What Is Scalp Cooling and How Does It Work?

Scalp cooling is a simple treatment developed to help prevent or reduce hair loss caused by chemotherapy. Chemotherapy works by targeting rapidly dividing cells, and hair is the second fastest dividing cell — which is why many chemotherapy drugs cause hair loss. Scalp cooling reduces the blood flow to the cells that produce hair and protects them from chemotherapy.

Scalp ooling involves placing a tight fitting silicone cap and an outer cover on the head before, during, and after each infusion. The cooling cap is attached to a temperature-controlled machine that circulates a liquid coolant through the cap.

Scalp cooling is only effective with certain types of chemotherapy. At Dana-Farber, the treatment is currently only offered in the Susan F. Smith Center for Women’s Cancers for breast cancer patients who need chemotherapy. Scalp cooling is recommended by the National Comprehensive Cancer Network (NCCN) as a standard of care treatment of alopecia in taxane regimens for early stage breast cancer. The cooling system used at Dana-Farber is approved by the U.S. Food and Drug Administration (FDA).

To be effective, scalp cooling must start at your first treatment and be followed at each chemotherapy treatment. It is a simple process.

  1. You lightly dampen your hair and apply a small amount of conditioner.
  2. You place the inner cap on your head and then tightly adjust the outer cap to secure a tight fit. A headband or cotton pad is placed on the forehead to decrease headache. The nurse attaches your cap to a refrigeration system that circulates a liquid coolant through the cap, gradually lowering the temperature of your scalp. You will need to wear the cap for 30 minutes before chemotherapy, during infusion, and for 90 minutes after each infusion.
  3. You can disconnect the cooling cap from the machine for short periods of time if you need to take a quick break to use the bathroom or get a snack.

You may feel discomfort for the first 10 to 15 minutes of cap use, largely due to the cold temperature. This should decrease as your body adjusts to the cold. Medication is available to help with discomfort as needed. Guided imagery and relaxation techniques can also help.

Patients using cooling caps also report side effects, including:

  • Headaches
  • Itching
  • Feeling cold
  • Discomfort

You may have a heavy feeling on your head or forehead. You may feel neck pain or lightheadedness during cooling and after you remove the cap.

You will need to be fitted for your cap before your first chemotherapy appointment, and getting a correct fit is very important for success. At Dana-Farber, fittings will be scheduled with a nurse at the time of your clinic appointment with your oncology provider. The provider completes the referral form and you will need to sign and bring it to the fitting appointment. It takes 5 to 7 days to receive the cap and you must bring your cooling cap to each chemotherapy treatment appointment.

Payment and receipt of your cap and kit is arranged with the Paxman company. Some nonprofit organizations, such as Hair to Stay, provide financial support to help pay for scalp-cooling supplies.

If you are considering whether to use scalp cooling, be sure to first talk with your care team about its pros and cons.