You don't have to lose your hair during chemotherapy.
Ask your doctor if cold capping is an option for you.
Dignicap & Paxman
Dignicap is an FDA approved cold capping device in the US. It consists of a silicone cooling cap that is placed securely on your scalp by a trained nurse.
The Dignicap is connected to a cooling device, and coolant circulates through the cap. The cap will maintain the optimal temperature through sensors and ensures that the cap does not go below the freezing point, to make sure no damage occurs to the scalp.
An outer insulating cap is placed on over the silicone cap to make sure it is the right temperature. It gradually cools to the correct temperature prior to treatment.
The Dignicap was unavailable at my oncologist’s office so I purchased a manual cap (see below). Unfortunately it is not available in many oncology offices yet but is available at most large academic centers and larger offices.
Click here to learn more about Dignicaps: https://dignicap.com/
Paxman is also an FDA approved cold capping device in the US and UK.
It has a soft silicone light cap that like the dignicap, circulates coolants to cool down the temperature of the scalp. Click here to learn more about Paxman: https://coldcap.com/
Manual caps
There are several types of cold caps available that have been in use for many years. I rented the Penguin cap. You are provided with a cooler, 4 caps and 4 bands as well as black velcro straps to secure the cap.
The Penguin cap is made of a special formulated crylon gel to hold the temperature consistently. They provide you with a cooler that you will fill with dry ice. My husband bought blocks of dry ice from a dry ice supplier the night before chemotherapy. The staff were fantastic and friendly and easily accessible to answer any questions I had about the process.
Everyone’s regimen is different, my regimen consisted of 4 chemotherapy drugs, Herceptin, Perjeta, Taxotere, and Carboplatin. The caps need to be pre-cooled prior to application. The Penguin cap staff will send you a personalized regimen on when to start cooling. For me, since Perjeta has been associated with hair loss, I began “pre-cooling” during my pre-meds and part of herceptin so that my scalp was adequately cooled prior to starting Perjeta, Taxotere and Carboplatin which are the drugs that can cause hair loss (primarily taxotere).
On my regimen, the chemocap needed to be worn for 4 hours after chemotherapy. This was a long day for me, as I typically was done with chemo at around 3:30/4:00 pm and wasn’t done with the caps until 7-8 pm, the first chemo day was the longest. Also unfortunately there is no gradual cool down so the first few caps are a little bit of a shock!
Click here to learn more about Penguin Caps: https://penguincoldcaps.com/us/
See below for a video of how these manual caps are applied.
Penguin Cap application tips
You need a dedicated team! Unfortunately there is not a dedicated nurse to apply the caps so you will need at least two, preferably 3 people to help you as it will be very difficult to apply the caps yourself!! Team work is key!!
My husband was “ice man” and was in charge of getting the dry ice, measuring the temperature of the ice, and ensuring it was in the right temperature range, and re-arranging the caps in the cooler so they maintained a consistent temperature.
My friend helped with applying the caps while he was doing this. My third friend who came for a short while during taxotere, helped me with icing my hands and feet. It takes a village!!!
This temperature gun was helpful for getting a quick gauge at the temperature. I’d recommend double checking it with the temperature probe supplied. This is the temperature gun I purchased off of amazon:
You will need the following things to bring with you:
-mole skin- sticky fabric soft tape to protect and cushion your skin from the cold cap, can find at CVS/Walgreens/Walmart
-maxi pad (yes, its true, I wore a maxi pad on my forehead)
-scissors
-2 coolers, one for caps and one for regular ice
-a radar temperature gun (mentioned above) and temperature probe , back up batteries are good to have
-ice handling gloves, I bought these for my helpers at Home Depot to protect their hands from dry ice!
-For cooler #1, my husband would fill it with slabs of dry ice he would purchase the night before. We would take the penguin caps out of the refrigerator to thaw, 2 days before, then put them into the cooler of dry ice as per the penguin cap instructions.
– Cooler #2- we would fill with regular ice. In this cooler we would put elastogel mitts (see nails) and booties as well as popsicles.
-Hair comb- it helps to part your hair different ways to change your part each time you use the cold cap.
Forehead and ear protection
Protecting forehead
Protecting ears and temple
Protecting ears and temple
This is how I'd recommend applying maxi pad and mole skin to protect forehead
Protecting ears and temple
Protecting ears and temple
Protecting ears and temple
Tape over ear and temples with moleskin to protect skin from coldcap. Note that anywhere the moleskin is, the cap cannot protect- so avoid placing on frontal scalp
Additional helpful items for coldcapping success
Handheld shower head
Gentle clear shampoo pH 4.5-5.5
Gentle clear shampoo pH 4.5-5.5
As you will need cold water on your scalp, it was nice to have a handheld shower head so I didn't have to take a cold shower!
Gentle clear shampoo pH 4.5-5.5
Gentle clear shampoo pH 4.5-5.5
Gentle clear shampoo pH 4.5-5.5
Using a pH balanced, sulfate free, gentle clear shampoo can be helpful. Avoid volumizing and opaque shampoos.
Detangling spray
Gentle clear shampoo pH 4.5-5.5
Detangling spray
Using a light detangling spray can be helpful instead of a heavy conditioner, in addition you will not want to put excessive tension on roots when brushing.
Electric Blanket
Avoid heat styling hair
Detangling spray
Using a electric blanket to heat up your core during treatments can be helpful to take the edge off the cold temperatures of the caps
Avoid heat styling hair
Avoid heat styling hair
Avoid heat styling hair
Throughout treatment you will want to avoid blow drying, flat irons, and curling irons
Satin pillowcase
Avoid heat styling hair
Avoid heat styling hair
Using a satin pillowcase can help with breakage.
Will I keep all my hair?
Unfortunately, a significant amount of shedding happens even with cold capping.
It is very common to get a "big shed" right after the first treatment or right before the second treatment (about 2-3 weeks after first treatment). Don't get discouraged and give up! After the first major shed typically the hair cycle stabilizes and you can still cover up patchy hair loss with headbands. If you stick with it, even with 50% hair loss you will regrow hair much quicker with cold capping rather than starting from scratch! Keep in mind you will be washing your hair much less frequently, and so every time you wash your hair it will seem like more than usual is coming out, but it is typically accumulated normal shedding!