Chemotherapy-induced alopecia (CIA) is a highly distressing event for cancer patients, and hence, we here aimed to assess the efficacy of various interventions in the prevention of CIA. We searched PubMed, EMBASE and the Cochrane Library, from June 20, 2013 through August 31, 2013. Two of the authors independently reviewed and selected clinical trials that reported the efficacy of any intervention for prevention of CIA compared with that of controls. Two authors extracted data independently on dichotomized outcome in terms of CIA occurrence. Relative risks (RRs) and 95% confidential intervals (CIs) were calculated for efficacy of CIA prevention by using random-effect or fixed-effect models. Out of 691 articles retrieved, a total of eight randomized controlled trials and nine controlled clinical trials involving 1,098 participants (616 interventions and 482 controls), were included in the final analyses. Scalp cooling, scalp compression, a combination of cooling and compression, topical minoxidil and Panicum miliaceum were used as interventions. The participants were mainly breast cancer patients receiving doxorubicin-or epirubicin-containing chemotherapy. Scalp cooling, which is the most popular preventive method, significantly reduced the risk of CIA (RR 5 0.38, 95% CI 5 0.32-0.45), whereas topical 2% minoxidil and other interventions did not significantly reduce the risk of CIA. No serious adverse effects associated with scalp cooling were reported. Our results suggest that scalp cooling can prevent CIA in patients receiving chemotherapy. However, the long-term safety of scalp cooling should be confirmed in further studies.Chemotherapy-induced alopecia (CIA) is a common and stressful adverse effect associated with chemotherapy. 1 CIA generally starts at 1-3 weeks after the first cycle of chemotherapy, and is aggravated after subsequent cycles. 2 Fortunately CIA is spontaneously recovered after 3-6 months in usual cases. 3 However, not a few patients suffer from permanent CIA, and many patients experience changes in hair color, texture and growth rate even after regrowth of hairs. 4 The occurrence and severity of CIA is dependent on the chemotherapeutic dose, administration schedule and other protocols. 5 Various cytotoxic chemotherapeutics can cause CIA. The chemotherapeutics target all rapidly proliferating cells, and consequently damage not only tumor cells but also the hair follicles. At any given time, approximately 90% of the hair follicles in the human scalp are in the anagen stage, and these hair matrix cells proliferate fast. The apoptosis of these cells caused by cytotoxic chemotherapeutics results in hair shedding, which is called anagen effluvium. 6 Although CIA is generally reversible 3-6 months postchemotherapy, it commonly causes psychosocial stress to the patients, including negative changes in body image, sexuality, self-esteem and disturbances in social relationships. The fear of hair loss and the associated distress may even result in cancer patients refusing proper chemotherapy treatment. 7 ...