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What is it?  Scalp hypothermia is cooling the scalp with ice packs or cold caps for a period of time before, during, and after each chemotherapy (chemo) treatment. How might it work? The theory behind scalp hypothermia is that the cooling tightens up or constricts blood vessels in the scalp. This constriction is thought to reduce the amount of chemo that reaches the cells of the hair follicles. The cold also decreases the activity of the hair follicles and makes them less attractive to chemo, which targets rapidly dividing cells. This could reduce the effect of chemo on the follicle cells and, as a result, prevent or reduce hair loss from the scalp. What does the research show? Controlled studies of scalp hypothermia have produced conflicting results. Many of the best outcomes from scalp cooling have come from studies in the Netherlands. It’s possible that cooling methods used there (cap type, temperature, duration, and other factors) may vary somewhat from those used in the United States. Some studies found have benefits, but many patients using scalp hypothermia still had some hair loss. Success of scalp hypothermia may be related to the types of chemo used, the chemo dosage, and how well the person tolerates the coldness. At least one researcher that related scalp temperature to reduction in blood flow during cooling suggested that people with a thicker hair layer were more likely to lose hair than those with a thinner layer of hair. This appeared to be because the scalp didn’t cool down enough due to the insulating effect of the hair. The same researcher showed that colder scalp temperatures correlated with much lower blood flow to that area. Cooling caps that didn’t fit well were also linked with more hair loss, often in patches where contact with the scalp was poor. (A thicker layer of hair also reduces scalp contact.) People who had more success with cool caps had very good contact between the cool cap and the scalp. Recently, the FDA has cleared the DigniCap® system manufactured by the Swedish company Dignitana, Inc., for marketing. This two-piece cooling cap system is controlled by a computer which helps circulate a cooled liquid through a cap that a woman wears during chemotherapy treatment. A second cap made from neoprene covers the cooling cap to hold it in place and keep the cold from escaping. The FDA based its decision on a clinical trial of 122 women with stage I or stage II breast cancer who were undergoing chemotherapy. More than 2/3 of the women who used DigniCap reported losing less than half their hair. The most common side effects were headaches, neck and shoulder discomfort, chills, and pain. There are also unanswered questions about the safety of scalp hypothermia. Some doctors are concerned that the cold could keep chemo from reaching any stray cancer cells lurking in the scalp. Some believe that the scalp cooling might protect cancer cells there and allow them to survive the chemo and keep growing. But, in people who have used scalp hypothermia, reports of cancer in the scalp have been rare. More studies are needed to answer questions about long-term safety. Scalp hypothermia devices can be rented or purchased online, and some cancer treatment facilities in the US allow patients to use them. What should I do? The potential discomfort, benefits, and risks should be carefully weighed when considering scalp hypothermia. Discuss the pros and cons of this option with your cancer treatment doctor. If this is an option for you, you might want to ask if the treatment center has experience in using cold caps and how successful they have been. To learn more We have a lot more information that you might find helpful. Explore www.cancer.org or call our National Cancer Information Center toll-free number, 1-800-227-2345. We’re here to help you any time, day or night. References Komen MM, Smorenburg CH, van den Hurk CJ, Nortier JW. Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. Oncologist. 2013;18(7):885-891. Janssen FE, Van Leeuwen GM, Van Steenhoven AA. Modelling of temperature and perfusion during scalp cooling.Phys Med Biol. 2005 Sep 7;50(17):4065-407373. Lemieux J, Desbiens C, Hogue JC. Breast cancer scalp metastasis as first metastatic site after scalp cooling: two cases of occurrence after 7- and 9-year follow-up. Breast Cancer Res Treat. 2011;128(2):563-566. Shin H, Jo SJ, Kim DH, Kwon O, Myung SK. Efficacy of interventions for prevention of chemotherapy-induced alopecia: A systematic review and meta-analysis. Int J Cancer. 2014 Aug 1. van de Sande MA, van den Hurk CJ, Breed WP, Nortier JW. [Allow scalp cooling during adjuvant chemotherapy in patients with breast cancer; scalp metastases rarely occur]. Ned Tijdschr Geneeskd. 2010;154:A2134. van den Hurk CJ, van den Akker-van Marle ME, Breed WP, et al. Impact of scalp cooling on chemotherapy-induced alopecia, wig use and hair growth of patients with cancer. Eur J Oncol Nurs.   2013;17(5):536-540. Last Medical Review: 12/02/2014 Last Revised: 12/15/2015