Hair loss can be one of the most distressing side effects of chemotherapy, but scalp cooling may help prevent it.

Also known as scalp hypothermia, scalp cooling involves wearing a cold cap before, during, and after chemotherapy treatments to prevent or reduce hair loss.

American Cancer Society. Cooling Caps (Scalp Hypothermia) to Reduce Hair Loss. August 3, 2022.

“One of the most devastating side effects of chemotherapy is hair loss, especially complete hair loss. Patients struggle with ‘looking sick,’ questions about their health, and losing part of their identity. This can have a significant negative effect on quality of life and mood, both of which are so important to support in patients undergoing cancer treatment. While scalp cooling may not be for everyone, the ability to offer this as a preventive option prior to initiating chemotherapy helps to empower patients during their cancer treatment,” Silvina Pugliese, MD, Clinical Associate Professor of Dermatology and an attending physician at the Stanford Medicine Outpatient Center and Stanford Cancer Institute,  tells MDLinx.

Since the 1970s, various scalp cooling methods have been used. Around the world, the most commonly used methods are cold caps or electronic cooling machines like Paxman.

The newest versions of scalp cooling devices involve a two-piece cap cooling system that is computer-controlled.

American Cancer Society. Cooling Caps (Scalp Hypothermia) to Reduce Hair Loss. August 3, 2022.

When in use, the person undergoing chemotherapy wears a cap on their scalp, which circulates a cooled liquid. A second neoprene cap is worn over the cooling cap to keep it in place and prevent the cold from escaping.

The cold from the cap also reduces the activity of hair follicles and makes them less appealing to chemotherapy drugs.

Effectiveness

Success rates of the cooling systems vary based on the type of chemotherapy drugs, their dosage, and how well a person tolerates the coldness of the cap on their scalp.

“Scalp cooling is effective, although reports of how effective vary based on the study. Remember that patients undergo treatment with different chemotherapeutic agents, in different combinations, and in different orders of administration, so it is challenging to land on one measure of effectiveness. There are other variables at play as well, such as how the scalp cooling devices are utilized, which device is utilised, and individual patient characteristics,” Dr. Pugliese says.

 “That being said, [the]overall effectiveness of scalp cooling in preserving hair is around 60–70%. The numbers can vary significantly based on the above factors. Using chemotherapy regimens as an example, anthracycline-based regimens generally show lower effectiveness of scalp cooling when compared to taxane-based regimens. It is important to note that many studies measure hair preservation as less than 50% hair loss. This is important to discuss with patients, who may be expecting 100% hair retention as success,” Dr. Pugliese adds.

Hope Rugo, a professor of medicine in the Division of Hematology and Oncology at the University of California San Francisco has been involved in research that led to the approval of scalp cooling systems for reducing hair loss in chemotherapy.

Rugo HS, Klein P, Melin SA, et al. Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. JAMA. 2017;317(6):606–614.

She says that for many patients undergoing chemotherapy, keeping their hair is important for their quality of life.

“For patients receiving chemotherapy for breast cancer in either the early or late stage settings, maintaining hair can provide a sense of normalcy and reduce the psychological impact of treatment, as well as allowing more privacy in a patient’s medical situation. Maintaining hair can have a positive impact in many aspects of a patient’s life during this challenging and often traumatic time, and is something a patient can do for themselves, when often the situation feels out of their control,” she tells MDLinx.

Scalp cooling can have some side effects, including headaches, chills, neck and shoulder discomfort, and scalp pain.

American Cancer Society. Cooling Caps (Scalp Hypothermia) to Reduce Hair Loss. August 3, 2022.

Both Drs. Pugliese and RUgo note that cost can also be prohibitive for some people.

“[Scalp cooling] comes with expense. Many insurers will now provide partial coverage, but usually reimburse; they do not pay up-front, so patients need to pay up-front [and] then seek reimbursement. There is a philanthropic organization called HairToStay in the United States, which can offset costs for those with financial barriers to use, and internationally many centers cover the cost of scalp cooling,” Dr. Rugo says.

She argues that physicians should inform their patients about the potential benefits of scalp cooling.  

“This is not just cosmetic; it is an important option that patients should know about and understand that [it] impacts quality of life. It is important to know that it doesn’t always work, but it can help with hair regrowth even if there is more hair loss than expected,” Dr. Rugo adds.