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How scalp cooling works

Scalp cooling (commonly known as "cold capping") is a means to lower scalp temperature to prevent hair loss during chemotherapy. Scalp cooling works by inducing vasoconstriction and reduction of metabolism, which leads to reduced blood flow to the hair follicles in the period of peak plasma concentration of the chemotherapy agent. As a result, the hair follicles become less vulnerable to damage from the chemotherapy agent.

Options available 

There are currently two methods for scalp cooling: ​​

Machine Cold Capping

This method employs a plug-in system which includes a hypothermia cap connected to a computer-operating cooling and control unit; the system circulates coolant through channels in the cap, and sensors ensure optimal temperature is continuously maintained throughout treatment.

This method is only used at participating cancer centers. You can check which cancer centers have these devices installed by visiting the following vendors' websites:



Manual Cold Capping

This method employs portable gel caps that are cooled (either by dry ice in a personal cooler or an infusions center’s bio-medical freezer) to an optimum temperature (typically between -26 and -36 degrees celsius) and rotated on the head every 20-30 minutes, depending on the company’s guidance.

These portable caps can be used at any location. You can see available vendors at the following websites:

Penguin Cold Caps

Chemo Cold Caps

Arctic Cold Caps

Warrior Caps

FDA Clearance 

The DigniCap and Paxman systems are the only two FDA-cleared systems at present. DigniCap is cleared for use in all patients who have solid tumors, and Paxman is currently cleared for use in patients with breast cancer. In a clinical trial, the DigniCap system prevented hair loss in 66.3% of patients with breast cancer who received neo/adjuvant chemotherapy, compared with the control group (patients who opted out of scalp cooling entirely), all of whom experienced significant hair loss. Women who received only taxane chemotherapy have had better results with cold caps and scalp cooling systems than women who received only anthracycline chemotherapy. There is currently no clinical or scientific evidence that the incidence of scalp metastases is increased in scalp cooled patients.

  Rugo H, et al: 2016 MASCC/ISOO International Symposium. Presented June 23, 2016.

When Not to Cold Cap

Cold capping is not advised for pediatric patients or for adult patients who meet one or more of the criteria below:

  • Cold sensitivity

  • Cold agglutinin disease

  • Cryoglobulinemia

  • Cryofibrinogenemia

  • Cold urticaria

  • CNS malignancies (either primary or metastatic)

  • Squamous cell carcinoma of the lung

  • Small cell carcinoma of the lung

  • Cancers of the head and neck

  • Skin cancers including melanoma, squamous cell carcinoma, and Merkel cell carcinoma

  • Hematological malignancies treated with curative intent by chemotherapy

  • Solid tumor malignancies with a high likelihood of metastases in transit

  • Patients who are scheduled for bone marrow ablation chemotherapy

  • Patients who are scheduled to undergo skull irradiation

  • Patients who have previously received skull irradiation

Additional Resources

The Rapunzel Project: A national non profit that promotes awareness of the existence and efficacy of cold cap therapy. Their website explains the scalp cooling process, identifies vetted cold cap providers, and lists all locations that offer machine capping as well as those who have a biomedical freezer to support manual capping. Helpful tips for cap users, and links to years of research and media coverage are also part of the site. They also donate biomedical freezers to supportive cancer centers.

Hair to Stay: A national nonprofit with the shared goal of making cold capping affordable for patients Provides an overview of cold capping during breast cancer treatment and a link to their forums where patients share their tips and experiences

More information and resources coming soon! Have a question in the meantime? Contact us:



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