Does Cold Capping Work?

On Oct 25, 2024

I was diagnosed with breast cancer in 2015, right around the same time the first FDA-approved cold cap came out. I’d heard about the potential hair-saving helmet on the news, and I crossed all my follicles that it could work for me as I prepared to start chemotherapy.

Unfortunately, I wasn’t a candidate for scalp cooling therapy. Back then, the cooling devices were only approved for early-stage breast cancer and less potent types of chemo. I was stage 3 and taking doxorubicin, also known as the “red devil.” So, yeah, pretty potent stuff.

Although I was disappointed that I couldn’t try cold capping to reduce hair loss during chemo, just knowing it was out there made me hopeful for advancements in cancer treatments. Hair loss may seem like a small thing when talking about disease, but it can be really devastating. One recent report cited up to 14% of women won’t consider chemotherapy because of hair loss.

Cold caps don’t work for everyone, and results vary from person to person depending on a lot of different factors. But new research shows using cold caps can help some people keep a good amount of hair during chemo — even people getting the red devil: In one study, 71.4% of people on doxorubicin saw successful hair retention. That’s a hair flip in the right direction.

If you or someone you know is interested in cold caps for chemo-induced hair loss, here’s what you need to know.

What is cold capping?

Cold capping involves wearing a helmet-like device to lower the temperature of the scalp during chemotherapy. The cold temperature decreases blood flow, which can reduce the amount of chemo that reaches the hair follicles and may reduce hair loss for some people.

What are the types of cold caps?

Scalp cooling therapy includes two types of devices:

Automated: The insulated cold cap is hooked up to a machine that circulates cooling liquid or gel inside the cap. Once the device is hooked up, the cooling system will keep the temperature where it needs to be. Automated cold caps are regulated by the FDA.

Manual: The frozen gel caps are stored in a freezer or with dry ice. Because the gel will start to warm once it’s on the scalp, a new frozen cap will have to be replaced about every 30 minutes. Manual cold caps are not regulated by the FDA.

How do cold caps work?

Both types of cold caps work by reducing the temperature of the scalp before, during and after chemo.

Typically, the person administering the chemo will help set up the automated cold cap machine and make sure the temperature is correct and that the cap is secured tightly around your head.

People using manual caps also need an outside pair of hands to help with the caps, although it doesn’t have to be a nurse — family or friends can help during treatment.

Who can use cold caps?

People with solid tumors (breast, colon, lung, gynecological) can use cold caps to help reduce hair loss during chemo.

Who shouldn’t use cold caps?

Cooling caps are relatively safe overall, but some people with certain health conditions shouldn’t use cold caps.

For example, people with blood cancers like leukemia or lymphoma shouldn’t use cold caps because the restricted blood flow may stop the chemo from getting to where it needs to go.

You also shouldn’t use cold caps if you:

Have central nervous system cancer
Are getting chemo for a bone marrow transplant
Had radiation to the head or will have radiation to the scalp

Cold capping is not recommended for people who have cold-agglutinin disease, cryoglobulinemia and post-traumatic cold dystrophy.

What are the side effects of cold caps?

Cold caps live up to the name, so if you’re sensitive to cold temperatures, you may feel uncomfortable during the sessions. Other side effects of cold capping can include:

Dry skin
Feelings of claustrophobia when wearing the cap
Headache attacks
Nausea
Cold thermal injury (burn) from manual caps

Do I need a prescription for scalp cooling therapy?

Whether you need a prescription depends on which type of cold cap you want to try. The automated systems require a prescription, and the manual systems do not. Always be sure to ask your healthcare provider before using any type of scalp cooling device.

Is cold capping covered by insurance?

Manual frozen caps are not covered by insurance, but automated cold caps are covered by Medicare and may be covered by other insurance plans.

If you need help paying for the cooling therapy, nonprofit organizations such as HairToStay and The Rapunzel Project may be able to help cover the cost of cold capping.

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