Scalp cooling

Scalp cooling can reduce hair loss caused by chemotherapy. It works by cooling and contracting the blood vessels to the scalp, which reduces the amount of chemotherapy drugs carried to the hair follicles. Scalp cooling doesn’t work with all chemotherapy drugs.

You will need to keep your head cold before, during and after treatment. There are two methods of scalp cooling:

  • A ‘cold cap’, which is filled with a chilled gel.
  • A refrigerated cooling system, which pumps liquid coolant through a cap.

Scalp cooling is not suitable in the following circumstances:

  • You have a haematological cancer such as myeloma, leukaemia or lymphoma.
  • You are having high doses of chemotherapy.
  • You are having continuous chemotherapy for several days.
  • Your liver isn't working well.
  • You have severe migraines.
  • You did not use scalp cooling during your first course of chemotherapy.

Scalp cooling can reduce hair loss, but your hair may thin or you may still lose it completely. Some doctors have concerns about scalp cooling as it may prevent uncommon cancer cells near the scalp being killed.

Talk to your doctor about whether scalp cooling is suitable for you.

Scalp cooling

Scalp cooling is a method of reducing hair loss (alopecia) caused by chemotherapy. Some types of chemotherapy drugs cause hair loss but the hair grows back once the treatment finishes.

How scalp cooling works

Every hair on the body grows out of a hair follicle. Small blood vessels in the scalp supply the cells of these follicles with food and oxygen, and carry away waste products. Any chemotherapy drugs in the bloodstream will also be carried to the hair follicles.

When blood vessels in the scalp are cooled, they become narrower, and so less blood flows through them. Cooling the scalp during chemotherapy means that less of the chemotherapy drug reaches the hair follicles. This means the hair is less likely to fall out.

There are two widely available methods of scalp cooling. One method uses a hat known as a 'cold cap', which is filled with a gel that can be chilled. The hat must be fitted snugly around the head to work properly. The other method uses a small, refrigerated cooling system to pump a liquid coolant through a cap that is attached to the cooling system.

Who can have scalp cooling?

Scalp cooling is not suitable for everyone. It isn’t suitable if the following applies to you:

  • You have a haematological cancer such as myeloma, leukaemia or lymphoma. This is because there is a high risk of cancer cells surviving in the blood vessels of the scalp, causing the cancer to come back after treatment.
  • You need very high doses of chemotherapy, as this makes scalp cooling less likely to work.
  • You’re having continuous chemotherapy through a pump for several days, as this makes it impractical to have scalp cooling.
  • Your liver isn't working as well as it should be. This may lead to the chemotherapy drugs circulating in the body for longer than usual, and it may not be possible to keep the scalp cold for long enough.
  • You have severe migraines.
  • You have already had your first course of chemotherapy and did not have scalp cooling for it.

Concerns about scalp cooling

Some doctors worry about using scalp cooling with treatment that aims to cure the cancer. They are concerned that cancer cells that may have spread to the scalp may be more likely to survive chemotherapy if scalp cooling is used. However, cancer spreading to the scalp is very uncommon. Clinical trials have shown that the risk of this occurring as a result of scalp cooling is very small, except in haematological cancers. Some people may prefer not to have scalp cooling because of this, but others are happy to try it. If you’re interested in scalp cooling, talk about it with your doctor.

Some drugs that scalp cooling may be used with

Scalp cooling is not effective with all chemotherapy drugs. It is most likely to be effective with:

  • cyclophosphamide 
  • daunorubicin 
  • docetaxel (Taxotere ®) 
  • doxorubicin 
  • paclitaxel (Taxol ®).

Having scalp cooling

For scalp cooling to work, your scalp temperature needs to be kept low for the whole time the drugs are circulating in your blood.

This means that your scalp needs to be cold for about 30-40 minutes before your chemotherapy drugs are given, throughout the time chemotherapy is given, and for some time afterwards.

If you are having your chemotherapy as an outpatient, you may need to spend up to three hours longer at the hospital for each treatment than if you weren’t having scalp cooling.

Some people find that the gel-filled hats feel heavy to wear. When using this type of hat you are usually free to walk about once your chemotherapy has been given. However, your hat will need to be changed every 20-40 minutes to keep your scalp cool, so you can’t go too far from the chemotherapy department.

Caps attached to the cooling machines generally feel lighter than the gel-filled caps. You will need to sit by the machine while the cap is in place, so you won’t be able to walk around freely with this method. However, the cap can be disconnected for short periods - for example, if you need to use the toilet. These caps don't need to be changed as the machine continuously cools the liquid circulating round your scalp.

You’ll probably feel chilly when having scalp cooling and may need to wear warm clothes. Hot drinks will also help you feel warmer.

You may get a headache during scalp cooling, especially in hot weather.

Illustration showing a person having scalp cooling with a gel-filled cold cap.
Illustration showing a person having scalp cooling with a gel-filled cold cap.

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How effective is scalp cooling?

Scalp cooling can be effective in preventing or reducing the loss of your hair. But you won't know how well it will work for you until you try it.

It is best to use a neutral pH shampoo and a wide-toothed comb if you are having scalp cooling. You should avoid excessive heat from hairdryers and straighteners, and avoid perming or colouring your hair.

Despite scalp cooling, you may find that your hair still thins slightly. And, unfortunately, some people who have scalp cooling will still lose their hair.

Some people find that losing their hair over a prolonged period while using scalp cooling is harder to cope with than the quicker, more predictable hair loss that tends to occur without scalp cooling.

If you lose your hair despite scalp cooling, your nurse will usually recommend discontinuing it to protect your scalp from the effects of the cold temperatures.

Scalp cooling only protects the hair on your scalp. Body hair, including eyelashes, eyebrows, beards and moustaches, chest hair and pubic hair, may still be lost.

Hair loss caused by chemotherapy is almost always temporary. Once the treatment is over, your hair will start to grow back. At first, the hair is very fine, but you’ll probably have a full head of hair after 3-6 months. You may find that the texture or colour of your hair is different, but this is often temporary. After about 12 months, new hair growth may be similar to the colour and texture you had before chemotherapy.

If you’re interested in scalp cooling, discuss it with your doctor or nurse. They can advise whether it’s suitable for you.

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