Cold Capping: Preventing and Treating Hair Loss

What is Cold Capping? 

Cold capping is a process of cooling the scalp with an ice-cold cap system during chemotherapy to prevent or lessen the side effect of hair loss. Cold capping is also referred to as scalp hypothermia, scalp cooling, or cryotherapy.

There are different forms of cold capping on the market including frozen cap systems and constant cold water circulation caps that are run by a computer system. Both systems work by cooling the scalp which causes the blood vessels to narrow or constrict. When the blood vessels constrict, this causes less blood flow to the scalp. Cold capping systems are made based on the idea that less blood flow to the scalp may stop or lessen chemotherapy damage of the cells near the hair follicles.  

How Do Different Types of Cold Cap Options Compare?

Manual scalp cooling: Manual scalp cooling consists of frozen gel caps that are applied to the scalp region, then wrapped with a secondary cap, typically made of neoprene that tightens and secures the cold cap into place. Caps are changed out frequently to avoid the scalp warming up as they melt.  

Computerized continuous circulating systems: This system of cold capping consists of a cap that has a tubing system where water circulates throughout the channels continuously. The water is cooled within the electronic unit. The cap itself is purchased and sized to the patient and connects to the central tubing/water circulation unit that is housed at many infusion centers.  


Manual Cap Cooling 

Computerized Continual Circulation Caps 

Facility Needs 

Can be done from any facility using a personal cooler and dry ice storage system. Some facilities will have a deep freezer available for storage of caps during treatment, however a freezer with dry ice is an additional option.  

This option depends on facility availability. Not all infusion centers have these systems available, and when they do scheduling must be coordinated to make sure the system is available and not reserved for use by other cold-cap patients.  

Time Requirements 

Recommendations vary, however generally speaking caps must be in place for 60-90 minutes prior to treatment, the entire treatment, and two to four hours after treatment is over. Obtaining dry ice prior to treatment can also require time.  

Cap must be in place 30 minutes prior to chemo start, throughout treatment, and 60-180 minutes after the infusion. Travel time to a facility that offers this type of unit is a consideration.  

Supply Needs 

Multiple caps, cooler, dry ice picked up each treatment for transport and storage. 

Personal Cap Kit that is the correct size and fit for you and will connect to the computerized water circulation system.  

Assistance Needs 

Caps are changed out every 20-30 minutes. Due to this, a support person typically needs to be present not only to help carry in supplies, but also for the duration of treatment and capping to assist with trading out caps. Cold capping requires a lot of time, and the nursing staff typically cannot provide this added assistance. 

This system resides at the treatment center and does not require cap changes due to the continuous circulation of cold water through the cap system. No assistance is typically required, however some facilities may charge for additional nursing assistance for setting up the machine, so this is important to inquire about.  


Penguin Cold Caps: Call for pricing  

Arctic Cold Caps: Starting around $379 per month for rental of an 8-cap system and all supplies  

This type of system is pay per use and typically needs to be available through the facility due to the high cost of the computerized unit.

Paxman system use (including cap kit) runs a fee of $350 per use for the first four treatments, $200 for treatments 5-6, and $100 for treatments 7-12 with a maximum cost of $2400.

Dignicap system use price varies based on location and number of treatments, but for the average patient this runs about $1500-$2000. 

Insurance Coverage 

Coverage is dependent upon insurance. Typically cold capping is not covered. Some insurances, however, are beginning to cover a portion of the cost, like what would be covered for a wig. Work closely with your insurance to inquire about needed orders or potential for coverage 

Coverage is dependent upon insurance. Typically cold capping is not covered. Some insurances, however, are beginning to cover a portion of the cost, like what would be covered for a wig. Work closely with your insurance to inquire about needed orders or potential for coverage 

Is Cold Capping Effective?

In 2019 the NCCN added the consideration of scalp cooling for reduction of alopecia (hair loss), with the added note that results may be less effective with certain types of chemotherapy regimens. The type of treatment and duration of treatment can play a big role in how successful cold capping is.  

Most studies that have been done are primarily focused on breast cancer patients. Mayo Clinic (2019) sites an overall success rate of 66%. It is important to note that success is considered a loss of less than 50% of your hair.

Among all people who use cold capping, some degree of hair loss or thinning is still likely. Research has found higher or lower success rates for patients based on the type of chemotherapy drug they are getting. Higher success was found with taxane-based chemotherapy drugs, and lower success rates for those on an anthracycline-based drug. 

Treatment type, length of treatment, and correct use of the caps are key factors that affect success rates. For a quick analysis of your specific regimen, Paxman has a handy tool.

It is important to discuss this option with your provider since they have the most insight into your treatment type and length.  

What Are Common Side Effects?

  • Chills 

  • Headaches 

  • Scalp irritation 

  • Neck and shoulder discomfort

What Things Should I Consider?

Every patient is unique. It is important to understand your own feelings and emotions about hair loss. For some, the added work and money of cold capping is worth it if there is a chance they could retain their hair. For others, cold capping may seem like an added stress and worry that is just too much to deal with during a stressful time.

Considering some of the following may help you make an informed decision:

  • Will obtaining cold capping supplies delay my treatment? 

  • What are the statistics for my specific treatment type? 

  • What is the financial cost, and can I afford this if insurance and financial assistance are not an option? 

  • Do I have a reliable support person who can attend all my treatments and assist with cold capping? 

Are There Financial Assistance Options Available?

There are several companies that offer financial assistance to help cover the out-of-pocket expense of cold capping. These companies typically have income limits and qualifications listed on their website.

Here is a list of some options to investigate:  

Questions to Ask Your Provider

  • What drugs will I be receiving and for how long/how many treatments? 

  • Would you suggest cold capping for my specific diagnosis and treatment? 

  • Is there someone within the facility that could help assist me with gathering further cold-capping information? 

  • Does this facility have cold capping equipment or a deep freezer for manual capping?  

  • If I decide to cold cap, are there any special steps I need to take to meet facility guidelines?