Do Cold Caps Work for Textured Hair?

Regardless of whether your hair is straight or curly, long or short, you may experience hair loss during breast cancer treatment. 

Some people use cold caps or scalp cooling systems to reduce hair loss during chemotherapy. But are these caps effective for all hair types? 

The short answer: No one seems to know for sure. That’s because most of the studies of cold caps and scalp cooling systems have included people with straight or wavy hair — not curly or kinky/coily hair.

“There is little evidence to confirm that scalp cooling works in women of color mainly because very few people of color were enrolled in the initial trials for scalp cooling,” says Ranju Gupta, MD, an oncologist, hematologist, and co-director of the Cardio-Oncology Program at Lehigh Valley Topper Cancer Institute. 

This doesn’t mean that Black women and others with curly or kinky hair can’t use cold caps. It just means you may need to alter your tresses to boost the success of your cooling cap.

Chemotherapy causes hair loss by targeting all fast-dividing cells, both healthy and cancerous. Within a few weeks of chemo, your hair may start to fall out. How much hair you lose will likely depend upon the type and dose of your medicine.

“Hair loss can cause body image issues in someone who is already overwhelmed by her cancer diagnosis and uncertainty over her prognosis,” says Dr. Gupta. “In addition, hair loss is a constant reminder to her and everyone around her that she has cancer.”

Cold caps and scalp cooling systems — which go on like a helmet — cool the scalp. “This causes the blood vessels to constrict so that the chemotherapy doesn’t go to the hair follicles and damage them,” says Kathleen Toomey, MD. Toomey is the medical director at Steeplechase Cancer Center and the Regional Director of Oncology Services for RWJBarnabas Health and Rutgers Cancer Institute of New Jersey. For the cap to be most effective, it needs to sit as close to the scalp as possible.

Cold caps can help many people with breast cancer keep some or most of their hair. However, if you’re Black and have curly or kinky hair, you may want to discuss these potential issues with your healthcare team:

To help the scalp to cool, hair should be wet before putting on the cold cap. But while this makes white or Asian hair lay flat, it does the opposite for Black hair: curls tend to bulk up and lift from the scalp. This can affect the cooling cap’s ability to penetrate the scalp. 

Another issue that may arise with Black women and cold caps is the type of hairstyle. Spreading hair evenly against your scalp is important to the cooling process. Some hairstyles, like braids or weaves, use hair extensions and can block parts of the scalp from the cold cap. 

Many studies have reported a 50 to 80% success rate for the FDA-approved Paxman cooling cap. Yet, few of these studies included Black people.

One study included 30 Black women with cancer. The women planned to get at least four chemotherapy cycles with cold caps. Unfortunately, the study closed early as researchers found that the cold caps were not very effective on Black women’s hair.

Researchers have been calling for more trials of cold caps to include women of color with kinky or curly hair. 

“Reducing barriers for successful [scalp cooling] treatment in Black women has the potential to increase the number of Black women choosing to undergo lifesaving [chemotherapy],” wrote the authors of a 2023 article in JAMA Oncology. The inclusion of diverse people with a variety of types of hair in clinical trials of scalp cooling can help researchers to better understand the different barriers to everyday use.

Here are suggestions for preparing your curly or textured hair for cold caps:

Avoid extensions, which can put additional strain on your hair follicles, during chemotherapy. Extensions can increase shedding and blocking the cap’s ability to penetrate the scalp. These include synthetic hair, such as braids, crochets, lace-front wigs, twists, and weaves. 

Apply heat to naturally straighten your hair. Then, use hair grease on the hair strands (not the scalp) to keep hair straight before wetting the scalp.

If you choose to chemically straighten your hair, treat the hair as the manufacturer recommends. With this hair type, it is OK to wet hair before treatment. However, some research suggests that chemical hair straighteners may increase the risk of breast cancer.

Section hair evenly across your crown to allow hair to stay as flat as possible during the scalp cooling process. 

If you have chemo-related hair loss, Dr. Toomey suggests finding resources for your hair type. “Women of color should also seek a facility that specializes in kinky/textured wigs as well as someone who works with make-up and hairstyles for women of color,” she adds.

“General principles for hairstyles following hair loss include keeping hair short, not combing too hard to decrease pulling of the hair, avoiding braids as it pulls on the hair, and no hair extensions,” Dr. Gupta says.