Cold Capping: A Practical Guide to Scalp Cooling During Chemotherapy

Cold capping... sounds odd, doesn't it? For those unfamiliar with the concept, cold capping—also known as scalp cooling—is a technique used to help preserve scalp hair during chemotherapy infusions.¹

When I learned that I would be starting a chemotherapy regimen that causes hair loss, I decided I wanted to preserve my hair if at all possible. Having lost my hair once before, I was eager to avoid going through it again. We all have our reasons: some people do not mind losing their hair, while others want to keep it at all costs. For me, I had recently relocated, was settling into a new town, making friends, and dating. It simply was not a time in my life when I wanted to be bald again.

That choice prompted me to explore the cold, unfamiliar world of cold capping. After completing multiple treatment sessions and learning through trial and error, I gathered several practical tips to make the process much smoother.

Accept the cold

While I went into my first infusion knowing it would be cold, I had not mentally or physically prepared myself for how cold it would actually be. During the first thirty seconds, the sensation was so intense that I nearly ripped the cap off my head and gave up. Before starting this process, accept that the cap will feel freezing right from the start, and remember that it will stay on your head for several hours.

Understand the process

How does scalp cooling work? Certain chemotherapy drugs cause hair loss by targeting rapidly dividing cells, including hair follicles. A cold cap cools the scalp, which constricts the local blood vessels and reduces blood flow to the hair follicles. This limits the amount of chemotherapy drug reaching the hair follicles during peak drug concentrations in the bloodstream.¹

In clinical settings, treatment "success" is generally defined as retaining 50 percent or more of your hair. Hair shedding after treatments is still very common, and most people who cold-cap will still experience some hair loss. Additionally, cold caps only target the scalp; they will not preserve eyebrows, eyelashes, or body hair.²

How machine-based cold capping works

Many cancer centers use automated cooling machines, such as the DigniCap Delta system. In this setup, patients purchase their personal cap attachment, which fits snugly on the head and connects via hoses to the cooling unit maintained at the clinic.

A trained nurse sets the machine to the targeted cooling temperature (typically around 6°C or 42°F). Once the system cools down, the nurse fits the cap securely to the head and connects the tubing. The infusion usually begins roughly 30 to 40 minutes later, giving the scalp temperature enough time to drop before the chemotherapy drugs enter the body.

How to prepare during treatment

While the machine cools down, preparation is key:

• Warmth: Plug in an electric blanket from home so it is hot by the time the cap goes on. If the infusion chair has built-in heat, turn that on as well.
• Accessibility: Gather all essential items—phone, charger, snacks, and drinks—within arm's reach of the chair. Moving around with an IV pole while tethered to a scalp cooling machine is challenging.
• Hair preparation: Dampen the hair thoroughly with a spray bottle before capping. Moisture improves thermal conductivity, helping the cap cool the scalp more evenly and effectively.
• Comfort and timing: Work with your care team to coordinate pre-medications. For instance, receiving IV Benadryl right after the cap is fitted prevents drowsiness while adjusting the fit. A proper, snug fit without air pockets is critical; any gaps or "air bubbles" can result in localized hair loss.
• Post-infusion cooling: Keep the cap on for the prescribed post-infusion cooling period (typically 30 to 90 minutes, depending on the specific chemotherapy regimen). Removing the cap too early allows blood flow to return to the scalp while drug levels in the blood are still high.

What if your center doesn't have a machine?

If your treatment center does not offer an automated cooling machine, manual cold capping systems are available. Companies like Penguin Cold Caps offer manual caps chilled using dry ice. This method requires bringing a dedicated support partner to manage the cooler and manually rotate freshly chilled caps onto your head every 20 to 30 minutes throughout the infusion.

Cold capping can feel daunting at first, but with the right preparation, assistance, and mindset, it is a viable option for hair preservation.

Have you tried cold capping, or are you considering it for an upcoming treatment? What advice would you add?

Editor’s Note: We are extremely saddened to share that on Friday, October 29, 2021, Danielle Thurston passed away. We know that Danielle’s voice and perspective continue to reach so many. She will be deeply missed.