HOW COLD CAPS CAN REDUCE HAIR LOSS DURING CHEMOTHERAPY
A cold cap for chemotherapy significantly reduces hair loss associated with chemotherapy. The cooling causes the blood vessels in the scalp to constrict, thereby limiting how much of the chemotherapy reaches the hair follicles.
At Rapunzel, we call these systems cold caps. Our mobile system allows patients to perform scalp cooling flexibly and independently of the clinic's technical equipment. This article explains the main differences between mobile and stationary systems, the timeline on the treatment day, and the correct hair care to achieve the best possible results.
THE BIOLOGY OF HAIR LOSS: HOW DOES A COLD CAP WORK DURING CHEMOTHERAPY?
Chemotherapy specifically targets cells that divide rapidly. This applies not only to cancer cells, but also to the cells in the hair roots. Hair grows in cycles. About 90% of the hair follicles are simultaneously in the active growth phase (anagen phase). It is precisely these active cells that are affected by the medication. The result of this toxic effect is so-called chemotherapy-induced alopecia, the medical term for hair loss.
A cold cap cools the scalp to a low temperature. The targeted cold effect causes the blood vessels to constrict significantly. The blood flow to the hair follicles is greatly reduced. The cold also lowers the metabolism of the cells, which makes them absorb the chemotherapy drugs even less.
Studies prove the effectiveness of this method. A newer Dutch registry study with more than 7,000 patients confirms that the results depend heavily on the medications used. In the studies, the satisfaction of the patients who used the cold method was just under 79%.
THE PSYCHOLOGICAL IMPORTANCE OF KEEPING YOUR HAIR
Hair loss is one of the most distressing side effects of treatment for many cancer patients. It makes the illness visible to those around them. Keeping your own hair can protect your privacy and give a sense of normalcy in the midst of a difficult time of illness. Seeing yourself in the mirror and still recognizing yourself can be of great importance for your self-esteem.
At Rapunzel, we have made it our mission to make this form of treatment more accessible. On our About Us page, you can learn more about our Danish roots and our mission to improve the quality of life of patients during chemotherapy.
MOBILE COLD CAPS VS. STATIONARY SYSTEMS
Hospitals and patients can choose between two basic methods of scalp cooling today.
Some hospitals offer permanently installed, stationary systems. Well-known manufacturers in this clinical field are Paxman and Hilotherm. These devices circulate a cooling fluid at a temperature of about -5 °C through a cap that is directly connected to the device.
The other method is mobile cold caps. There are various brands on the market, whose quality varies. The cold caps from Rapunzel are the only mobile systems with CE marking - your guarantee of a safe quality product. Our cold caps are gel-based and remain flexible even at low temperatures. They are brought to the treatment in a special cooling bag. Since the caps gradually absorb heat from the body, they must be replaced at regular intervals.
The biggest advantage of mobile cold caps is independence. Not every clinic has an expensive Paxman or Hilotherm device. With a mobile system, you can perform the treatment at any treatment location. You can view our cold cap system here to get an idea of how it is put together.
THE EXACT TIMELINE ON THE DAY OF CHEMOTHERAPY
The cold treatment requires careful planning. You must wear the cold caps before, during, and after the chemo infusion. Expect a total of about four to five hours of wear time on the chemotherapy day. The process is divided into three phases.
Pre-cooling before treatment
You put on the first set of cold caps about 30 minutes before the start of chemotherapy. For very thick hair, this time is extended to 45 minutes. The scalp must have reached the desired temperature before the medication enters the bloodstream.
Cooling during the infusion
During the entire infusion, you must wear the cold caps. With mobile systems, you change the cold caps every 30 minutes. Only take the new set out of the cooling bag when you take off the old one. The change itself must be done quickly so that the scalp does not get warm.
Post-cooling
After the end of the infusion, the medication is still active in the bloodstream. Therefore, you cool the scalp for another 120 minutes. Only after that can you take off the cold cap completely.
Further details on the process can be found in our instructions for using the cold caps.
PREPARATION AND HAIR CARE DURING THE COLD TREATMENT
The right preparation is crucial to ensure good contact between the cold cap and the scalp. Moisture conducts cold much better than dry air.
Find a quiet place for preparation, for example a patient toilet or the waiting area. Moisten the entire scalp with a water spray. Then put on a thin disposable shower cap. It helps to keep the moisture on the scalp.
If you have long hair, let it hang loose under the cap. Avoid folding or tying the hair under the cold cap. Pull the cold cap down as far as it reaches the eyebrows. It must lie flat and tight, without air pockets.
After treatment, the hair should be allowed to dry in the air. Give the scalp and hair as much rest as possible in the following three days.
Specific tips for washing your hair can be found in our hair care guide during chemotherapy.
PRICES, RENTAL, AND HEALTH INSURANCE SUBSIDIES
The financing of scalp cooling depends on your insurance status and the chosen system.
As part of the two-year pilot project in Denmark 'Cancer Package 5' (starting October 2026), breast cancer patients can now have the costs of cooling caps covered during their chemotherapy.
At Rapunzel, you can rent the systems on flexible terms. When you rent our cold caps, prices start at 250 euros per month. We also offer a 30-day guarantee, where 50% of the first month's rent is refunded, so you can try the system without major financial risk.
Contact your health insurance fund directly before treatment begins and ask for an individual review of the possibility of cost coverage.
If you have questions about our rental terms, you can reach us anytime via our contact page.
CONTRAINDICATIONS: WHEN IS A COLD CAP NOT SUITABLE?
Scalp cooling can be safely used for most solid tumors, for example breast cancer and gynecological cancers. However, there are medical circumstances that may speak against its use.
Patients with a cold allergy must not use cold caps.
For certain hematological cancers such as leukemia and lymphoma, doctors also advise against scalp cooling. Here, the chemotherapy must reach all cells in the body, including the cells in the scalp.
Always clarify with your treating oncologist before starting whether the treatment is suitable for you.
SCIENTIFIC DATA: HOW BIG ARE THE CHANCES OF KEEPING YOUR HAIR?
Scientific research shows that scalp cooling can reduce the risk of significant hair loss during chemotherapy. Across several studies, 60–80% of patients achieve a result where they keep more than half of their hair. The result depends on other factors, including the type of chemotherapy, the dosage, and the individual circumstances of the person.
Research also shows that scalp cooling is a safe and well-documented method. An increased risk of metastases in the scalp or a worse survival rate as a result of the treatment has not been proven. The most common side effects are a temporary cold sensation, headaches, and discomfort.
Studies have also found no significant difference in effectiveness between stationary and mobile cooling systems.
The conclusion: Scalp cooling offers many patients a real chance to retain a substantial part of their own hair during chemotherapy.
Learn more about the research behind the method on our information page Research and Insights.
FREQUENTLY ASKED QUESTIONS ABOUT COLD CAPS
Is the cold treatment painful?
In the first 5–10 minutes, many users experience the treatment as particularly cold. The scalp must get used to the cold. After that, the cold numbs the nerve endings, and the cold sensation subsides significantly.
Warm clothing and blankets during treatment can help counteract the general cold sensation.
Will I still lose hair if I use a cold cap during chemotherapy?
Yes. Most people experience increased hair loss during treatment, even if they use cold caps. Cold caps do not completely prevent hair loss, but reduce it to a level where it is often possible to do without a wig.
How long do I have to wear the cold caps in total?
You must wear the cold caps 30-45 minutes before the infusion, during the entire infusion, and for another 120 minutes afterward.
Therefore, expect four to five hours of treatment time on the chemotherapy day.
Further answers can be found in our FAQ.
Can I change the cold caps myself?
You should take an accompanying person to chemotherapy. The caps must be changed every 30 minutes, and this can be difficult if you have an infusion needle in your arm at the same time.
Keeping your own hair gives many patients a sense of normalcy during a difficult time. A cold cap requires discipline and careful planning on the treatment day.
With mobile cold caps, you can actively participate in the decision to keep your hair yourself - regardless of the technical equipment of your clinic.
If you have questions about the application or would like to rent a system, the Rapunzel team is at your disposal for personal advice.
Talk to your doctor and clarify whether scalp cooling is an option for your individual treatment course.