Scalp Cooling: How Does It Work and How Safe Is It?


Hair loss is a common side effect in treatment for cancer, but for patients looking to manage it Dr. Julie Rani Nangia breaks down how scalp cooling can slow down hair loss.

Hair loss is just one of the many unwelcome side effects that patients with cancer may endure as a result of treatment with chemotherapy. But the use of cold caps — also known as scalp cooling – is a safe way to potentially reduce the amount of hair loss in some patients with solid tumors, according to Dr. Julie Rani Nangia of the Baylor College of Medicine.

In a recent interview with CURE, Nangia explained the science behind scalp cooling and went into greater detail about why the process is safe for patients with solid tumors like breast or ovarian cancer but should be avoided by those with blood cancers such as leukemia or lymphoma.


The way cold caps work — I'm going to kind of simplify it an easy way to understand – but there are kind of two main ways that they work. There are two big companies in the US: DigniCap and Paxman, and Paxman is the company that I worked with. But they're very similar and they basically have this mini refrigeration unit that attaches to a cold cap.

And these are different than the caps that you put in the freezer and put on that aren't attached to anything, because it circulates coolant and it keeps the cold temperature at a constant level on the scalp. And this is easier for both providers and patients because when you do scalp cooling, the fit is really important because if you have areas where there's not contact, you lose hair in those areas. So, you can just get a really good fit with a cap at the beginning of treatment and not have to keep putting it on and off. And then you have this constant temperature, you're not going from like really cold and drying out to warmer.

What this cold temperature does is two things: it constricts the blood vessels in the scalp and helps prevent chemotherapy delivery to the hair follicles, and then it also decreases the protein and enzyme activity in the hair follicles so the chemo that is delivered may not work as efficiently in the hair follicles. It's the combination of those two things.

And as far as safety goes, there's actually quite a few very large studies from other countries and US data also shows that these are safe to use. And what these studies have shown is that people who use scalp cooling devices or caps, that there's no difference in survival, so how long they live, and that there's no difference in having cancer recur in the scalp.

This is true for solid tumors. And by solid tumors, I mean cancers like breast cancer, lung cancer, ovarian cancer. But there are some cancers that spread through the bloodstream like leukemias and lymphomas, and in those types of cancers, these devices are not safe because you can protect cancer cells in the scalp and see local recurrences. So, I would not recommend using these for those types of tumors.

But these devices have been very well studied and they're FDA cleared for most solid tumors.

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