an older person on the right is wearing a cold cap. they are hugging a younger child. they both are looking away from the cameraShare on Pinterest
FatCamera/Getty Images

Cold Caps

Scalp Cooling Systems

Sometimes, chemotherapies used to treat certain cancers can cause alopecia, or hair loss. In an effort to help preserve hair during chemotherapy treatments, you may consider using cold caps. While they’re not likely to prevent hair loss entirely, cold caps may help minimize chemotherapy-related alopecia.

Also known as scalp hypothermia, cold caps rely on cold temperatures to help offset damage to the hair follicles. While there’s evidence that scalp hypothermia could benefit some people undergoing chemo, it’s not suitable for everyone.

This article introduces how cold caps work, where to get one, price, and how to go about getting started.

Cold caps are frozen devices intended to decrease the risk of hair loss from chemo treatments. The cold temperatures may decrease blood flow to your scalp, thereby preventing chemotherapy drugs from affecting your hair follicles.

In theory, by preserving your hair follicles, you may be able to thwart significant subsequent hair loss. However, it’s still possible that you’ll shed some hair. The purpose isn’t to prevent all hair loss — rather, it’s to prevent more noticeable, widespread hair loss.

Cold caps vs. scalp cooling systems

When referring to cold caps, we’re referring to the traditional manual or standalone versions that are frozen before each use.

Another similar treatment option, known as a scalp cooling system, requires the use of a machine and typically includes professional service.

Scalp cooling systems or automated cooling systems are Food and Drug Administration (FDA)-approved for preventing hair loss. This option may offer better temperature control over a longer period of time but can be harder to use and come at a higher cost.

The types of cold caps covered in this list may be differentiated based on the following information:

  • rental vs. purchase
  • those sold in retail shops
  • those sold by sales representatives only
  • low number of caps vs. several
  • materials, such as steel or gel
  • extra features for comfort, such as chin straps

Cold caps are not the same as scalp cooling systems. While both are used for similar purposes, scalp cooling systems require computer machines to operate, and are exclusively used at cancer treatment centers.

The exact efficacy of cold caps is unclear, and is believed to range anywhere from 10% to 100%.

While the technology has been used in some form since the 1970s, researchers are still determining when cold caps might work best.

For example, research from 2016 found that using cold caps effectively minimized some hair loss in women with breast cancer.

Here are a few considerations about traditional cold caps and scalp cooling for chemo:

  • Type of cancer: This treatment option is intended for solid tumors only. It isn’t recommended for leukemias or lymphomas.
  • Location of tumors: You shouldn’t use this method if you have tumors in your brain or scalp area.
  • Hair thickness: Cold caps may not work as well if you have thick hair.
  • Hair loss location: Cold caps don’t address hair loss in other areas of the body that may occur with chemotherapy, such as your arms, lashes, and eyebrows.
  • Computerized alternatives: Traditional cold caps may be effective, but research shows that computer-assisted scalp cooling systems could work even better.
  • Type of chemotherapy: Cold caps aren’t effective with all types of chemo. Research from 2018 found that patients undergoing taxane-based chemo had a greater response to scalp cooling than those undergoing other types of chemo.
  • Timing: According to a 2020 review, cold capping and scalp cooling are most effective 30 minutes before starting each chemotherapy treatment. This allows time for the scalp to cool before any chemo drugs enter your hair follicles.

Common side effects of cold caps for chemo include:

  • scalp and forehead irritation
  • numbness
  • chills
  • headaches
  • pain
  • nausea
  • discomfort that extends to your neck and shoulders
  • patchy hair loss
  • dizziness

Side effects are more severe in some people, potentially making cold caps too uncomfortable to use.

There are no known long-term risks associated with these devices.

If an oncologist gives the go-ahead for cold capping, consider the following tips for the most successful treatment possible:

  • Wear your cold cap before and after your appointment.
  • Bring your cold cap with you to each chemo session.
  • Allow yourself extra time for preparation and use. Overall, you may spend anywhere from 15 minutes to 4 hours of cold capping after a chemotherapy session.
  • Bring more than one cold cap (stored in a portable cooler) if your treatment sessions last more than 20 minutes. This way, you can switch out your cold cap for another if it defrosts during use.
  • Make sure your cold cap is snug against your head. The tighter, or closer to the skin, the cold cap is, the more effective it is.
  • Consider dressing in layers and bringing blankets with you to help offset the cold sensations from your scalp.

Although cold caps may be effective at preventing hair loss, they’re not suited for everyone. Talk with a doctor about your options, potential side effects, alternatives, and more before getting started.

Keep in mind that if you’re using a cap that requires a cooling machine, you’ll need to finish the process at a medical facility.

When wearing a cold cap, you may notice mild to moderate pain or discomfort from the freezing temperatures. Side effects may be worse at first as you build a tolerance to cold capping. Side effects are common: In a 2019 study with 32 participants who did cold capping, 94% of them experienced side effects.

You may also feel cold from the cap as well as the temperatures in the cancer treatment facility. Wearing a jacket, blankets, or other layers can help keep you comfortable during your treatment.

You will also need assistance with changing out your cold caps during chemo treatments. A friend, family member, or trained caregiver (sometimes called a “capper”) may be able to assist.

Once you’re finished with the chemo portion of your treatment, you may be moved to another area of the treatment facility to complete your cold capping process.

When looking for a cold cap for chemo, consider the following elements to help you make the best decision:

  • customer reviews
  • price
  • additional features, such as coolers
  • ease of use
  • access to a medical professional for assistance
  • any FDA clearance or clinical backing

The prices of cold caps vary among companies.

It’s common to rent them. While renting may be cheaper in the short run, it could lead to more long-term expenses should you need more chemo in the future.

Below are some estimated rental costs, provided by the manufacturers:

It’s also important to consider the following factors when thinking about the total cost:

  • if cold cap treatment services include help with cap transfers during treatment sessions
  • if the initial cost of the cap is included or separate from other fees
  • any security deposits
  • ongoing rental fees
  • how many chemo treatments you need
  • portable coolers and dry ice for transporting the cold caps to your appointments
  • the possibility of needing multiple caps for longer chemo sessions
  • facility fees, if you need to use cooling machines

Medical insurance typically doesn’t cover cold caps for chemotherapy, although it may be possible to obtain a partial reimbursement from your insurance company. Contact your insurance company ahead of time to ask about possible coverage.

There are several brands of cold caps to consider, with varying features and price points. Note that, while you may be able to find more affordable cold caps for purchase from online markets, such as Amazon, such caps may not be approved for use at your cancer treatment center.

Below are Healthline’s vetted picks you may rent directly from the manufacturer:

With assistance from a nurse

Arctic Cold Caps

Arctic Cold Caps offers a complete system that includes eight caps, a cooler, a timer, and more.

If you have questions about the treatment, the company provides free access to a registered nurse.

Refreezes your caps

Chemo Cold Caps

Like Arctic Cold Caps, Chemo Cold Caps offers a complete system.

One key difference is that you receive six caps instead of eight. This is possible because of a steel-infused cooling system that refreezes them during your treatments.

Rental only

Penguin Cold Caps

Also sold as portable kits, Penguin Cold Caps is one of the first companies to provide these products for chemo treatment.

The caps come with chin straps for a tighter fit to make sure your scalp receives a uniform treatment.

Penguin Cold Caps are offered as rentals only. To get started, you must visit the company website to find your closest sales representative.

When considering cold caps, it’s important to also consider computerized scalp cooling systems and any lifestyle changes that may minimize hair loss. Discuss the following information with your doctor.

Scalp cooling systems

While sometimes confused with traditional cold caps for chemo, scalp cooling systems work with computers and are offered directly at cancer treatment centers.

There are two types of FDA-cleared scalp cooling system: DigniCap and Paxman.

Provided for you

DigniCap

DigniCap is provided by your oncologist during each chemo round. The average cost of this system is $1,500 to $2,000, charged by the treatment center for each full course of chemotherapy.

You can learn more about the DigniCap systems through the manufacturer’s website and see if your cancer treatment center offers this option.

Prescription necessary

Paxman

Paxman is another scalp cooling system. It may minimize hair loss from chemo and prevent thinning hair. If you’re interested in this option, your doctor can prescribe the device. You obtain it from a medical supply store or pharmacy.

Lifestyle changes

Certain lifestyle changes may also help minimize hair loss during chemo. Consider the following tips:

  • Cut your hair shorter before starting treatment.
  • Avoid tight hairstyles like braids and ponytails.
  • Refrain from using heated styling tools like hair dryers and straighteners.
  • Extend the amount of time between washes.
  • Pat your hair dry gently after washing.
  • Use a wide-tooth comb to gently remove tangles from wet hair, starting at the ends.
  • Avoid using chemical-based hair products like perms, relaxers, and dyes.

Do cold caps work during chemo?

Not enough clinical studies have been done to determine the exact effectiveness of cold capping during chemotherapy. The success rate is anywhere between 10% and 100%. Many of the reported benefits are anecdotal.

How long do you keep a cold cap on?

You’ll likely spend a minimum of 20 minutes at a time with a cold cap on. Longer sessions may be a few hours.

The exact amount of time you spend during each cold capping session depends on the brand and your chemotherapy treatment plan.

Does cold capping help hair growth while on chemo?

No. Rather than promoting hair growth, the purpose of cold capping during chemotherapy is to help minimize hair loss from your treatment.

However, even with cold capping, it’s still possible to shed hair. Overall, this method may be worth trying, but it’s not guaranteed to prevent hair loss altogether.

Is cold capping painful?

Depending on your tolerance to cold temperatures, it’s possible to experience pain during the cold capping process.

Also, though considered uncommon, cold caps carry the risk of cold thermal injuries. One 2016 study found that such risks were more prominent in cases of improper usage. Researchers noted that such injuries are usually mild to moderate.

Cold caps may help minimize hair loss during chemo treatments for cancer. The majority of cold caps are available as monthly rentals that you bring with you to the treatment center.

Clinical studies have shown that for some individuals, cold caps can indeed reduce hair loss and thinning hair. Still, they’re not guaranteed to work, and possible discomfort may make these caps unfeasible for longer usage.

Talk with your oncologist about cold caps, including their potential benefits and risks. You may then consider the above roundup of cold cap options, any alternatives, and whether your insurance company might cover the associated costs.