Scalp cooling

Scalp cooling, or cold cap therapy, is a treatment that may help reduce or prevent hair loss from chemotherapy.

Some chemotherapy drugs can damage hair follicles and cause hair to fall out. Chemotherapy-induced hair loss, known as alopecia, affects up to 65% of people receiving infusions.

Scalp cooling involves wearing a cap, which is kept cold. Scalp cooling works by lowering the temperature of the scalp before, during, and after chemotherapy infusions. Cooling the scalp:

• Reduces blood flow to hair follicles so less chemotherapy reaches them
• Slows cell activity in the hair follicles, making them less likely to be damaged

For many people, scalp cooling can help them keep some or most of their hair during chemotherapy. Others may still experience hair loss or choose to stop because of:

• The feeling of cold or pressure from the cap
• Headache or dizziness
• The time required before and after each infusion

Scalp cooling is considered to be safe for people undergoing treatment for breast cancer. Research shows that scalp cooling is not associated with breast cancer spread to the scalp, and that it does not appear to have an effect on breast cancer survival.

If your healthcare team has recommended chemotherapy and you haven’t yet started it, and keeping your hair is important to you, ask about scalp cooling. To get the most benefit, you’ll need to begin cooling at your first chemotherapy session.

What is scalp cooling or cold cap therapy?

Scalp cooling, also called cold cap therapy, is a way to reduce or prevent hair loss during chemotherapy.

During chemotherapy, certain cancer treatments can damage the hair follicles, the tiny openings in the skin that grow hair. This can cause hair to fall out. Hair loss caused by chemotherapy usually starts 1 to 3 weeks after treatment begins.

Scalp cooling lowers the temperature of the scalp, helping protect the follicles from damage. Keep in mind that:

• It doesn’t work for everyone, but many people who try it keep more of their hair.
• Hair that is lost during treatment usually grows back after chemotherapy ends.

If chemotherapy has been recommended for you and keeping your hair is important, talk with your care team about scalp cooling before your first infusion. Ask them if the infusion center offers scalp cooling. It works best when started at the very beginning of treatment.

How does scalp cooling work?

Scalp cooling works by gently lowering the temperature of your scalp to slow the blood flow in that area. This helps protect your hair follicles from chemotherapy.

During scalp cooling, a snug cold cap is placed and worn before, during, and after the infusion session. Here’s how it helps:

• Blood vessels constrict. Cooling causes the small blood vessels in your scalp to narrow, so less chemotherapy medicine reaches your hair follicles.
• Cell activity slows. Cold temperatures slow how quickly cells divide in the follicles. Because chemotherapy targets fast-dividing cells, slowing them down helps reduce damage.
• Hair follicles stay stronger. By protecting the follicles, cooling can lower your chance of losing hair or reduce how much you shed.

Scalp cooling starts about 30 minutes before chemotherapy begins and continues through the infusion and for a short time afterward—often around 90 minutes, depending on the manufacturer’s directions.

Types of scalp cooling systems

There are two main ways scalp cooling is done during chemotherapy:

• Refrigerated scalp cooling systems, available in many cancer treatment infusion centers
• Cold caps, which are manually chilled and brought from home

Both work by keeping the scalp cold to help protect hair follicles from chemotherapy.

Refrigerated scalp cooling systems

Refrigerated scalp cooling systems use a small machine to keep the cooling cap cold throughout the infusion. The machine circulates chilled liquid through tubes inside the cap.

These systems are usually in cancer centers and infusion rooms, where staff can help fit and monitor the cap for treatment.

Examples include:

• Paxman scalp cooling system
• DigniCap scalp cooling system
• Amma portable scalp cooling system

Key differences between refrigerated systems:

• Paxman and DigniCap are infusion room-based systems.
• Amma is a portable system. You can leave the infusion chair and complete your scalp cooling anywhere in the infusion center.

These refrigerated systems are FDA-cleared and most often used in infusion centers because they maintain a steady, safe cooling temperature throughout treatment.

What to expect:

• A healthcare professional will fit the cap to your head before your first chemotherapy infusion.
• You’ll wear the cap:
  • Before treatment begins, about 30-45 minutes
  • During treatment (how long depends on your care team’s recommendations)
  • After treatment is finished, usually for about 90 minutes, depending on the system you use
• During cooling sessions, the cap may feel cold or tight at first. This sensation usually improves within 10–15 minutes.

Cold caps

Cold caps are another way to cool the scalp. This type of scalp cooling does not use a machine. Instead, each cap is pre-frozen using dry ice or a special freezer.

Here’s how cold caps work:

• You bring several caps to your infusion session in a cooler or freezer cart.
• Each cap stays cold for about 30 minutes. As the cap becomes warm, it needs to be replaced with a new frozen one.
• You’ll likely need a friend or family member to help swap caps quickly and to help fit the new cap snugly.

This type of scalp cooling is sometimes called “manual” because the cold caps aren’t attached to a machine.

Cold cap options include:

• Arctic Cold Caps
• Penguin Cold Caps
• Chemo Cold Caps
• Wishcaps

Some cold cap companies offer training sessions, either in person or online, to teach you and your support person how to use them correctly.

Some treatment centers have special freezers for cold caps. Others do not. Cold cap manufacturers have information on how to find coolers, freezers, and dry ice.

Cold caps are not FDA-cleared yet, which means infusion centers can’t supply them directly. Still, many people rent them on their own and find they work well.

How effective is scalp cooling at preventing hair loss?

Research shows that scalp cooling can help many people keep some or most of their hair during chemotherapy, although results can vary widely.

How well scalp cooling works depends on several factors, including:

• The type of chemotherapy you receive
• The dose and schedule of chemotherapy
• Your hair type and texture
• Your age and overall hair health

Some people find that scalp cooling reduces their hair loss enough that they do not need to wear a wig or head covering. Others may still have a lot of hair thinning, even when cooling is used correctly.

If you’re considering scalp cooling, talk with your oncology team about:

• Whether your infusion center offers scalp cooling, and if so, what type
• If your type of recommended chemotherapy will affect how well the scalp cooling works
• What results other people have experienced with similar treatments

Even though results are different for each person, studies show that scalp cooling can work well for many people, and that most people who try it are satisfied with the results.

Chemotherapy type and dose

Scalp cooling success can depend on the type and amount of chemotherapy a person receives.

Studies have shown that scalp cooling can be very effective for some chemotherapy drug regimens and less effective for others.

2024 Dutch scalp cooling registry study

The largest study of scalp cooling looked at 7,424 people across 68 hospitals using Paxman and DigniCap systems in the Netherlands. The researchers found:

• 56% of participants did not wear a head covering, and
• 53% reported a small amount of hair loss by the end of their final treatment
• Effectiveness depended on chemotherapy type:
  • Taxane regimens: 78% success rate; taxane chemotherapy includes the drugs docetaxel (Taxotere), paclitaxel (Taxol), and nab-paclitaxel (Abraxane).
  • Anthracyclines: 40% success rate; anthracyclines include doxorubicin (Adriamycin) and epirubicin (Ellence)
  • Combination anthracycline + taxane: 45% success rate
• People receiving lower doses of chemotherapy had better outcomes than those receiving higher doses of the same drugs.
• No other individual or lifestyle factors significantly affected results, and outcomes were similar across genders.

Researchers concluded that scalp cooling is effective for the majority of patients receiving chemotherapy for breast and other cancers.

Past Paxman and DigniCap clinical trials

Earlier clinical trials of these systems showed similar effectiveness by drug type:

• Paxman scalp cooling system trial (SCALP trial, U.S., 2017):
  • 59% success in people receiving taxane-based chemotherapy
  • 16% success in those receiving anthracyclines
• DigniCap scalp cooling system trial (U.S., 2016):
  • 66% overall success rate (anthracyclines were not included)
  • Higher doses of chemotherapy were linked to lower success rates

Across studies, “success” was typically defined as not needing a wig or keeping at least 50% of hair during treatment.

Amma study

A small 2024 study of the Amma portable refrigerated system in 14 people reported similar outcomes to Paxman and DigniCap systems. Because the study was done in a very small number of people, researchers said that more studies are needed to confirm its effectiveness in larger, more diverse groups.

Cold cap research

• In a small study of Penguin Cold Caps, 61% of people avoided hair loss from chemotherapy.
• Keeping hair depended on the type of chemotherapy given. People receiving anthracycline regimens were less likely to keep their hair.

Study takeaways

The key takeaways from these studies are:

• Scalp cooling tends to work best with taxane-based chemotherapy and lower-dose regimens.
• Results varied by person and treatment type. Most people using refrigerated systems reported some level of hair preservation.
• If keeping your hair is important to you, ask your care team whether your infusion center offers scalp cooling.

If you’re planning scalp cooling, ask if your care team can help you make any small adjustments—such as parting or dampening your hair before fitting the cap—to improve scalp contact and comfort.

Hair type

Researchers haven’t yet done large studies on how hair type affects scalp cooling results. Still, many oncologists and nurses have noticed some patterns in the clinic:

• Thinner or straighter hair often cools more evenly and may respond better to scalp cooling.
• Thicker, wavy, or curly hair can make it harder for the cap to stay in full contact with the scalp, which may reduce how well cooling works.
• Research suggests that scalp cooling may not work as well to preserve hair in Black women. Experts recommend wetting the hair or adding conditioner to the scalp before putting on the cap so the cap fits more tightly. Too much water can cause the hair of Black women to become curly and bulky. This can prevent the cap from fitting as well as it could. In a 2020 Journal of Clinical Oncology letter to the editor, doctors at Johns Hopkins School of Medicine shared observations and suggestions for Black women preparing for scalp cooling:
  • Remove any hair extensions. This helps the cold temperature reach the scalp.
  • For natural hair that has not been chemically straightened or relaxed, use heat to straighten the hair, and apply grease to the ends of the hair. When you wet your hair, focus only on the scalp area.
  • If your hair is chemically straightened or relaxed, follow the scalp cooling manufacturer’s recommendations for hair preparation. It is okay to wet your hair before scalp cooling.
  • Read the letter to learn more.

Age

A large study in the Netherlands (2012) found that scalp cooling worked better in younger people than in older people. Researchers believe this may be due to:

• Hair becomes more brittle with age, and
• Older hair may break more easily, even when follicles are protected.

That said, age alone doesn’t determine success. Many older adults still report positive results with scalp cooling—especially when the cap fits well and is used consistently throughout treatment.

Caring for your hair during scalp cooling therapy

Taking care of your hair gently throughout chemotherapy can help reduce breakage and protect new growth while you use scalp cooling.

Experts recommend focusing on gentle products, minimal styling, and patience before, during, and after treatment.

Tips for gentle hair care

• Avoid chemical treatments such as dyeing, bleaching, perming, or relaxing your hair.
• If you wear extensions or braids, remove them before you begin scalp cooling so the cap can fit closely to your scalp.
• Use mild, fragrance-free shampoos and conditioners that are sulfate-free.
• Wash your hair less often—for many people, once or twice a week is enough.
• Let your hair air dry instead of using heat tools like blow dryers or flat irons.
• Use a wide-tooth comb or soft brush and detangle gently, starting from the ends.

Hair care after chemotherapy is finished

Continue gentle care for about 2 months after your final infusion, as your scalp and hair follicles recover.

You may notice slower regrowth at first. This is normal. Hair often returns with a slightly different texture or color, which usually fades over time.

There’s no single proven hair care routine that improves scalp cooling success. Being gentle can help most people feel more comfortable and confident as their hair adjusts through treatment.

FDA oversight of scalp cooling therapy

The U.S. Food and Drug Administration (FDA) reviews and clears medical devices that are used to treat or manage side effects of cancer therapy, including hair loss prevention during chemotherapy.

Refrigerated scalp cooling systems are FDA-cleared for use in the U.S. They include:

• Paxman scalp cooling system
• DigniCap scalp cooling system
• Amma Portable Scalp Cooling System

These systems are considered medical devices because they connect to a machine that controls temperature during chemotherapy.

Cold caps, the kind you rent and freeze yourself, are not FDA-cleared yet. This means cancer centers can’t provide or store them on site, but it does not mean they’re unsafe or ineffective. Many people still use cold caps successfully by renting them directly from the manufacturer and following their care team’s guidance.

NCCN guidelines on scalp cooling therapy

The National Comprehensive Cancer Network (NCCN) develops evidence-based guidelines that help doctors manage cancer and its side effects.

In 2022, the NCCN added scalp cooling to its breast cancer treatment guidelines as a Category 2A recommendation.

That means:

• There is strong agreement among experts that scalp cooling works to help prevent chemotherapy-related hair loss.
• More research is still being done to strengthen the evidence.

If you’re planning to start chemotherapy, ask your cancer care team if scalp cooling is available, as described in the hair loss recommendations set by NCCN guidelines.

Side effects of scalp cooling therapy

Scalp cooling is generally safe, but it can cause temporary discomfort for some people. Most side effects are mild and go away soon after the cap is placed.

Common side effects

• Headache or pressure from the tight fit of the cap
• Feeling very cold on the scalp and upper body
• Neck or shoulder stiffness from the weight of the cap
• Dizziness or nausea, especially during the first few sessions

These sensations usually lessen after the first 10–15 minutes of cooling as your scalp adjusts to the temperature.

When to tell your care team about side effects

Let your nurse or oncologist know if you feel:

• Pain that doesn’t ease with repositioning or over-the-counter medicine
• Dizziness, nausea, or chills that last after treatment
• Frostbite-like pain (pins, needles) or blisters on your scalp (this is very rare)

Your team may adjust the fit or cooling time to make you more comfortable.

Studies show that most people do not stop scalp cooling because of side effects. Only about 3%–12% of people are reported to stop scalp cooling for comfort-related reasons.

Paying for scalp cooling treatment

Scalp cooling can help many people keep their hair during cancer treatment with chemotherapy. It may also involve added costs.

In this section, we’ll explain what to expect when paying for scalp cooling, including:

• Typical expenses
• New 2026 insurance billing codes
• Programs that may help make treatment more affordable

Paying for refrigerated scalp cooling

In 2022, the Centers for Medicare and Medicaid Services (CMS) approved insurance reimbursement for refrigerated scalp cooling. There are now two Current Procedural Terminology codes, or CPT codes, for refrigerated scalp cooling units used at chemotherapy infusion centers. Healthcare providers across the U.S. use these codes to bill insurance companies for medical services.

Reimbursement codes for refrigerated scalp cooling

In 2021, Centers for Medicare & Medicaid Services (CMS) issued two temporary Category III CPT codes for refrigerated scalp cooling: 0662T and 0663T. This includes reimbursement for use of the Paxman, DigniCap, and Amma scalp cooling systems.

• 0662T is used for initial cap measurement and fitting, as well as adjustment of cooling intensity tailored to your chemotherapy regimen.
  • If your treatment plan includes multiple chemotherapy infusions, the single 0662T reimbursement covers measurement and fitting once.
• 0663T applies to cap placement, monitoring, and removal during each session.
  • Each time you use the cap, your provider bills your insurance company with the 0663T code.
  • Reimbursement amounts for the 0663T code can vary.

What’s changing in 2026

Starting January 1, 2026, the temporary Category III codes (0662T and 0663T) will be replaced by new, permanent Category I CPT codes for refrigerated scalp cooling in infusion centers. This includes the Paxman, DigniCap, and Amma scalp cooling systems.

The new Category I CPT codes are:

• Code 97007 for initial cap fitting and education: Medicare coverage will be $1,696.77 per person, per course of treatment (multiple chemotherapy sessions and rest periods)
• Code 97008 for each pre-infusion cooling session: Medicare coverage will be $10 per chemotherapy session
• Code 97009 for each 30 minutes of post-infusion cooling: Medicare coverage will be $6.35 for each 30 minutes per chemotherapy session

It’s important to know that these codes will not apply to non-refrigerated cold caps you bring to the infusion center in a cooler, such as Penguin, Arctic, Chemo, or Wishcaps cold caps.

Until 2026, 0662T and 0663T remain the active reimbursement codes for refrigerated scalp cooling. Future coverage under private insurers may vary. If you are using or planning to use refrigerated scalp cooling, talk with your insurance company and billing team about what the 2026 changes mean for your situation.

Learn more about paying for using the DigniCap System and the Paxman System.

Paying for cold caps

Cold cap costs vary depending on the company, your treatment schedule, and how much support you choose. On average, people can expect to pay:

• $300–$600 per chemotherapy session, or
• $380–$600 per month for cap rentals

Some advocacy groups and hospitals use $500 per infusion as a general estimate for cold cap cost planning. This can include:

• Cold cap rental fees
• Cold cap equipment security deposits (often refundable)
• Shipping costs
• Dry ice costs
• Optional help from a trained cold cap technician who assists with changing caps during treatment

Costs may be higher or lower depending on the provider and location.

Payment assistance

Because insurance coverage for cold caps is uncommon, many organizations and nonprofits help people afford cold caps:

• The Rapunzel Project, Hair to Stay, and Sharsheret offer help to people who have a financial need.
• Some hospitals and infusion centers also partner with local foundations or sponsor small grants for cold caps.

Before you rent

Before ordering a cold cap, talk with your care team about:

• Which brands they’ve seen work best with your type of chemotherapy
• How long you’ll need to rent caps
• Whether your infusion center can store caps in a freezer between sessions
• Whether your cancer center has information about financial assistance for cold caps

Some common brands of cold cap are:

• Arctic Cold Caps
• Penguin Cold Caps
• Chemo Cold Caps
• Wishcaps