Cold caps - may help some women keep their hair during chemotherapy.

Cold caps — tightly fitting, strap-on hats filled with gel that’s chilled to between -15 to -40 degrees Fahrenheit — may help some women keep some or quite a bit of their hair during chemotherapy.

Because the caps are so cold, they narrow the blood vessels beneath the skin of the scalp, reducing the amount of chemotherapy medicine that reaches the hair follicles. With less chemotherapy medicine in the follicles, the hair may be less likely to fall out.

During each chemotherapy session, you wear the caps for:

20 to 50 minutes before
each chemotherapy session (the amount of time you wear the cap after the chemotherapy session depends on the type of chemotherapy you’re getting)

There are several brands of cold caps. Penguin Cold Caps, Chemo Cold Caps, and ElastoGels are chilled with dry ice in your own cooler or in a special freezer at the chemotherapy treatment center (the freezer in your house can’t get the cap as cold as it needs to be). Penguin Cold Caps and Chemo Cold Caps rent out caps for the length of your chemotherapy treatment. Chemo Cold Caps rents out caps sold directly by ElastoGels.

You may have to change the Penguin, Chemo, and ElastoGel caps several times during the chemotherapy treatment. Each cap is usually worn for about 30 minutes; then it warms up and is replaced with a new cap.

The DigniCap Scalp Cooling System and Paxman Scalp Cooling System caps connect to a cooling/control unit that then chills the cap to the proper temperature. Since the DigniCap and Paxman systems are chilled by the control unit, you don’t have to change caps during treatment.

Because the caps are so cold, some women get a headache while wearing the cap. Most women get very cold, so it makes sense to dress warmly and bring warm blankets with you if you decide to try the cold caps.

Women who use cold caps during chemotherapy are advised to baby their hair during treatment:

no blow drying, hot rollers, or straightening irons
shampoo only every third day with cool water and a gentle shampoo
no coloring until 3 months after chemotherapy is done
gentle combing and brushing
The cost of using the caps varies depending on the manufacturer, the number of chemotherapy sessions you’ll be having, and the number of months you’ll be using the caps. Some users have said the cost of the caps is comparable to the cost of a having a wig made. Check with your insurance carrier to see if the cost of renting the caps is covered.

It’s important to know that some doctors are concerned that the caps may prevent the chemotherapy medicine from reaching cancer cells that may be in the scalp. Many studies in Europe, where cold caps have been used since the 1970s, found that scalp cooling does not increase risk of scalp skin metastases, including a 2013 German study.

At this time, only the DigniCap Scalp Cooling System has been approved by the U.S. Food and Drug Administration (FDA). It was approved on Dec. 8, 2015. This approval means the DigniCap can be marketed in the United States. In its approval announcement, the FDA said the risk of scalp skin metastases was “extremely rare.”

Dignitana, the Swedish company that makes the DigniCap, is negotiating with insurance companies for coverage.

The FDA approval was based on a study lead by Professional Advisory Board member Dr. Hope Rugo, M.D., clinical professor of medicine at the University of California, San Francisco. The study found that more than 66% of the 106 women in the study who wore the DigniCap for each chemotherapy cycle said they lost less than half their hair. Only three of the women stopped using the DigniCap because of side effects.

Several U.S. studies are underway to look at the safety and effectiveness of the caps. Studies on the DigniCap System are continuing, as are studies on the Paxman Scalp Cooling System. These two brands of caps are only available to clinical study participants. Learn more about participating in a clinical trial in the Clinical Trials section.

It’s important to know that cold caps may not work for everyone. In multiple small studies, cold caps were considered highly effective in 50% to 60% of the women who used them. Women who got only anthracycline chemotherapy had slightly better results with cold caps than women who got only taxane chemotherapy. One study from 2000 found that 92% of women getting anthracycline chemo only had no hair loss compared with 88% of women getting taxane chemo only.

Adriamycin (chemical name: doxorubicin), Ellence (chemical name: epirubicin), and daunorubicin are anthracyclines.

Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel), and Abraxane (chemical name: albumin-bound or nab-paclitaxel) are taxanes.

In the DigniCap study led by Dr. Rugo, most of the women were treated with taxane chemotherapy.

Women who got both an anthracycline and a taxane in their chemotherapy regimen (combination chemotherapy), especially in combination with cyclophosphamide, seem to have the worst results with cold caps, though some of them still kept some of their hair.

If you’re interested in trying cold caps, talk to your doctor about all the factors that need to be taken into account, including your chemotherapy regimen and any other health issues you may have.

The Rapunzel Project is a nonprofit organization dedicated to helping women and men undergoing chemotherapy access and use scalp-cooling technology to help keep their hair. Visit the Rapunzel Project site for more information and for a list of treatment centers with freezers available for use.

See what our Community members are saying about cold caps in the Discussion Board thread Cold Caps Users Past and Present, to Save Hair.