# Scalp cooling (cold caps: DigniCap, Paxman)

Source: https://onco.cc/technologies/scalp-cooling/  
OnCo record `scalp-cooling` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.

## Summary

Two machine-cooled systems are FDA-cleared: DigniCap (Dignitana; cleared December 2015 for breast cancer and extended to solid tumours in July 2017) and Paxman Scalp Cooling System (cleared April 2017 for breast cancer, extended to solid tumours in June 2018); manual gel caps (Penguin, Chemo Cold Caps, Arctic) that are swapped from dry ice every 20 to 30 minutes are the older, cheaper alternative. In the SCALP randomised trial (Nangia et al., JAMA 2017) 50.5% of women with early breast cancer using Paxman kept at least half their hair after four cycles of taxane, anthracycline or combined chemotherapy versus 0% of controls; the DigniCap cohort study (Rugo et al., JAMA 2017) reported 66.3% hair preservation on non-anthracycline taxane regimens.

Efficacy depends on the regimen: best with weekly or three-weekly paclitaxel and docetaxel alone, intermediate with docetaxel-cyclophosphamide, and poorest with anthracycline-containing regimens such as AC or EC followed by taxane, where preservation rates in trials were low. It is not used in haematological malignancies because of the theoretical risk of scalp metastases, though a systematic review of more than 1,900 breast cancer patients found scalp metastases in about 0.6% with cooling, similar to the rate without. The cap adds around 30 minutes before and 60 to 90 minutes after each infusion to the chair time; headache, chills and scalp discomfort are common but mild. Cost and reimbursement are the main barriers: the NHS provides it in many but not all units, often funded by charities such as Walk the Walk, and US coverage varies with charities (HairToStay, the Rapunzel Project) subsidising fees or lending manual caps.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-04
- Also known as: Cold cap; Scalp hypothermia; DigniCap; Paxman Scalp Cooling System
- Tags: complementary; supportive-care; evidence:strong; hair-loss
- Principle: Cooling the scalp to around 18 to 22 degrees Celsius vasoconstricts scalp vessels, reducing blood flow and drug delivery to the follicle by a large fraction during the peak plasma phase, and lowers follicular metabolic rate so dividing matrix cells take up less drug.
- Since: 2015
- Strengths: Randomised evidence of hair preservation in about half of taxane-treated women; FDA-cleared devices; no scalp metastasis excess in systematic review; Meaningful reduction in one of the most feared side effects
- Limitations: Much less effective with anthracyclines and not offered in haematological cancers; Adds one to two hours to each chemotherapy visit; cold discomfort; Cost and inconsistent NHS and insurer coverage

## Notes

- Triple-negative breast cancer regimens contain a taxane and usually an anthracycline. In the SCALP randomised trial (Nangia 2017) 50.5% of women cooled kept more than half their hair after the fourth cycle against none of the controls; 36% had anthracycline-based chemotherapy. In the DigniCap cohort (Rugo 2017), which excluded anthracyclines, 66.3% kept at least half their hair. Ask whether your unit offers cooling with your regimen and with sacituzumab govitecan.
- Macmillan advises getting a wig fitted before treatment starts so it can be matched to your own hair, and says hair usually starts to grow back after treatment, sometimes with a different texture or colour.
- Breast cancer, the equity gap in the evidence. A phase II feasibility study of the Paxman scalp cooling device planned to enrol 30 Black patients receiving chemotherapy for stage I to III breast cancer and closed early after 15, for lack of efficacy: median hair loss and alopecia distress scores both rose during cooling, most participants stopped before finishing chemotherapy because of grade 3 alopecia, and only one avoided significant hair loss. The authors concluded that scalp cooling may not be efficacious in preventing alopecia in Black women, and pointed to differences in hair thickness and volume and to limitations of cap design. The randomised evidence that supports scalp cooling, including the SCALP trial, did not include enough Black participants to answer the question.
- Practicalities worth asking about before the first cycle: cooling adds time at each end of the infusion, so a treatment day gets longer, and availability varies by unit. Macmillan says a wig is easier to match if it is obtained before treatment starts, that eyebrows and eyelashes can go too and it helps to buy and practise with products beforehand, and that the Little Princess Trust provides free real-hair wigs to people up to the age of 24.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Scalp_cooling
- SCALP randomised trial (JAMA 2017): https://doi.org/10.1001/jama.2016.20939
- DigniCap cohort with concurrent controls (JAMA 2017): https://doi.org/10.1001/jama.2016.21038
- Scalp cooling and scalp metastases: systematic review and meta-analysis (Breast Cancer Res Treat 2017): https://doi.org/10.1007/s10549-017-4185-9
- Paxman Scalp Cooling: https://paxmanscalpcooling.com/
- DigniCap: https://www.dignicap.com/
- Macmillan: scalp cooling: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/hair-loss
- Nangia et al., scalp cooling device and alopecia in women having chemotherapy for breast cancer, SCALP randomised trial (JAMA 2017): https://doi.org/10.1001/jama.2016.20939
- Rugo et al., scalp cooling and alopecia after chemotherapy for breast cancer, DigniCap cohort (JAMA 2017): https://doi.org/10.1001/jama.2016.21038
- Macmillan: hair loss: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/hair-loss
- Dilawari et al., does scalp cooling have the same efficacy in Black patients receiving chemotherapy for breast cancer? (The Oncologist 2021): https://doi.org/10.1002/onco.13690

## Connected records

- ideas: [A dedicated programme for cachexia and treatment toxicity research](https://onco.cc/ideas/idea-fund-cachexia-programme/), [Fund scalp cooling and hair-preserving measures for every alopecia-inducing regimen](https://onco.cc/ideas/idea-moon-hair-preservation-for-all/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Ovarian cancer](https://onco.cc/cancers/ovarian/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Devices & Physical Therapies](https://onco.cc/fronts/devices/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Bimatoprost for eyelash and eyebrow regrowth](https://onco.cc/technologies/bimatoprost-eyelash-regrowth/), [Body image after cancer treatment: how it is measured, what drives it, and what helps](https://onco.cc/technologies/rejuv-mind-body-image-after-cancer/), [Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield)](https://onco.cc/technologies/closed-system-transfer-devices/), [Creams and lotions tried to prevent chemotherapy hair loss](https://onco.cc/technologies/hair-topical-prevention-agents/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Frozen gloves, socks and compression for taxane nail and nerve damage](https://onco.cc/technologies/frozen-gloves-compression-taxane/), [Low-level light therapy (photobiomodulation) for hair](https://onco.cc/technologies/hair-photobiomodulation/), [Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss](https://onco.cc/technologies/minoxidil-chemotherapy-alopecia/), [Nails after chemotherapy: lifting, ridges and discolouration](https://onco.cc/technologies/nail-changes-after-chemotherapy/), [Oral cryotherapy (ice chips) to prevent mucositis](https://onco.cc/technologies/oral-cryotherapy-mucositis/), [Scalp care during and after cancer treatment](https://onco.cc/technologies/scalp-care-cancer-treatment/), [What recovery costs in the UK, and what it does not](https://onco.cc/technologies/rejuv-access-what-it-costs-uk/), [Wigs, cranial prostheses and head coverings](https://onco.cc/technologies/wigs-cranial-prosthesis/)
- drugs: [Cabazitaxel](https://onco.cc/drugs/cabazitaxel/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/)
- companies: [Dignitana](https://onco.cc/companies/dignitana/), [Luminate Medical](https://onco.cc/companies/luminate-medical/), [Paxman](https://onco.cc/companies/paxman/)
- trials: [Comparative Study of Scalp Cooling System and Chemical Cold Cap (COHAIR Study)](https://onco.cc/trials/nct03711877/), [Prevention of Persistent Alopecia Following Docetaxel by Means of Scalp Cooling](https://onco.cc/trials/nct00515762/), [Scalp Cooling in MBC](https://onco.cc/trials/nct04986579/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [SCALP: scalp cooling to prevent hair loss during chemotherapy for early breast cancer](https://onco.cc/key-papers/paper-scalp-trial-jama-2017/)
- terms: [Anagen effluvium (chemotherapy hair loss)](https://onco.cc/terms/hair-anagen-effluvium/), [Hair loss and scalp cooling with breast cancer chemotherapy](https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/), [Persistent chemotherapy-induced alopecia](https://onco.cc/terms/alopecia-persistent-chemotherapy/)
- people: [Hope S. Rugo](https://onco.cc/people/hope-rugo/)
- institutions: [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants](https://onco.cc/roadmaps/devices-roadmap/), [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)
- collections: [Look Good Feel Better](https://onco.cc/collections/look-good-feel-better/)

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