A young Asian women is wearing a cool cap for cancer treatment, The cap is thick grey fabric with a black chinstrap to keep it in position. It is connected to the Paxman scalp cooling machine by a long tube
Woman wearing a cool cap. All images
are used courtesy of Paxman

Chemotherapy induced alopecia is widely documented as a cause of massive upset to patients undergoing treatment for cancer. Although not all chemotherapy drugs cause alopecia it is the initial stereotypical thought that the hair will fall out. This has been the single reason that patients have refused to partake in treatment regimens because the psychological impact would be too great to bare. 

Chemotherapy drugs are powerful and attack rapidly growing cells with hair follicles being one of them. The hair will usually start to fall out approx. 2-4 weeks following the first treatment. Not all chemotherapy drugs cause alopecia and the severity of the hair loss depends on the drug being given. Some patients may lose all of their hair whilst others it becomes patchy. The hair can fall out all at once or it can be gradual. Some patients have explained that the scalp becomes tender before the hair comes away. 

Treatment for this type of alopecia is limited and patients are always given the choice to obtain a wig, scarves or we discuss the use of the scalp cooling machines. As previously mentioned not all drugs / regimens cause alopecia so the clinician will advise if this will affect you. Scalp cooling reduces the temperature of the scalp, restricting the blood supply and protecting the hair follicles. 

The time attached to the cool cap is determined by the chemotherapy drug being infused. There is always a 30-minute pre-infusion cooling (this can be increased up to 45 minutes for thick or afro hair) and up to 1 hour 30 minutes post-infusion.

  • Weekly Taxol – 30 minutes pre-cooling – 1 hour infusion – 60 minutes post-cooling
  • Docetaxel – 30 minutes pre-cooling – 60 minute infusion – 20 minutes post-cooling
  • All other alopecia inducing drugs – 30 minute pre-cooling – length of infusion – 90 minutes post-cooling

During the 30-minute pre-infusion cooling, the cap cannot be removed. If you need to go to the toilet during this period, the 30 minutes will need to be re-started. Please ensure you use the toilet prior to the cooling commencing.

If your treatment is being administered via a cannula, this will need to be inserted prior to the cooling commencing. This is because, once the cooling process commences, it can make your veins constrict to try and retain heat in the body making the cannulation process harder to achieve. If you have a PICC line in situ, there is no need to worry.

You may experience some pain in the forehead during the cooling period - using a stretchy fabric hairband can help to lessen this.

The first 10-15 minutes of the pre-cooling can be painful - some patients recommend taking mild painkillers prior to attending to help with this. They also recommend a distraction like music or a film to help. (Free patient wifi is available on the unit.)

A towel

While we can supply a towel, they may not always be available so please bring one with you.

A blanket

Again this may not be available on the day of your infusion so please bring your own to manage your comfort during the infusion.


This is needed prior to the cap being fitted and for infection control purposes we cannot share products so please bring your own conditioner. (Information will be provided later re recommended products to use.)

A woman is pouring hair conditioner into her hand to put on her hair before using the scalp cooling machine

A stretchy fabric headband

This helps with comfort during the infusion.

A woman puts a stretchy black headband around her head to keep her hair back before she puts on the cool cap

A detangling hairbrush / comb

You will need to brush your hair before and after the infusion to prevent your hair becoming matted.

A spray bottle

Your hair needs to be wet prior to the cap being fitted.

A woman uses a small spray bottle with water to wet her hair before using the scalp cooling machine

A hat / hoody

Your hair will be wet on leaving the unit and you will feel cold after the scalp cooling. This will help to keep you warm on leaving the unit.

Warm comfortable clothing

Think about layers to keep yourself warm.

The cap comes in 3 sizes - small, medium and large. The nurse will help you to determine the best fitting cap and document the size in your notes.

Once the fluid filled cap is positioned onto your head the outer cap is then fitted. This may be the same size as the inner cap or it may need to be smaller to really ensure that the fit is snug. 

The cap is then tightened under the chin using a chin strap. This can be loosened once the cap is correctly fitted. 

A young Black woman is putting on the cool cap. The inner cap is bright blue. On top of that is an outer cap made from thick grey fabric. There is a black chinstrap that she can attach when the cap is in position
The inner cap is bright blue. The outer cap
fits on top of it with a chinstrap to fasten it

For the most successful experience, the fluid-filled cap needs to touch as much of the surface of your scalp as possible. Where it does not touch it does not work. 

With this in mind, remove any thick braids, a weave or hair extensions as they can prevent the scalp cooling from working effectively. It is also advisable not to have any curl-relaxing treatments.

You should not dye the hair during scalp cooling - this is because hair dye can cause scalp sensitivity during chemotherapy treatment. It can also cause damage to the hair which may make it more unmanageable. If you want to dye your hair, it is recommended that you do this prior to commencing treatment, at least a week before you begin.

When washing your hair after commencing treatment, smooth shampoo and conditioner in rather than rubbing in a circular motion as this could lead to matting.

You can use clips and headbands, but it is not recommended to apply tension to the roots. If you want to tie your hair back, it is advisable to put into a low ponytail or braid.

If you have very curly or afro type hair, it is recommended that you don’t wash your hair as often as normal as this will have a drying effect on the hair. It is also recommended to use plenty of conditioner or natural oils on the hair in between treatments. However, don’t use these on the day of treatment as they will make it harder to wet the hair prior to the cool cap fitting.

Wash your hair with sulphate / paraben /colour and perfume-free shampoo and conditioner. It does not matter which brand you use for this.

You can wash your hair as frequently as you need to. It is recommended to rinse your hair within 24 hours of using the cool cap.

You should be very gentle with your hair - a cool hairdryer can be used but it is recommended that you use your fingers for drying rather than a hairbrush. It is advisable not to use any additional heat on the hair like hair straighteners or curling tongs as they can cause damage to the hair.

Additional information

If you require any additional information, this can be found at Coldcap.com (Paxmans official website). Paxman are the company that make and supply the scalp cooling machines.

Here you will be able to find video tutorials and information about the success rates for different treatments.

Any questions can be directed to the chemotherapy nurse on the day of treatment.

Please be aware that scalp cooling is not successful for every patient.