Scalp cooling, using cold caps to reduce blood flow and chemotherapy uptake by hair follicles during infusion, has become an established option for patients receiving certain chemotherapy regimens. The Paxman and DigniCap systems are FDA-cleared, with active cooling that maintains scalp temperatures around 18–22°C throughout chemotherapy infusion and for a defined period afterward.

The 2025 international scalp cooling registry combined data from 8,400 patients across 14 countries. Overall, 51% of patients achieved 'good' hair preservation (defined as not requiring a wig or head covering). Response varied dramatically by chemotherapy regimen: taxane-based protocols achieved 65% success, anthracycline regimens 38%, combination regimens fell in between. Patient factors included hair texture (straight Asian hair generally responded better), thickness, and adherence to cap fit and cooling duration.

Practical considerations for patients considering scalp cooling: out-of-pocket costs typically £1,500–3,000 in private practice (increasingly covered by insurance), some discomfort from sustained cold exposure, and the need for proper cap fitting which significantly affects outcomes. The psychological benefit for patients who maintain visible hair through treatment is substantial. For chemotherapy regimens with poor scalp cooling response, the option may not be worth the cost and discomfort, discussing realistic expectations with oncology and the cooling provider matters.