JAAD Reviews · Published 2026-08-01 · DOI 10.1016/j.jdrv.2026.07.015
Yash C. Jani, Ahana Gaurav, Joo Young Jung, Amy McMichael
Chemotherapy-induced alopecia is a visible and psychosocially consequential toxicity of systemic cancer therapy. Scalp cooling is the primary preventive intervention, yet the evidence base informing its use has largely been generated from predominantly White cohorts, with limited race- and ethnicity-stratified efficacy data. This literature review summarizes current evidence on scalp cooling outcomes in patients with skin of color and diverse hair phenotypes, emphasizing efficacy gaps, biologic and technical determinants, access barriers, and survivorship implications. Available studies suggest that scalp cooling success may be influenced by chemotherapy regimen, cap-to-scalp contact, hair morphology, pharmacogenetic susceptibility, device design, counseling, cost, and geographic access. Early prospective data in Black women and registry data identifying Asian race and non–West-European hair type as predictors of reduced success raise concern that current devices and protocols may not perform equally across populations. Persistent chemotherapy-induced alopecia and alopecia-related distress also vary across racial and ethnic groups. Future scalp cooling research should prioritize diverse enrollment, objective hair phenotyping, scalp temperature mapping, patient-reported outcomes, adaptive device design, and equitable implementation strategies. A non-systematic literature search was performed using PubMed, Google Scholar, and reference lists of relevant articles. Search terms included “chemotherapy-induced alopecia,” “persistent chemotherapy-induced alopecia,” “scalp cooling,” “skin of color,” “hair morphology,” “hair phenotype,” “Black women,” “Asian patients,” “racial disparities,” “ethnic disparities,” and “supportive oncology.” Priority was given to prospective trials, registry studies, retrospective cohort studies, qualitative studies, reviews, and consensus statements evaluating scalp cooling efficacy, persistent chemotherapy-induced alopecia, hair morphology, biologic susceptibility, device design, access barriers, and psychosocial outcomes across diverse populations.
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Jani, Y., Gaurav, A., Jung, J., et al. (2026). Scalp Cooling in Skin of Color: Efficacy Gaps, Biological Determinants, and a Framework for Equitable Care. JAAD Reviews. https://doi.org/10.1016/j.jdrv.2026.07.015