Managing Hair Loss with Scalp Cooling During Chemotherapy for Breast Cancer

This information explains how scalp cooling (using a cold cap) during chemotherapy can help minimize hair loss. It also provides some basic information about caring for your head and hair during chemotherapy.

Hair Loss Related to Chemotherapy

Chemotherapy works by attacking fast-growing cells. Cancer cells are fast growing, but so are other cells, including hair. Chemotherapy can cause hair loss on your scalp, eyebrows, eye lashes, arms, legs, pubic area, or some or all of these areas. You may start to see your hair fall out 1 to 4 weeks after your first chemotherapy. How much of your hair falls out depends on the type, how much, and how often you receive chemotherapy. Talk with your healthcare team about the amount of hair loss you should expect from the chemotherapy you will receive.

How quickly hair falls out also varies from person to person. At first, you may notice hair on your pillow in the morning, or see it when you shower or brush your hair. Once your chemotherapy has stopped, your hair should begin to grow back. It can take 3 to 5 months for your hair to grow back, and it may have a different texture, color, or volume. It would be very rare for your hair not to grow out as fully as it did before.

Minimizing Hair Loss with Scalp Cooling

While hair loss is a normal side effect of many chemotherapy drugs, you may find it upsetting and want to minimize it as much as possible. Scalp cooling is a way that has been scientifically proven to do that. Scalp cooling involves wearing a cold cap on your head during and after receiving chemotherapy. It has been used by people in Canada and parts of Europe for years; and now becoming more common in the United States. Now there are results from clinical trials (research studies) in the US, as well as growing experience with scalp cooling in other countries. Results from clinical trials (research studies) in the United States have provided important information on what we might expect from scalp cooling and how to best use this method to minimize hair loss during chemotherapy for breast cancer.

How effective is scalp cooling?

The amount of hair loss that can be prevented by scalp cooling depends on the chemotherapy you are receiving. Studies have shown that scalp cooling can work anywhere from 10% to 100% of the time. Therefore, it is difficult to predict how effective scalp cooling will be for you. Most studies, however, have found that people lose less hair and use head coverings or wigs less often when scalp cooling is used compared to when it is not used.

Is scalp cooling hard to tolerate?

Most people can tolerate scalp cooling. Side effects such as headaches or feeling chilly can been seen 30% to 50% of the time. Some people also find the caps uncomfortable and cold. A small number of patients find they do not want to continue cooling because of these side effects.

How is scalp cooling done?

Scalp cooling is done by wearing a cooling cap on your head. To keep a consistent temperature, multiple caps are used and changed throughout the treatment as they become warm. The number of caps you will need and length of time recommended for wearing them is determined for you by the company. All caps have to be frozen ahead of time and brought to your chemotherapy appointment in a portable cooler with dry ice. You will need to plan ahead to bring a friend, family member or a trained ’capper’ to help you change your cold cap.

Scalp cooling will add time to your overall treatment, both before and after. Once your treatment is completed, you may complete your cooling in the patient library, waiting room or you may choose to return home with your cold cap on. In order to provide treatment to all patients during the day we are unable to utilize chairs just for cooling once treatment is complete.

How much does a cold cap cost?

There are 3 well known brands of cooling caps. The Chemo Cold Cap™ and Elasto-Gel™ caps are available for purchase through the internet. A third product, the Penguin™ cap, is available by monthly rental and all arrangements can be made directly through the company. Your nurse will provide you with further information about all of these products.

The cost of these products varies and can be found by contacting the company or looking on their website(s) but can be as much as $600 per month. Most insurance companies do not cover the cost of scalp cooling at this time; however they can help you with questions and talk with you about payment plans.

Caring for Your Hair and Head

Here are suggestions on how to care for your hair and head while you are receiving treatment:

  • Wash and condition your hair every 2 to 4 days with a fragrance-free shampoo and a cream rinse or hair conditioner.
  • Always rinse your hair well and pat it dry with a soft towel.
  • Cover your head with a hat, scarf, turban, or wig to keep it warm in winter and protected from sunburn year round. This can also help to contain falling hair.
  • Sleep on a satin or silk pillowcase because they are smoother than other fabrics and can decrease hair tangles.
  • Brush or comb your hair gently with a soft-bristle brush or comb. Start brushing or combing your hair at the ends and gently work your way up to your scalp. You can also finger-comb your hair by moistening your fingers with water.
  • If your hair is long, you may want to have it cut short before you begin treatment.
  • Try using hair products specially designed to cover bald spots and thinning areas of your hair (e.g., Bumble and bumble™ Hair Powder).

Do not use the following on your hair during treatment because they can be too harsh or pull on your hair:

  • Hair spray, creams or oils, hair dye, bleach, relaxers, or permanents (perm)
  • Clips, barrettes, bobby pins, pony tail holders, or scrunchies
  • Hair dryers, curlers, curling irons, hot rollers or a hair straightener
  • Rubber bathing or swimming caps
  • Do not put your hair in braids, corn rows, or pony tails.

Wigs and Head Coverings

You may still want to wear a wig or other hair covering during chemotherapy. Below is some basic information. If you have an additional questions or concerns, talk with your nurse.


If you want to wear a wig, try to get one before your hair falls out because it will be easier to match your hair color and style. If you’ve already experienced hair loss, bring a photo of your usual hairstyle, and if you can, a lock of your hair. This will help you find a wig that looks like your hair did before your treatment started. When shopping for a wig you may want to shop around and compare prices. A wig should fit properly, be comfortable, and be easy to care for. You may want to start wearing your wig as soon as your hair begins to thin. As your hair gets thinner, you may need to have your wig adjusted to make it fit better.

Many insurance companies will pay for wigs when hair loss is related to medical treatment. Contact your insurance company to find out what your plan offers. If you need help finding a place to purchase a wig, talk with your nurse.

Head coverings

Scarves, turbans, and hats can help hold hair that is falling out and also hide a bald scalp. Head coverings come in a variety of colors, textures, and styles. When selecting one, consider that scarves made from silk can easily slide off your head and that a cotton blend can be more comfortable and less likely to com untied or slip off your head. Some women choose not to wear any of the above. This is an individual choice.

To learn more about what you can do to help you look and feel your best, you may want to attend the Look Good Feel Better program. To register or find a workshop near you, call 1-800-395-LOOK or visit their website,