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PUBLISHED: 25 May 2017
UPDATED: 8 February 2022
Hair loss can be an extremely distressing side effect of chemotherapy. ‘Should I use a cold cap?’ is one of the most common questions about chemotherapy asked by women on Breast Cancer Now’s Forum.
Cold caps, worn during scalp cooling, offer the possibility of preventing or reducing hair loss from certain chemotherapy drugs. How well scalp cooling works depends on the chemotherapy drug and doses used.
But what is scalp cooling and does it work?
We asked several women who have used cold caps to share their experiences and tips.
Scalp cooling works by reducing the blood flow to the hair follicles, which reduces the amount of chemotherapy drugs that reach them.
There are two main types of scalp cooling, and both involve wearing a ‘cold cap’.
The first type uses a gel-filled hat that is chilled and replaced at regular intervals during your chemotherapy to keep the scalp cool.
The second type uses a refrigerated cooling machine to continuously pump a liquid coolant through the cap throughout the treatment.
Both types need to be worn for some time before, during and after chemotherapy is given. This means you may be at the hospital for longer.
As you’d expect cold caps worn during scalp cooling are very cold, and they can feel quite heavy. Some women describe having a headache while wearing one, but these usually wear off quickly once the cap is removed.
I did use the cold cap and can only explain the experience as having a severe ice cream headache or brain freeze for 10–15 minutes. Once the freezing had taken place I did not feel the cold cap anymore.Amanda
It was worse for first half hour then became bearable and, as the time went on, no problem at all.Niki
How well scalp cooling works depends on the chemotherapy drug and doses used, and it does not work for everyone.
Scalp cooling is suitable for all hair types, although it may be less effective on Afro hair.
My hair thinned on the first chemo regime, but this last regime of chemo I have kept a full head of hair. To keep as much hair as possible and look as much like you when you look in that mirror makes such a difference, and for me has been worth every hour I have spent wearing the cap.Mandy
I'm so pleased I persevered with the cold cap. I kept a good covering of hair throughout treatment, which helped keep me much more positive.Amanda
Some women have little success with scalp cooling.
I was told there were no guarantees with the cold cap. In the end I cold capped but I still lost a significant amount of hair. I wore a wig for about four months as despite cold capping I did have a fair bit of hair loss.Christine
To improve the chances of the cold cap being effective, it’s important the cap covers the whole scalp and fits snugly. You can also lightly dampen your hair with lukewarm water. To make removing the cap easier, apply a small amount of conditioner to your hair before putting on the cold cap.
I wore the cold cap and on my first wearing it was not tight up the back of my head or right hand side. I lost all my hair on the back of my head up to half way. I also lost most of my hair on my right hand side over my ear.Amanda
If you do keep your hair, you may find that it’s patchy or thinner.
My hair did definitely thin out, and towards the end of treatment I did wonder if it had been worth the cold cap. People who knew me could see the difference but those that didn’t know me before just thought I had thin hair. I never used a scarf, bandana or wig.Niki
You can ask your specialist or chemotherapy nurse if scalp cooling is available and whether it would be suitable for you. The condition of your hair and any previous use of chemicals on it may affect how well scalp cooling works. Your chemotherapy nurse will discuss this with you.
Depending on the type of scalp cooling your hospital offers, the advice may be different. Check with your treatment team for specific guidance.
The following tips from women who have experienced scalp cooling may help:
If you’re struggling with the side effects of the cold cap speak to your chemotherapy nurse or treatment team. They may recommend taking mild pain relief, such as paracetamol, before wearing the cold cap.
Things like water spray bottles, conditioner and extra layers may not be available in the chemotherapy suite so you may want to bring your own.
You can find more tips and information on scalp cooling in our Breast cancer and hair loss booklet. You can also find out more about scalp cooling on the Cancer Hair Care website.
Even if scalp cooling works and you keep your hair, chemotherapy may make your hair brittle, dry or straw-like, so it’s a good idea to treat your hair as gently as possible.
Try not to wash your hair more than twice a week or less than once every ten days
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