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Scalp cooling shedding and hair loss

Shedding and hair loss during scalp cooling can be scary but are a normal part of the process. This information will help you to understand what can happen and to feel prepared if you do have to deal with it


Shedding is often the most dreaded part of scalp cooling. Hair loss can be distressing, messy and tiring. When shedding first begins, it is commonly and mistakenly seen as a sign that scalp cooling isn’t working - but it is important to know that shedding is an inevitable and completely normal part of the scalp cooling process.

Here’s some information on what to expect and how to cope with hair shedding.
Shedding happens to everyone  who scalp cools 
Even people who retain lots of hair will see some amount of shedding. It usually starts between 14 and 21 days after your first treatment, as the chemo’s effect on the follicles begins to show. If you haven’t scalp cooled, this is where total hair loss would begin. Scalp cooling will protect your follicles, but it can’t save every hair.
Shedding doesn’t mean that scalp cooling isn’t working
Shedding is scary, no matter how much you anticipate it happening. It is common to feel panic and think scalp cooling isn’t going to work once your hair starts to fall out. Try to trust the process and remember that what you are experiencing is normal and not representative of the rest of your scalp cooling journey.
The shedding is likely to be heaviest early in your treatment
This can vary a little and depends on the drugs you are receiving, but for the majority, the shedding will be at its worst after your second and third treatments. For most people, after this, it can slow down, but you should expect some level of shedding throughout your treatment.
Shedding isn’t the same for everyone 
Shedding varies a lot from person to person but is mostly influenced by the drug regimen you are receiving. If you are having an anthracycline-based regimen such as doxorubicin, epirubicin, or cyclophosphamide, you should expect more hair loss than those receiving taxane-based therapies such as docetaxel or paclitaxel. Use the Outcomes Calculator to get a realistic idea of the amount of hair retention you could expect with your treatment plan.
Shedding isn’t a result of having done something wrong
You can follow all the guidance to the letter, and you will still experience shedding. It is not a sign of failure or that you have done something wrong, just an inevitable part of the scalp cooling process.
It’s really important to remove shedding hair
You may feel that the last thing you want to do when your hair is shedding is to encourage those lose strands out, but it so important that you continue to brush your hair daily and wash your hair regularly enough to keep it manageable. This won’t remove hair that wouldn’t have fallen out anyway, but it can help to prevent knotting, tangling, and even matting.
Shedding will likely change if you swap drugs
If your regimen changes from one drug to another, there may be an initial increase in shedding. This is your hair follicles and body adjusting to the change in drug. It will likely happen 14 to 21 days after the first treatment on the new drug, but it can happen sooner too. Most of the time this increase is temporary.
Deal with shedding in a way that works for you
Dealing with heavy shedding can be difficult. Don’t be afraid to tie your hair up loosely, wear a sleep cap at night, or even wear a hair net when you are at home to help catch those stray hairs.

Seeing hair in the shower or on your brush can also be tough. Ask for someone to help you if it feels easier. Some people have found heavy shedding so tough that they decide to cut their hair off but continue to scalp cool. This gives the benefit of faster regrowth but means the hair loss is no longer an issue. Whatever you find works for you, go with it.
Shedding and regrowth can happen at the same time
It’s normal to see hair loss happening as new hair also starts to grow. The two processes can absolutely happen at the same time.
Don’t forget that shedding is a healthy function of your body
It’s easy to forget when you are deep in your treatment that shedding is a normal and healthy process. Everyone loses around 100 hairs a day as part of the hair growth cycle.
Post-treatment shedding is also normal
Unfortunately, your last chemo treatment doesn’t necessarily mean the end of shedding. It can take many weeks for the drugs to work their way out of your system, 8 to 12 weeks of elevated shedding after chemotherapy is normal. If shedding persists for longer than this, it may be worth speaking to your doctor as other factors can affect hair retention, including low hemoglobin levels and anemia.

Significant hair loss

Sadly, significant or extensive hair loss can happen for some patients who scalp cool. This is usually the result of a particularly harsh drug regimen. Unfortunately, there are no guarantees with scalp cooling.

Here are a few commonly asked questions from those that have experienced a lot of hair loss:

Should I stop scalp cooling?

Scalp cooling may not have given you the hair retention rates you would have hoped for, but it is worth noting that cooling your scalp during chemotherapy has been protecting your hair follicles. If you stop scalp cooling, that protection stops. This means that you will not see the long-term benefit of scalp cooling – faster hair regrowth.

Is it safe to continue with the cold cap if my scalp is exposed?

Yes, absolutely. But it is important that you cover any exposed areas of scalp to make the treatment as comfortable as possible. There are a few ways you can achieve this – if you have retained hair that is long enough you can arrange it over any exposed scalp. Alternatively, a disposable theatre/surgical cap will be thick enough to provide a barrier between your scalp and the inner cap, but not so thick that it stops the cooling effect.

I hate the way my hair looks now; can I shave my head?

Of course, if it would make you more comfortable there is no reason not to cut your hair. Just be mindful that you may benefit from a theatre/surgical cap worn underneath your inner cap.

I have lost most of the hair at my crown, why is this?

The crown is the area where scalp cooling has the most work to do because it is the hottest part of your scalp, and in some people, it just can’t cool the scalp to the right temperature to prevent hair loss. We are working on ways to tackle this, and hope that in the future, this shouldn’t be a problem for patients.

If you have high levels of hair retention everywhere other than your crown, this could be a sign that you have a cap that is too small. As the coolant from the system fills the cap, it will become tighter and if your cap is too small, it can rise and prevent proper contact with your scalp at your crown. Watch our ‘How-To’ videos for guidance on cap fitting and how to put the cap on properly, and if you’re still concerned with the size of your cap, speak to your clinical team.

My hair loss is patchy, why is this?

As mentioned above, losing patches of hair at your crown is not uncommon, but you may see patches of hair loss in other areas of your scalp. Usually this is because the cap is not in full contact with your scalp. This might be due to the shape of your head (it’s really normal to have flat or recessed areas on your scalp), or it could be a problem with the way your cap has been put on. Watch our ‘How-To’ videos for information on how to get the best possible fit.

Could I have done anything to stop the hair loss?

In most circumstances, there isn’t anything anyone could have done to prevent significant hair loss. If you were prepared for your treatment, got a great cap fit and put it on properly, there is nothing else that you could have done to change the outcome. Sadly, there are certain factors that are out of your control when it comes to hair retention – see more on this here.

Disposable gauze theatre/surgical cap – when and how to use one

Coldcap.com_Haircare products_Disposable theatre cap

When do you need to use a paper/theatre cap?

You only need to use the theatre cap if you have exposed scalp, if your hair has thinned but there aren’t specific areas of hair loss, you won’t need a theatre cap
no cap required
No Theatre Cap required
Theatre Cap required

How to use a theatre/surgical cap

Prepare your hair as shown in the hair preparation How-to video, then place the theatre/surgical cap over your head so that it is positioned correctly for the inner cooling cap to fit on top. The material of the disposable cap is thick enough to provide protection to any exposed scalp and make the scalp cooling more tolerable, but not thick enough to compromise the cooling process.

If you have patchy hair loss and you still have hair that is long enough, you can arrange your hair over the exposed scalp once it is dampened and conditioner is added. This is a simple but effective way of protecting exposed scalp without additional items.

As long as any exposed scalp is protected, it is completely safe to continue to scalp cool.
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