title: Cold thermal injury from cold caps used for the prevention of chemotherapy-induced alopecia.
abstract: The use of scalp cooling for the prevention of chemotherapy-induced alopecia (CIA) is increasing. Cold caps are placed onto the hair-bearing areas of the scalp for varying time periods before, during, and after cytotoxic chemotherapy. Although not yet reported, improper application procedures could result in adverse events (AEs). At present, there are no evidence-based scalp cooling protocols, and there is no regulatory oversight of their use.
  
  
  
  To report the occurrence of cold thermal injury (frostbite) on the scalp, following the use of cold caps for the prevention of CIA.
  
  
  
  We identified four patients who developed cold thermal injuries on the scalp following the application of cold caps. Medical records were analyzed to retrieve the demographic and clinical characteristics.
  
  
  
  The cold thermal injuries in our patients were grade 1/2 in severity and improved with topical interventions and interruption of cold cap use, although grade 1 persistent alopecia ensued in 3 patients. The true incidence of such injuries in this setting, however, remains unknown.
  
  
  
  Cold thermal injuries are likely infrequent and preventable AEs that may result from improper device application procedures during cold cap use. Although these untoward events are usually mild to moderate in severity, the potential occurrence of long-term sequelae (e.g., permanent alopecia and scarring) or the need to discontinue cold cap use, are not known. Prospective studies are needed to further elucidate the risk and standardize healthcare delivery methods, and to improve patient/supportive/healthcare provider education.
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA.
authors.forename: Viswanath Reddy
authors.initials: VR
authors.lastname: Belum
authors.affiliation: Centro Paulista de Oncologia, Sao Paulo, Brazil.
authors.forename: Giselle
authors.initials: G
authors.lastname: de Barros Silva
authors.affiliation: Centro Paulista de Oncologia, Sao Paulo, Brazil.
authors.forename: Mariana Tosello
authors.initials: MT
authors.lastname: Laloni
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ciccolini
authors.affiliation: Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Shari B
authors.initials: SB
authors.lastname: Goldfarb
authors.affiliation: Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Norton
authors.affiliation: Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Nancy T
authors.initials: NT
authors.lastname: Sklarin
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 60th Street Outpatient Center, 16 East 60th St., Suite 407, Room 4312, New York, NY, USA. lacoutum@mskcc.org.
authors.forename: Mario E
authors.initials: ME
authors.lastname: Lacouture
mesh_terms: D000505:Alopecia / Q000139:chemically induced / Q000517:prevention & control*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy; D005260:Female; D005627:Frostbite / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000295:instrumentation; D015994:Incidence; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy-induced alopecia; Cold caps; Cryotherapy; Frostbite; Scalp hypothermia; Thermal injury