chemotherapy hair loss evidence
Proof before promises
Clinical studies and real-world evidence have consistently shown that hair follicle protection via scalp cooling provides short, medium, and long-term benefits.
Regrowth & PCIA
Quality of Life
Safety & Tolerability
Efficacy and retention
Backed by over 20 years of clinical and real-world scalp cooling data.
In a selection of clinical efficacy studies from a range of populations, countries and alopecia scales, scalp cooling has been consistently proven to reduce hair loss.
The graph below shows a representative selection of 12 studies across various countries and populations, highlighting the percentage of patients that had scalp cooling success defined by 50% or more hair retention.
patients across 12 studies
Studies ranging from 2012-2025
mean average success rate across all 12 studies
| Ref. 1, United States, CTCAE V4.0/V5.0 | 50.5% |
|---|---|
| Ref. 2, Japan, CTCAE V4.0/V5.0 | 26.7% |
| Ref. 3, India, CTCAE V4.0/V5.0 | 56.3% |
| Ref. 4, Mexico, CTCAE V4.0/V5.0 | 74% |
| Ref. 5, United States, CTCAE V4.0/V5.0 | 43% |
| Ref. 6, India, Dean scale | 81% |
| Ref. 7, United States, Dean scale | 66.3% |
| Ref. 8, Italy, Dean scale | 54% |
| Ref. 9, Japan, other scale | 33.3% |
| Ref. 10, Germany, other scale | 71% |
| Ref. 11, Netherlands, WHO scale | 50% |
| Ref. 12, Netherlands, WHO scale | 53% |
Alopecia scales
- CTCAE V4.0/V5.0
- Dean scale
- Other
- WHO
The Scalp Cooling Registry
One of the key studies from this selection is The Scalp Cooling Registry – proof of scalp cooling efficacy in the real world.
- 13 years with over 7,000 patients across more than 60 sites
- 53% success rate defined by less than 50% hair loss according to the WHO alopecia scale
- 56% success rate based on patient head covering usage
Hair regrowth and preventing PCIA*
*Persistent Chemotherapy-Induced Alopecia
Scalp cooling mechanisms mean that despite hair loss, hair follicle cells can be protected, promoting quicker regrowth after chemotherapy.
Studies conducted in Asia have demonstrated faster regrowth, greater hair thickness, increased density, and reduced incidence of persistent alopecia compared to no scalp cooling, using both qualitative (scalp photography) and quantitative methods (trichoscopic measurements).
Hair recovery at baseline vs 12 weeks following treatment
Ref 2.| Scalp cooling (%) | Control (%) | |
|---|---|---|
| No alopecia (Grade 0 to 1) at end of chemotherapy | 26.7% | 0% |
| Recovered to Grade 0 at 12 weeks (for those with alopecia at end) | 5% | 8.3% |
| >50% hair volume recovery at 12 weeks | 85.7% | 50% |
- 48 patients.
- Meaningful difference in hair recovery following on from chemotherapy treatment.
- Patients who cooled were 2 times more likely to regain at least half of their hair.
- Patients were 3 times more likely to fully recover compared to hair recovery at baseline vs 12 weeks following treatment controls.
Primary endpoint assessment of persistent chemotherapy, wig and scarf use
Ref 13.| Scalp cooling (%) | Control (%) | |
|---|---|---|
| No alopecia (Grade 0 to 1) at end of chemotherapy | 13.5% | 52% |
| Recovered to Grade 0 at 12 weeks (for those with alopecia at end) | 17% | 32% |
| >50% hair volume recovery at 12 weeks | 46% | 71% |
- 89 scalp cooling patients.
- Only 13.5% of scalp cooling patients had PCIA at 6 months post-chemotherapy.
- Demonstrates that hair retention is not the sole factor of scalp cooling success.
This data, along with many others shows that scalp cooling promotes faster regrowth and significantly reduces the risk of persistent chemotherapy-induced alopecia (PCIA), even in patients receiving anthracycline-based therapies.
Scalp cooling improves Quality of Life
Chemotherapy-induced alopecia can lead to feelings of anxiety and depression, a loss of identity and confidence, as well as social withdrawal, thus a slower return to normal life.14
Certain studies have analysed the impact of scalp cooling in mitigating the emotional and psychological trauma of hair loss compared with those who did not scalp cool.
This study assessed patient quality of life factors through EORTC QLQ BR23 questionnaires between scalp cooling and control groups to ascertain the effect of scalp hair retention on quality of life.7
- Study in patients with early-stage breast cancer.
- 106 patients scalp cooled while 16 were in the control group.
- Psychological and emotional wellbeing were positively impacted when scalp cooling successfully reduced alopecia.
- For women who used scalp cooling, 3/5 QoL measures showed statistically significant improvement: less hair loss distress, feeling more physically attractive, and greater body satisfaction.
| Scalp cooling (%) | Control (%) | |
|---|---|---|
| Difficulty looking at self naked | 33.0% | 68.8% |
| Felt less feminine | 32.4% | 60.0% |
| Dissatisfied with body | 27.3% | 56.3% |
| Felt physically less attractive | 21.6% | 31.3% |
| Upset about hair loss | 15.9% | 18.8% |
| Lost any hair | 15.9% | 37.5% |
Quality of Life Outcome 1 Month after Chemotherapy Scalp Cooling vs Control
Safety and tolerability of scalp cooling
incidence of scalp metastases, from a systematic review and meta-analysis of longitudinal studies totalling 1,959 patients.15
While historically there were concerns among critics that scalp cooling could increase the incidence of scalp metastases, studies have shown that the risk remains low.
average discontinuation rate across available data in the 12-study selection above.
Scalp cooling is well tolerated by most patients, and its safety is well documented in clinical research. Across studies, minimal numbers of patients report cessation of scalp cooling due to the cold or cold-related side effects.
Extensive studies confirm that scalp cooling is safe and well-tolerated, with no serious adverse events reported and minimal patient discomfort.
The Paxman Scalp Cooling system clinical evidence brochure
The clinical brochure for the Paxman Scalp Cooling System provides in-depth detail and analysis on these four key benefit areas.
Clinical studies library
Explore a comprehensive library of more than 100 clinical trials focused on chemotherapy side effect management. Review the science, evaluate the outcomes, and inform your clinical decisions with confidence.
The science behind scalp cooling
Learn about the four established scalp cooling mechanisms that protect the hair follicles from chemotherapy and discover how the Paxman system sets the right conditions for success.
References
- Nangia, J., Wang, T., Osborne, C., Niravath, P., Otte, K., Papish, S., . . . Rimawi, M. (2017). Effect of a Scalp Cooling Device on Alopecia in Women Undergoing Chemotherapy for Breast Cancer: The SCALP Randomized Clinical Trial. JAMA, 317(6), 596-605. https://doi.org/10.1001/jama.2016.20939
- Kinoshita, T., N. T., Fukuma, E., Inokuchi, M., Ishiguro, H., Ogo, E., . . . Toi, M. (2019). Efficacy of Scalp Cooling in Preventing and Recovering From Chemotherapy-Induced Alopecia in Breast Cancer Patients: The HOPE Study. Frontiers in Oncology, 9(733). https://doi.org/10.3389/fonc.2019.00733
- Bajpai, J., Kagwade, S., Chandrasekharan, A., Dandekar, S., Kanan, S., Kembhavi, Y., . . . Gupta, S. (2020). Randomised controlled trial of scalp cooling for the prevention of chemotherapy induced alopecia. Breast, 49, 187–193. doi:10.1016/j.breast.2019.12.004
- Villarreal-Garza, C., Mesa-Chavez, F., Garza-Ledezma, M. R., Peña-Curiel, O., Martinez-Cannon, B. A., Canavati-Marcos, M., & Cardona-Huerta, S. (2021). Impact of chemotherapy regimen and sequence on the effectiveness of scalp cooling for alopecia prevention. Breast Cancer Research and Treatment, 185(2), 453-458. doi:10.1007/s10549-020-05968-w
- Goldfarb, S. B., Blinder, V., Gajria, D., Chang, C., Dacunto, A., Park, J., . . . Lacouture, M. (2023). Safety and Tolerability of Paxman Scalp Cooling at Lower Temperatures to Improve Efficacy with Anthracycline Chemotherapy. Cancer Research, 83(5_Supplement), P5-08-10. doi:10.1158/1538-7445.SABCS22-P5-08-10
- Mekha, M., Joshi, A., Maniar, V., Maheshwari, U., Joshi, K., Kalaskar, P., . . . Dhande, S. (2024). The Efficacy of Paxman Scalp Cooling System in Preventing Hair Loss in Breast Cancer Patients Receiving Chemotherapy in Western India – Multicentre Retrospective Cohort Study. Indian Journal of Dermatology, 69(1), 16-23. doi:10.4103/ijd.ijd_345_23
- Rugo, H. S., Klein, P., Melin, S. A., Hurvitz, S. A., Melisko, M. E., Moore, A., . . . Cigler, T. (2017). Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. JAMA, 317(6), 606-614. doi:10.1001/jama.2016.21038
- Munzone, E., Pagan, E., Bagnardi, V., & Mazzocco, K. (2019). Reply to Comments on: “Preventing chemotherapy-induced alopecia: a prospective clinical trial on the efficacy and safety of a scalp cooling system in early breast cancer patients treated with anthracyclines”. British Journal of Cancer, 121(9), 806. doi:10.1038/s41416-019-0577-4
- Oki, S., Ishihara, Y., Takahashi, S., Kato, T., Ietani, K., & Makabe, T. (2025). Feasibility of Anticancer Treatment Using Scalp Cooling for Patients With Gynecological Cancer in Japan: A Case Series Study. J Obstet Gynaecol Res, 51(3), e16270. https://doi.org/10.1111/jog.16270
- Vasconcelos, I., Wiesske, A., & Schoenegg, W. (2018). Scalp cooling successfully prevents alopecia in breast cancer patients undergoing anthracycline/taxane-based chemotherapy. Breast, 40, 1-3. doi:10.1016/j.breast.2018.04.012
- Van den Hurk, C. J., Peerbooms, M., van de Poll-Franse, L. V., Nortier, J. W., Coebergh, J. W., & Breed, W. P. (2012). Scalp cooling for hair preservation and associated characteristics in 1411 chemotherapy patients – results of the Dutch Scalp Cooling Registry. Acta Oncologica, 51(4), 497-504. doi:10.3109/0284186X.2012.658966
- Brook, T. S., Seetsen, T., Dercksen, M. W., van Riel, A., Derleyn, V. A., van den Bosch, J., . . . Van Den Hurk, C. J. (October 2024). Results of the Dutch Scalp Cooling Registry in 7424 Patients: Analysis of Determinants for Scalp Cooling Efficacy. The Oncologist, 29(10), e1386-e1395. https://doi.org/10.1093/oncolo/oyae116
- Kang, D. et al. (2024). Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial. Journal of Clinical Oncology, 42. doi:https://doi.org/10.1200/JCO.23.02374
- Lemieux, J., Maunsell, E., & Provencher, L. (2008). Chemotherapy-induced alopecia and effects on quality of life among women with breast cancer: a literature review. Psycho-Oncology, 17(4), 317-328. doi:10.1002/pon.1245
- Rugo, H. S., Melin, S. A., & Voigt, J. (2017). Scalp cooling with adjuvant/neoadjuvant chemotherapy for breast cancer and the risk of scalp metastases: systematic review and meta-analysis. Breast Cancer Research and Treatment, 163(2), 199-205. doi:10.1007/s10549-017-4185-9
