Scalp cooling

Scalp cooling is a supportive treatment used during chemotherapy that may help to reduce hair loss caused by some medicines. It involves wearing a fitted cold cap, connected to a cooling machine. The cap lowers the temperature of your scalp, which helps to reduce the amount of chemotherapy reaching the hair follicles.  

Scalp cooling works by: 

• narrowing the blood vessels in your scalp so that less chemotherapy reaches the hair follicles  
• making the hair follicles less sensitive to damage 

Before your treatment, your chemotherapy nurse will tell you if scalp cooling is suitable for you. This will depend on the medicines you are having. We offer it to people who would normally have total hair loss caused by chemotherapy. Total hair loss is also called alopecia. We will only offer it to people having these medicines: 

• Paclitaxel
• Docetaxel
• Nab-Paclitaxel
• Epirubicin
• Doxorubicin

Scalp cooling is not suitable for everyone. You may not be able to have it if you: 

• have a blood cancer 
• have a health condition that causes your blood or nerves to react strongly to cold  
• are due to have radiotherapy to your head soon after chemotherapy 
• are due to have chemotherapy before a bone marrow transplant 
• are having oxaliplatin, because of the risk of cold-related side effects 
• are having continuous chemotherapy over several days 
• have metastatic cancer, including brain metastases (cancer that has spread to another part of your body) 
• have cold agglutinin disease 
• have cryoglobulinemia 
• are receiving high-dose chemotherapy

Scalp cooling does not completely prevent hair loss. But some people have less hair loss and may keep some of their hair.

What should I be aware of when considering scalp cooling?

All treatments and procedures have risks. Your chemotherapy nurse will explain the risks of scalp cooling in detail. These include: 

• patchy hair loss, even if you keep some hair  
• thinning hair over time 
• headaches caused by the cold scalp cooling cap 

Please also be aware that scalp cooling adds a minimum of 2 hours to your appointment time.

If you decide not to have scalp cooling, it is likely that you will temporarily lose all or some of your hair. Your chemotherapy will go ahead as planned.

We can refer you to the UCLH wig and headwear adviser who can:

• help you to choose a wig 
• offer advice on headwear options 
• teach you head scarf tying techniques

To make scalp cooling more comfortable and effective, please bring the following: 

• Hair conditioner – we use this to prepare your hair before fitting the cap 
• A spray bottle – we use this to wet your hair before fitting the cap 
• A stretchy fabric headband – this helps to protect your skin 
• A detangling hairbrush or comb – we recommend you use this before and after scalp cooling to avoid your hair tangling 
• A warm hat, warm clothes and a blanket – you will feel cold while the cap is on, and your hair will be damp afterwards, so these will help keep you warm 
• If you have curly or afro hair, it can help to prepare or style your hair before we fit the cap. Please remove hair extensions or hair weaves beforehand 

Before chemotherapy

Your chemotherapy nurse will: 

• explain the procedure, including the timings
• take you to your treatment chair or bed and make sure you are comfortable
• assess your hair before each treatment. If you have lost a lot of hair, we will discontinue scalp cooling
• ask you to wet your hair and apply conditioner to help the cap fit close to your scalp
• ask you to put a soft headband around your forehead
• fit the cap to cover your full scalp and hairline
• connect the cap to the cooling machine

Once the nurse switches the cooling system on, a cool liquid passes through the cap. The cap may feel tight and cold at first. This usually settles within the first 10 to 15 minutes.  

During chemotherapy

You will wear the cap while you have the medication that causes hair loss. You may continue to have other medicines once your nurse removes the cap. 

After chemotherapy

• You will continue to wear the cooling cap for a while after the medication which causes hair loss finishes.
• Your nurse will let you know when they can remove the cap.
• Once it’s removed, your hair will be damp and you will feel cold. 
• We recommend you de-tangle your hair with a comb or brush before leaving.

While you wear the cap, you may: 

• feel cold or shivery
• feel discomfort or a heavy sensation on your head
• get a headache
• have temporary redness or mild discomfort on your scalp
• have patchy hair loss

If you don’t wish to continue with scalp cooling at any time, please tell your nurse. You will continue to have your chemotherapy as normal.

For more information on scalp cooling, visit:

Cancer Hair Care (search ‘scalp cooling’)

Macmillan Cancer support (search ‘scalp cooling’)