Cooling therapies such as cold caps, scalp cooling systems, frozen gloves, and frozen socks may offer the best protection against the adverse effects of taxane-based chemotherapy, according to a new study in JAMA Dermatology.

“Taxanes induce dermatologic changes through direct cytotoxic effect,” says study author Adam Friedman, MD, director of the Supportive Oncodermatology Clinic at the GW Cancer Center, professor of dermatology at the GW School of Medicine and Health Sciences, in a news release. “While they are an important tool in our chemotherapy armamentarium, cutaneous side effects can limit their use and therefore we want to establish the best approaches, both prophylactic and active, to limit their negative impact.”

Dr. Friedman and his team at GW performed a comprehensive systematic review of 34 studies published between Jan. 1, 1980 and Aug. 13, 2018 to assess the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse effects.

The team found cold therapy offers the most promising preventative intervention for taxane-induced dermatologic events, followed by urea-based creams specifically for hand/foot side effects, while off-label use of topical lovastatin and systemic corticosteroids did not provide adequate protection.

“Most of the studies we looked at support the use of cold caps or scalp cooling systems to reduce hair loss,” Dr. Friedman explains. “These seem to be the most effective in preventing taxane-induced alopecia, and there is even evidence supporting their ability to prevent toxic events affecting both the skin of the hands/feet and the nails.”

Additional research is need to establish routine protocols for cooling methods and to identify new approaches to mitigate these adverse events, says Dr. Friedman. Researchers must also determine more standardized outcome measures for successful hair, skin, and nail injury prevention, and the long-term efficacy and safety of these interventions.