597. doi:10.1016/j.ad.2016.11.014PubMedGoogle ScholarCrossref
Garbe  C. Antimicrotubule agents. In: Lacouture  ME, ed.  Dermatologic Principles and Practice in Oncology: Conditions of the Skin, Hair and Nails in Cancer Patients. Philadelphia, PA: Wiley-Blackwell; 2014:208-214.
Bülow  J, Friberg  L, Gaardsting  O, Hansen  M.  Frontal subcutaneous blood flow, and epi- and subcutaneous temperatures during scalp cooling in normal man.  Scand J Clin Lab Invest. 1985;45(6):505-508. doi:10.3109/00365518509155250PubMedGoogle ScholarCrossref
Trüeb  RM.  Chemotherapy-induced alopecia.  Semin Cutan Med Surg. 2009;28(1):11-14. doi:10.1016/j.sder.2008.12.001PubMedGoogle ScholarCrossref
US Food and Drug Administration. FDA clears expanded use of cooling cap to reduce hair loss during chemotherapy [news release]. Silver Springs, MD. Published July 3, 2017. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm565599.htm. Accessed March 26, 2018.
Hanai  A, Ishiguro  H, Sozu  T,  et al.  Effects of cryotherapy on objective and subjective symptoms of paclitaxel-induced neuropathy: prospective self-controlled trial.  J Natl Cancer Inst. 2018;110(2):141-148. doi:10.1093/jnci/djx178PubMedGoogle ScholarCrossref
Poi  MJ, Berger  M, Lustberg  M,  et al.  Docetaxel-induced skin toxicities in breast cancer patients subsequent to paclitaxel shortage: a case series and literature review.  Support Care Cancer. 2013;21(10):2679-2686. doi:10.1007/s00520-013-1842-3PubMedGoogle ScholarCrossref
Oxford Center for Evidence-based Medicine. Levels of evidence. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Updated March 2009. Accessed January 26, 2018.
Betticher  DC, Delmore  G, Breitenstein  U,  et al.  Efficacy and tolerability of two scalp cooling systems for the prevention of alopecia associated with docetaxel treatment.  Support Care Cancer. 2013;21(9):2565-2573. doi:10.1007/s00520-013-1804-9PubMedGoogle ScholarCrossref
Christodoulou  C, Klouvas  G, Efstathiou  E,  et al.  Effectiveness of the MSC cold cap system in the prevention of chemotherapy-induced alopecia.  Oncology. 2002;62(2):97-102. doi:10.1159/000048253PubMedGoogle ScholarCrossref
Cigler  T, Isseroff  D, Fiederlein  B,  et al.  Efficacy of scalp cooling in preventing chemotherapy-induced alopecia in breast cancer patients receiving adjuvant docetaxel and cyclophosphamide chemotherapy.  Clin Breast Cancer. 2015;15(5):332-334. doi:10.1016/j.clbc.2015.01.003PubMedGoogle ScholarCrossref
Fehr  MK, Welter  J, Sell  W, Jung  R, Felberbaum  R.  Sensor-controlled scalp cooling to prevent chemotherapy-induced alopecia in female cancer patients.  Curr Oncol. 2016;23(6):e576-e582. doi:10.3747/co.23.3200PubMedGoogle ScholarCrossref
Joshi  R, Olver  I, Keefe  D, Marafioti  T, Smith  K.  A phase I study to assess the safety and activity of topical lovastatin (FP252S) for the prevention of chemotherapy-induced alopecia.  Support Care Cancer. 2007;15(9):1109-1112. doi:10.1007/s00520-007-0267-2PubMedGoogle ScholarCrossref
Katsimbri  P, Bamias  A, Pavlidis  N.  Prevention of chemotherapy-induced alopecia using an effective scalp cooling system.  Eur J Cancer. 2000;36(6):766-771. doi:10.1016/S0959-8049(00)00012-5PubMedGoogle ScholarCrossref
Komen  MMC, Breed  WPM, Smorenburg  CH,  et al.  Results of 20- versus 45-min post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia.  Support Care Cancer. 2016;24(6):2735-2741. doi:10.1007/s00520-016-3084-7PubMedGoogle ScholarCrossref
Lemenager  M, Lecomte  S, Bonneterre  ME, Bessa  E, Dauba  J, Bonneterre  J.  Effectiveness of cold cap in the prevention of docetaxel-induced alopecia.  Eur J Cancer. 1997;33(2):297-300. doi:10.1016/S0959-8049(96)00374-7PubMedGoogle ScholarCrossref
Macduff  C, Mackenzie  T, Hutcheon  A, Melville  L, Archibald  H.  The effectiveness of scalp cooling in preventing alopecia for patients receiving epirubicin and docetaxel.  Eur J Cancer Care (Engl). 2003;12(2):154-161. doi:10.1046/j.1365-2354.2003.00382.xPubMedGoogle ScholarCrossref
Nangia  J, Wang  T, Osborne  C,  et al.  Effect of a scalp cooling device on alopecia in women undergoing chemotherapy for breast cancer: the SCALP randomized clinical trial.  JAMA. 2017;317(6):596-605. doi:10.1001/jama.2016.20939PubMedGoogle ScholarCrossref
Ridderheim  M, Bjurberg  M, Gustavsson  A.  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.  Support Care Cancer. 2003;11(6):371-377. doi:10.1007/s00520-003-0451-yPubMedGoogle Scholar
Rugo  HS, Klein  P, Melin  SA,  et al.  Association between use of a scalp cooling device and alopecia after chemotherapy for breast cancer.  JAMA. 2017;317(6):606-614. doi:10.1001/jama.2016.21038PubMedGoogle ScholarCrossref
Schaffrin-Nabe  D, Schmitz  I, Josten-Nabe  A, von Hehn  U, Voigtmann  R.  The influence of various parameters on the success of sensor-controlled scalp cooling in preventing chemotherapy-induced alopecia.  Oncol Res Treat. 2015;38(10):489-495. doi:10.1159/000440636PubMedGoogle ScholarCrossref
van den Hurk  CJ, Peerbooms  M, van de Poll-Franse  LV, Nortier  JW, Coebergh  JWW, Breed  WP.  Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients - results of the Dutch Scalp Cooling Registry.  Acta Oncol. 2012;51(4):497-504. doi:10.3109/0284186X.2012.658966PubMedGoogle ScholarCrossref
van den Hurk  CJG, Breed  WPM, Nortier  JWR.  Short post-infusion scalp cooling time in the prevention of docetaxel-induced alopecia.  Support Care Cancer. 2012;20(12):3255-3260. doi:10.1007/s00520-012-1465-0PubMedGoogle ScholarCrossref
van den Hurk  CJ, van den Akker-van Marle  ME, Breed  WP, van de Poll-Franse  LV, Nortier  JW, Coebergh  JW.  Cost-effectiveness analysis of scalp cooling to reduce chemotherapy-induced alopecia.  Acta Oncol. 2014;53(1):80-87. doi:10.3109/0284186X.2013.794955PubMedGoogle ScholarCrossref
Rice  BA, Ver Hoeve  ES, DeLuca  AN, Esserman  LJ, Rugo  HS, Melisko  ME.  Registry study to assess hair loss prevention with the Penguin Cold Cap in breast cancer patients receiving chemotherapy.  Breast Cancer Res Treat. 2018;167(1):117-122. doi:10.1007/s10549-017-4506-zPubMedGoogle ScholarCrossref
Kurbacher  C, Herz  S, Kurbacher  A, Kolberg  G. Sensor-controlled scalp cooling for chemotherapy-induced alopecia: safety and effectiveness in primary breast cancer patients exposed to anthracyclines and/or taxanes in the neoadjuvant or adjuvant setting. J Clin Oncol. 2018;36(15)(suppl):e22196. http://ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.e22196. Accessed June 5, 2018.
Vasconcelos  I, Wiesske  A, Schoenegg  W.  Scalp cooling successfully prevents alopecia in breast cancer patients undergoing anthracycline/taxane-based chemotherapy.  Breast. 2018;40:1-3. doi:10.1016/j.breast.2018.04.012PubMedGoogle ScholarCrossref
Chan  A, Bauwens  A, Pontre  S,  et al.  Efficacy of scalp cooling in reducing alopecia in early breast cancer patients receiving contemporary chemotherapy regimens.  Breast. 2018;41:127-132. doi:10.1016/j.breast.2018.07.006PubMedGoogle ScholarCrossref
van den Hurk  CJG, van den Akker-van Marle  ME, Breed  WPM, van de Poll-Franse  LV, Nortier  JWR, Coebergh  JWW.  Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer.  Eur J Oncol Nurs. 2013;17(5):536-540. doi:10.1016/j.ejon.2013.02.004PubMedGoogle ScholarCrossref
Hayashi  T, Fujita  T, Mase  T,  et al.  Phase II clinical study of protection of nail change and skin toxicity by using a frozen glove in Japanese patients with early breast cancer treated by docetaxel and cyclophosphamide (TC)  [TBCRG-03 Study].  Cancer Res. 2009;69(24)(suppl):808. doi:10.1158/0008-5472.SABCS-09-808Google ScholarCrossref
Sakurai  M, Todaka  K, Takada  N,  et al.  Multicenter phase II study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity for the breast cancer patients (Kinki Multidisciplinary Breast Oncology Group: KMBOG-0605).  Cancer Res. 2009;69(2)(suppl):4093. doi:10.1158/0008-5472.SABCS-4093PubMedGoogle ScholarCrossref
Scotté  F, Banu  E, Medioni  J,  et al.  Matched case-control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel-induced onycholysis and cutaneous toxicity of the foot.  Cancer. 2008;112(7):1625-1631. doi:10.1002/cncr.23333PubMedGoogle ScholarCrossref
Kawaguchi  K, Ishiguro  H, Morita  S,  et al; Japan Breast Cancer Research Group (JBCRG).  Correlation between docetaxel-induced skin toxicity and the use of steroids and H2 blockers: a multi-institution survey.  Breast Cancer Res Treat. 2011;130(2):627-634. doi:10.1007/s10549-011-1641-9PubMedGoogle ScholarCrossref
Kim  JY, Ok  ON, Seo  JJ,  et al.  A prospective randomized controlled trial of hydrating nail solution for prevention or treatment of onycholysis in breast cancer patients who received neoadjuvant/adjuvant docetaxel chemotherapy.  Breast Cancer Res Treat. 2017;164(3):617-625. doi:10.1007/s10549-017-4268-7PubMedGoogle ScholarCrossref
McCarthy  AL, Shaban  RZ, Gillespie  K, Vick  J.  Cryotherapy for docetaxel-induced hand and nail toxicity: randomised control trial.  Support Care Cancer. 2014;22(5):1375-1383. doi:10.1007/s00520-013-2095-xPubMedGoogle ScholarCrossref
Ishiguro  H, Takashima  S, Yoshimura  K,  et al.  Degree of freezing does not affect efficacy of frozen gloves for prevention of docetaxel-induced nail toxicity in breast cancer patients.  Support Care Cancer. 2012;20(9):2017-2024. doi:10.1007/s00520-011-1308-4PubMedGoogle ScholarCrossref
Can  G, Aydiner  A, Cavdar  I.  Taxane-induced nail changes: predictors and efficacy of the use of frozen gloves and socks in the prevention of nail toxicity.  Eur J Oncol Nurs. 2012;16(3):270-275. doi:10.1016/j.ejon.2011.06.007PubMedGoogle ScholarCrossref
Begon  E, Blum  L, Fraboulet  G, Assouad  S, Bachmeyer  C.  Frostbite as a complication of frozen gloves in the prevention of docetaxel-induced onycholysis.  Eur J Dermatol. 2011;21(4):628-629. doi:10.1684/ejd.2011.1390PubMedGoogle Scholar
Ding  P, Thomas  R.  A case report of a cold water bath to prevent docetaxel induced onycolysis.  Clin Focus Cancer Med. 2010;2(1):18-19.Google Scholar
Matsumoto  K, Hino  C, Fukuda  K, Hamamoto  M. Prospective study of ice gel pack as less expensive alternative for prevention of skin and nail toxicity in patients with breast cancer receiving docetaxel. Cancer Res. 2009;69(24)(suppl):abstract 1114. http://cancerres.aacrjournals.org/content/69/24_Supplement/1114.short. Accessed June 5, 2018.
Trüeb  RM. Chemotherapy-induced hair loss. Skin Therapy Letter. http://www.skintherapyletter.com/hair-loss/chemotherapy-induced/. Published August 1, 2010. Accessed March 20, 2018.
Miller  KK, Gorcey  L, McLellan  BN.  Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management.  J Am Acad Dermatol. 2014;71(4):787-794. doi:10.1016/j.jaad.2014.03.019PubMedGoogle ScholarCrossref
Memorial Sloan Kettering Cancer Center. Nail changes during treatment with taxane-based chemotherapy. https://www.mskcc.org/cancer-care/patient-education/nail-changes-during-treatment-taxanes. Updated September 28, 2017. Accessed March 18, 2018.
Robinson  JK, Dellavalle  RP, Bigby  M, Callen  JP.  Systematic reviews: grading recommendations and evidence quality.  Arch Dermatol. 2008;144(1):97-99. doi:10.1001/archdermatol.2007.28PubMedGoogle ScholarCrossref
Gregory  RP, Cooke  T, Middleton  J, Buchanan  RB, Williams  CJ.  Prevention of doxorubicin-induced alopecia by scalp hypothermia: relation to degree of cooling.  BMJ (Clin Res Ed). 1982;284(6330):1674. doi:10.1136/bmj.284.6330.1674PubMedGoogle ScholarCrossref
Batchelor  D.  Hair and cancer chemotherapy: consequences and nursing care–a literature study.  Eur J Cancer Care (Engl). 2001;10(3):147-163. doi:10.1046/j.1365-2354.2001.00272.xPubMedGoogle ScholarCrossref
Belum  VR, de Barros Silva  G, Laloni  MT,  et al.  Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia.  Breast Cancer Res Treat. 2016;157(2):395-400. doi:10.1007/s10549-016-3799-7PubMedGoogle ScholarCrossref
Rugo  HS, Melin  SA, Voigt  J.  Scalp cooling with adjuvant/neoadjuvant chemotherapy for breast cancer and the risk of scalp metastases: systematic review and meta-analysis.  Breast Cancer Res Treat. 2017;163(2):199-205. doi:10.1007/s10549-017-4185-9PubMedGoogle ScholarCrossref
Lemieux  J, Amireault  C, Provencher  L, Maunsell  E.  Incidence of scalp metastases in breast cancer: a retrospective cohort study in women who were offered scalp cooling.  Breast Cancer Res Treat. 2009;118(3):547-552. doi:10.1007/s10549-009-0342-0PubMedGoogle ScholarCrossref
Lacouture  ME, Konner  JA, Stevens  J, Brouwer  S, Niven  RN, Ye  R.  Topical calcitriol (BPM31543) for the prevention of chemotherapy-induced alopecia (CIA): efficacy findings from a phase I safety study.  J Clin Oncol. 2016;34(15)(suppl):2564.Google ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
State Requirements