Cold Caps & Scalp Cooling to Reduce Hair Loss

Scalp cooling is real, it is regulated, and it works for some people some of the time. It is not a guarantee, and the honest answer to "will this save my hair?" depends heavily on which chemotherapy you are getting.

A cold cap chills your scalp before, during, and after a chemotherapy infusion. The cold makes blood vessels in the scalp constrict, so less chemotherapy reaches the hair follicles. Cooling also slows follicle activity and cell division, which makes the follicles less vulnerable to drugs that target rapidly dividing cells.

The FDA describes the DigniCap Cooling System as computer-controlled: cooled liquid circulates through a cap worn tightly on the head, covered by a neoprene insulating layer. The National Cancer Institute notes that the idea is not new — in the 1970s, clinicians used ice packs, and some manual cap systems still require the caps to be swapped out repeatedly during a session.

This is the concrete, citable part.

• DigniCap Cooling System (Dignitana Inc.) was cleared by the FDA in 2015 for patients with breast cancer.
• In 2017 the FDA expanded that clearance to "reduce the frequency and severity of hair loss during chemotherapy in solid tumor cancer patients" where chemotherapy that causes hair loss is used. This was the first cooling cap cleared beyond breast cancer.
• The Paxman Scalp Cooler (Paxman Coolers Limited) was cleared on June 7, 2018, "to reduce the likelihood of chemotherapy-induced alopecia (CIA) in cancer patients with solid tumors."

Note what these clearances have in common: solid tumors. Scalp cooling has not been cleared for blood cancers such as leukemia and lymphoma.

The numbers below come from the trials the FDA and NCI cite. They are not promises.

In the original DigniCap study of 122 patients with stage I–II breast cancer, the FDA reports that "more than 66 percent of patients treated with the DigniCap reported losing less than half their hair." NCI's account of that trial adds detail: among 101 patients who used cooling, 4% had no hair loss and 61.4% lost less than half their hair, while all 16 patients in the control group lost more than half. A separate 226-patient trial found 65% had no or mild hair loss, and only 28% needed a wig.

For the Paxman system, NCI reports a study in which all 47 women in the control group lost more than half their hair, compared with 5% of the cooling group who lost none and 45% who lost less than half.

The regimen matters enormously. NCI states that effectiveness depends on the chemotherapy regimen, and that anthracycline-based treatments were less responsive to scalp cooling. The DigniCap trial above enrolled patients on non-anthracycline regimens. If you are on an anthracycline, the odds are less favorable — ask your oncologist how your specific drugs compare.

Dr. Hershman, quoted by NCI, put the limit plainly: "Scalp cooling is not 100% effective," and it should not be offered during chemotherapy regimens that continue indefinitely.

The FDA lists cold-induced headaches, neck and shoulder discomfort, chills, and pain from wearing the cap for long periods.

The FDA states DigniCap is contraindicated for pediatric patients, for patients with certain cancers, and for patients receiving certain chemotherapy treatments. It is not recommended for people with cold sensitivity or susceptibility to cold-related injury.

You may hear a concern that cooling the scalp could shield cancer cells hiding there from chemotherapy. Here is where the two sources sit slightly differently, and both are worth knowing.

The FDA notes a rare risk of chemotherapy missing isolated cancer cells in the scalp, and states directly: "Long-term effects of scalp-cooling and risk of scalp metastasis have not been fully studied."

NCI reports that there is no evidence scalp cooling leads to more scalp metastases, a conclusion supported by recent reviews.

In plain terms: no study has found harm, and the long-term data are still thin. Both statements are true at once.

NCI reported an average total cost of roughly $1,500 to $3,000 per patient, and that insurance did not cover scalp cooling. Coverage can change, so confirm current pricing and any coverage or grant programs with your treatment center rather than relying on that figure alone.

• Call your care team the same day if a cold-induced headache during or after a cooling session turns severe, or it does not ease once the cap comes off and you have warmed up. The same goes for neck, shoulder or scalp pain that is still there hours later.
• Call your care team within a day or two if the chills or the discomfort of wearing the cap are becoming hard to tolerate session after session, so the plan can be reviewed before your next infusion.
• Call your care team within a day or two if you have cold sensitivity, a condition that makes cold injury more likely, or a blood cancer, and nobody has yet confirmed that scalp cooling is appropriate for you.

• U.S. Food and Drug Administration — FDA clears expanded use of cooling cap to reduce hair loss during chemotherapy: https://www.fda.gov/news-events/press-announcements/fda-clears-expanded-use-cooling-cap-reduce-hair-loss-during-chemotherapy
• FDA 510(k) clearance K173032 — Paxman Scalp Cooler (June 7, 2018): https://www.accessdata.fda.gov/cdrh_docs/pdf17/k173032.pdf
• National Cancer Institute — Cooling Cap to Reduce Chemotherapy-Related Hair Loss: https://www.cancer.gov/news-events/cancer-currents-blog/2017/fda-cooling-cap-chemotherapy