Guest Blog | Scalp Cooling
Updated: Dec 7, 2020
A massive thank you to the lovely Susy from Paxman Scalp Cooling for this week's guest blog. Scalp cooling has been scientifically proven to help prevent chemotherapy related hair loss, but many of us still don't know much about it. In this blog, Susy demystifies scalp cooling for us, as well as providing some top tips on getting the best results from scalp cooling and looking after our hair during chemo treatment.
Let’s start at the beginning - what is scalp cooling?! Unfortunately, not a lot of people know about scalp cooling, but it’s a simple treatment that can prevent hair loss caused by certain chemotherapy drugs. The use of scalp cooling has been proven to be effective in preventing chemotherapy induced alopecia, and can result in people retaining much of their hair.
Chemotherapy works by targeting all rapidly dividing cells in the body, it’s designed to target cancer cells, but it can’t tell the difference between a fast dividing cell that the body needs and the cancerous ones. Hair is the second fastest dividing cell in the body, which means that your follicles are chemo targets, resulting in extensive hair loss almost like clockwork between days 14 and 21 after the first chemo treatment.
Using the Paxman cold cap lowers the temperature of the scalp immediately before, during and after chemo, which helps to prevent damage in several ways – firstly, by reducing the temperature of the scalp, vasoconstriction occurs, which significantly reduces blood flow (to as little as 40%) and means that less of the drug will reach the hair follicles. Secondly, the cooling process can cause the rapidly dividing hair cells to become dormant, meaning they stop dividing, so any chemo drugs that do reach the scalp will bypass the follicles.
One of the common things you will hear is that scalp cooling doesn’t work. Well, that simply isn’t true! We know that scalp cooling isn’t for everyone. There are different results with different drugs and dosage. Each person will also respond differently to scalp cooling – some will retain a huge amount of hair, for others, even on the same drug regime, they may see poorer results. We are working hard in conjunction with Huddersfield University at the Paxman Research and Innovation Centre to understand why this happens and to find ways to improve efficacy for everyone. At the moment there are no guarantees that you will be able to retain your hair with scalp cooling, but our current data shows (across all drug regimens) that you have a 50% chance of keeping 50% of your hair, and as much as 80% chance with some drugs. And to be completely blunt, if there is 20% or even less of your hair left at the end of chemo treatment, scalp cooling has worked, as without it there wouldn’t be a single hair left on your head within a month of your first treatment.
If you do choose to scalp cool, hair care is enormously important. One of the side effects of chemo is that it is incredibly drying to hair, skin and scalp. Keeping your hair manageable is absolutely paramount, not only to make cold capping as effective as possible, but to ensure that the hair you do retain is in the best possible condition once you have finished your chemo. We have recently released our ‘Common Sense Guide to Cold Cap Haircare’ guide, which has some simple but effective suggestion for how to look after your hair while you are scalp cooling. You can find it here.
This guide will let you know what works, what to avoid, and how to get through all of this as simply as possible, so that your hair isn’t another thing, on top of everything else, to be stressed and anxious about (easier said than done!)
Something that isn’t too often spoken about is shedding. It’s one of the most feared chemo side effects and can be incredibly traumatic, even if you know it’s coming. It’s the biggest reason many people decide to shave their heads when they find out they have to have chemo, because the handfuls of hair dropping out is just too much to take.
But you are cold capping, so shedding isn’t something you need to worry about, right? Well, unfortunately, wrong, it is an inevitable part of the process. Being realistic, scalp cooling cannot save every hair on your head. Shedding is something that will most likely happen at some level throughout chemo and quite likely for a number of additional weeks after. We know that people will begin to shed between days 14 and 21 after their first treatment and this is something that you need to be prepared for.
Shedding is completely normal and it does not mean that scalp cooling isn’t going to work for you
You can lose an almighty amount of hair and still have an enormous amount left
Try and focus on the hair that is on your head, not the hair that you are losing
Shedding is a misery, but it will not last forever
There are a few things that you can do that will make shedding more manageable. They seem simple, and they are, but they are also so important:
BRUSH YOUR HAIR! People are often terrified to brush their hair, and there has been some advice around in the past that you should avoid brushing your hair during cold capping, but it’s exactly the opposite. We would recommend brushing your hair every day, ideally once in the morning and once in the evening, and definitely before washing your hair. Liberating the loose hairs is imperative to prevent tangling and knotting, that can easily lead to matting (which you really, really don’t want). Start from the bottom of your hair, holding your hair below the root to avoid tension, and gently brush through with a detangling brush. Once the bottom section is knot free you can move up your hair and do the next section. Don’t brush straight through from the root to the end – this can create all kinds of knotting!
Wash your hair regularly – no more than twice a week, but probably no less than once every 10 days. Wash day can strike fear in to some cold cappers, as washing your hair will really liberate shed hairs, which can leave a shower drain that is hard to look at. But this is exactly why it’s so important. Washing your hair won’t pull it out, just like brushing, but reveals and liberates the already shed hairs.
If you are in the depths of a big shed, there are a couple of tricks that will help to avoid the hair everywhere effect. If your hair is long enough you can try a loose braid, or a low bun. You’ll need to make sure you give your hair a thorough brush when you take it down, to ensure you’re not just trapping the shedding hairs in. Some people have found a hair net useful for the same reason when they are at home, and for overnight a silk sleep cap can help to keep your hair less tangled, and catch shed hairs too.
Shedding may continue for several weeks after chemo treatment is complete, which people often don’t expect. This is because it can take a while for the drugs to work themselves out of your system. But it will stop. It is also fairly common to see shedding and regrowth at the same time too.
Shedding won’t be consistent. There will be some cycles, probably the first couple, where it may feel like not only will it never stop, but that you didn’t know you had so much hair in the first place, given how much has dropped out. Then out of nowhere it will slow significantly. These patterns are different for everyone, and vary for different drug regimes.
We know that shedding is inevitable, which means some level of hair loss. This falls in to two categories – consistent thinning, or patchy hair loss. When fitting a cap, you are looking for a consistent all over contact with the scalp - this may result in all over thinning, but this is generally something that you might notice, but other people wouldn’t. Patchy hair loss is a sign that the cap isn’t making contact in certain areas and therefore isn’t able to cool the scalp effectively. This is usually at the back of the head, or on the crown. You may want to review the size of your cap (too small can be just as detrimental to hair loss as too big). You can watch our instructional videos to get an idea of the best practice for cap sizing and fitting.
Crown hair loss or a widening of the parting is really common. This isn’t always about cap fit, but can just be because this is naturally the hottest part of the head.
A common thought is that you cannot continue to scalp cool if you have patchy hair loss, or have lost a lot of hair. This is just not the case. We would recommend that you ensure that any scalp is covered to prevent direct contact with the cold cap to increase tolerability. This can be done by rearranging any retained hair to hide the scalp, with gauze cut to size, or if you have experienced quite a lot of hair loss, a thin theatre cap. There have even been people who have begun scalp cooling mid treatment and have no hair at all, and this has not been a problem at all. There is clinical data to show that scalp cooling encourages stronger, faster and healthier regrowth than would occur with out the cold cap.
Scalp cooling is a tough road and an emotional one, but we would always recommend giving the cold cap a try. You have a lot to lose and potentially a lot to retain.
Keep an open mind, stay positive, and be kind to yourself. No matter what happens, you will always know that you did everything you could to retain your hair.
And finally, if you are thinking about scalp cooling or are in the process now, you may find our Facebook Support Group helpful facebook.com/groups/PaxmanScalpCooling/ It’s a wonderful online community which is full of people from all over the world, who have scalp cooled in the past or are currently scalp cooling, with so much collective knowledge. We know how powerful peer to peer support can be, so it’s a great place to start to learn, find advice, support or to chat about all things cold cap.
If you are interested in scalp cooling and are based in the UK, ask your doctor or oncologist. Paxman systems are in 98% of private and public hospitals in the UK, so it shouldn’t be too difficult to access one. As long as you have a solid tumour cancer, you should be able to use scalp cooling.