Table 3.

Studies, Positive and Negative Aspects, Probable Mechanisms of Action, and Recommendations of Available Drugs and Devices in CIA Prevention and Treatment

Available Drugs and Devices	Studies	Positive Aspects	Negative Aspects	Probable Mechanism of Action	Recommendations
Scalp cooling	Breed et al [12] Macduff et al [7] Shin et al [9] Prochilo et al [8]	High patient compliance	Headache, discomfort, nausea, and xerosis may occur Action limited to the application time	Local vasoconstriction and reduction of drug inflow to the hair follicles	Recommended for patients affected by solid tumors undergoing chemotherapeutic protocols associated with high risk of developing CIA Not recommended for patients affected by hematological tumors, cold agglutinin disease, cryoglobulinemia, and posttraumatic cold injury or receiving platinum derivatives
Topical epinephrine and norepinephrine	Soref & Fahl [15] Rathman-Josserand et al [16]	Action also during the weeks from one infusion to another Possible use also in patients receiving platinum derivatives	Application more times per day	Induction of hypoxia signal by local vasoconstriction preserves hair follicle cells and reduces the amount of drug reaching hair follicle	Recommended for patients affected by solid tumors undergoing chemotherapeutic protocols associated with high risk of developing CIA (including platinum derivatives), including patients affected by cold agglutinin disease, cryoglobulinemia, and posttraumatic cold injury Not recommended for patients affected by hematological tumors
Topical minoxidil 2% and 5%	Rodriguez et al [19] Duvic et al [20]	Good safety and tolerability Hair regrowth acceleration	No results regarding hair loss prevention	Vasodilation and angiogenesis induction (greater permanence of the anticancer drug around the hair follicle) Hair growth stimulation by activating prostaglandin endoperoxide synthase 1 Shorten telogen phase and extend anagen phase (hair follicle most susceptible to drug insult)	Not recommended for CIA prevention Recommended after chemotherapy discontinuation in order to obtain a greater regrowth (in particular in patients with previous male and female pattern hair loss)
Topical bimatoprost 0.03%	Glaser et al [23]	Good safety and tolerability Hair regrowth acceleration	No results regarding hair loss prevention	Protection of follicles in anagen phase and improving follicular growth in anagen I (hair follicle most susceptible to drug insult)	Not recommended for CIA prevention Recommended after chemotherapy discontinuation in order to obtain a greater regrowth
Topical calcitriol (1,25-dihydroxyvitamin D3)	Jimenez et al [26] Hidalgo et al [27]	None with topical application	Contact dermatitis	Action on keratinocytes	Not recommended Evaluate systemic calcitriol (1,25-dihydroxyvitamin D3) administration in postchemotherapy phase

CIA = chemotherapy-induced alopecia.