Progress in the battle against chemotherapy-induced hair loss

By Laura Bourdeanu NP, PhD

Chemotherapy-Induced hair loss can be one of the most difficult side effects of cancer treatments to deal with for women and men, as it affects different people differently. For decades, the only option in dealing with hair loss available to patients was wigs. Although certainly not a treatment, it allowed patients to ease through hair loss with confidence. Recent research has lead to the development of the cold cap.

Currently the only approved treatment for chemotherapy-induced hair loss is scalp cooling. Scalp cooling has been used since the 1970s to reduce or prevent chemotherapy-induced hair loss, however it wasna��t until December or 2015 that the Federal Drug Administration (FDA) approved the DigniCap scalp cooling system. The approval was based on a study evaluating the usefulness of DigniCap cooling system in preventing chemotherapy-induced hair loss. The study reported that more than 66% of patients using DigniCap reported losing less than half their hair.

So How Does It Work?

Scalp cooling systems work by either narrowing the blood vessels of the scalp resulting in less amount of chemotherapy reaching the hair follicles or by slowing down the division of the hair follicle cells, making them less affected by the chemotherapy.

What Do You Need to Do

Depending on the company providing the cool cap, you generally wear the caps for 20-50 minutes before, during, and after each chemotherapy session. The duration of treatment will depend on the type of chemotherapy you are receiving.


There were concerns regarding the risk of scalp metastases or brain metastases as a result of the decreased drug exposure by the decrease of scalp blood perfusion or cooling of the skull or brain. Studies have not found an increase incidence of scalp metastases or brain metastases, concluding that the use of scalp cooling systems is safe. However, caution should still be used when considering using the scalp cooling system since the FDA acknowledges that, although extremely rare, scalp metastases could occur.


Cooling caps may cost as much as $600 per month, however with the current FDA approval the treatment may be more accessible for patients who cannot afford the full out-of-pocket expense.


There are several brands of cold caps, such as DigniCap Scalp Cooling System, Paxman Scalp Cooling System, Penguin Cold Caps, Chemo Cold Caps, and ElastoGels. The DigniCap and Paxman are chilled by a control unit and patients don’t have to change the caps during treatment. The Penguin Cold Caps, Chemo Cold Caps, and ElastoGels use dry ice to be chilled and may have to be changed several times during the chemotherapy treatment.