Here is some guidance on haircare during scalp cooling which will help to ensure your hair is as easy as possible to manage and in the best possible condition, so that you can move forward when your chemotherapy is done. 

Don’t wash your hair more than twice a week or less than once every 10 days 

Keep in mind that a common side effect of chemo is a drying effect on your hair and scalp skin. Washing very frequently will strip the natural oils from your hair and contribute to and exacerbate dryness. For some people washing your hair less frequently may feel daunting, particularly if you are a daily washer. Your scalp adapts quickly, even if you are a daily washer and you shouldn’t find your hair to be too greasy once your treatment is in full swing. 
 
It is however important to keep washing your hair regularly, even if it’s once a week and especially if you are shedding heavily – keeping your hair and scalp clean and manageable is crucial, so do try to wash your hair at least once every 10 days. 
 
Washing also has the benefit of liberating hairs that are in the process of shedding. This can be scary, particularly if you are shedding quite a lot, but it’s really important to remember that washing will not cause hairs to fall out that weren’t already in the process of shedding. 
 
In conclusion, you know your hair best – be open minded and follow your instincts, you’ll find out what works for you. 

Use hypoallergenic and sulfate-free shampoo and conditioner 

It doesn’t matter which brand you use if it fits these criteria. Color and perfume are ingredients that can act as irritants, even if you were perfectly fine with them before you started treatment. Chemotherapy will most likely cause your scalp to become very sensitive and sometimes itchy, and your hair to become dry, so these ingredients are best avoided. Also avoid baby shampoo as it is very alkaline, and not gentle enough for a sensitive scalp. It’s often suggested as an option, but we know that it has caused people problems in the past. Try to avoid parabens too, as they are believed to disrupt hormone function by mimicking estrogen. 

Smooth shampoo and conditioner into your hair, don’t rub

Piling hair on top of your head and massaging in shampoo is all very well and good in commercials, but it’s a one-way street to tangled, matted hair while cold capping. Smooth shampoo and conditioner in and run your fingers through your hair but avoid the circular rubbing motions you may be used to.

Brush your hair everyday 

This may seem counterintuitive, especially if you are experiencing heavy shedding, but it is SO important to liberate any shedding hairs. Brushing gently morning and night will not pull out any hairs that weren’t already shed, but will ensure that loose strands, and hairs that are in the process of falling out will be removed, making it significantly less likely to tangle and even become matted. If you brush before you wash your hair, it can make washing easier too. 

Avoid heated styling tools 

Using straighteners, flat irons, curling wands or air wraps, can have a further drying effect on already dry hair, not to mention the tension that it can put on the roots of your hair. Heatless curls can also cause problems. It is fine to use your hairdryer on a cool setting but use your hands and fingers rather than a brush, again to avoid tension at the roots. 

Feel free to use headbands, clips, hats, and scarves 

Accessorize to your heart’s content! You can be creative to hide patchy baldness or thinning with whatever works for you, just avoid tension at the roots, so no tight ponytails, etc. For those with long hair, a braid or low bun can be a good solution, for those with shorter hair, pin back front sections of hair, or a soft headband can be great. 

Dry shampoo and colored root sprays are fine 

Always patch test first to be sure of no scalp sensitivity but using dry shampoo on type 1 or 2 hair if you are having a bad hair day, or colored fibers or root spray to cover patchy hair loss is completely fine. Use sparingly though to avoid build-up which can make your hair hard to wash. 

Wash your hair less frequently than normal 

Chemotherapy has a drying effect on your hair, scalp, and skin – you will probably quickly notice that your hair doesn’t require washing as often. Washing too frequently will strip your hair of the natural oils it needs. It is important to keep washing your hair regularly though, especially if you are shedding heavily – keeping your hair and scalp clean and manageable is important. Washing has the added benefit of liberating hairs that are in the process of shedding, which can be scary. But it’s really important to remember that washing will not cause hairs to fall out that weren’t already in the process of shedding. You know your hair best – be open minded and follow your instincts, you’ll find out what works for you.

Use hypoallergenic and sulfate-free shampoo and conditioner 

It doesn’t matter which brand you use if it fits these criteria. Color and perfume are ingredients that can act as irritants, even if you were perfectly fine with them before you started treatment. Chemotherapy will most likely cause your scalp to become very sensitive and sometimes itchy, and your hair to become dry, so these ingredients are best avoided. Also avoid baby shampoo as it is very alkaline, and not gentle enough for a sensitive scalp. It’s often suggested as an option, but we know that it has caused people problems in the past. Try to avoid parabens too, as they are believed to disrupt hormone function by mimicking estrogen. 

Smooth shampoo and conditioner into your hair, don’t rub

Piling hair on top of your head and massaging in shampoo is all very well and good in commercials, but it’s a one-way street to tangled, matted hair while cold capping. Smooth on shampoo and conditioner and run your fingers or a wide tooth comb through your hair to work the products in, or alternatively mix some shampoo with a little water and pour over your hair to get right into the scalp. Avoid the circular rubbing motions you may be used to at all costs.

Use plenty of conditioner and natural oils 

Chemo is going to really dry your hair out, so use plenty of conditioning products to keep your hair as manageable and healthy as possible. 

Use lots of conditioner when washing, and leave in/spray in conditioner whenever you feel you need it along with natural oils such as vitamin E, grape seed, or argan oil. Just avoid oils the day before your treatment as it will make it harder to wet your hair in preparation for the cap. 

Make sure your hair is wet before putting on your cold cap 

If you have high porosity hair, it can be difficult to keep it wet. You may need some help from a friend or assistant to prepare your hair for scalp cooling and to make sure that it hasn’t dried before the cap goes on. It may be that you need to use more water than someone with lower porosity hair, or that once you have conditioner in your hair, you keep topping up the water with a spray bottle before the cap goes on. 

Curls and brushing don’t usually mix, but it is really important while scalp cooling

The thought of brushing curly hair can be pretty horrible for anyone with a practised curly haircare method, but it is an essential part of looking after your hair while scalp cooling. Make sure that every day, ideally morning and night you are finger combing through your hair to remove shed hair. Not removing these hairs can cause, sometimes irreversible, tangling and matting. When you wash your hair, make sure that when you are at the conditioner stage you give it a thorough but gentle brushing with a wide tooth comb or wet detangling brush suitable for curls and coils. It’s also advisable every couple of days, to dampen your hair with an appropriate detangling or conditioning product and brush your hair. 
 
Brushing or finger combing gently but thoroughly will not pull out any hairs that weren’t already shed, but will ensure that loose strands, and hairs that are in the process of falling out will be removed. 

Avoid heated styling tools 

Using straighteners, flat irons, blow dryers, curling wands or air wraps can have a further drying effect on already dry hair, not to mention the tension that it can put on the roots of your hair. You can use a hairdryer with a diffuser on a low and cool setting. 

Use a scarf, loose headband or hat if you want to keep your hair away from your face 

They will keep your hair back without adding tension to your roots. A soft fabric headband or combs can also be great. Avoid clips, pins or tight ponytail bands as your hair is likely to tangle around them. 

Don’t use dry shampoo on type 3 and 4 hair, but colored root sprays are fine 

Dry shampoo will clog your follicles but colored root sprays are fine and can be a really simple way to hide roots or cover patchy hair loss. Always patch test first in case it causes problems with scalp sensitivity and use sparingly to avoid build-up which can make your hair hard to wash. 

No weaves or protective styling that cause root tension 

The additional tension on the roots of the hair caused by these styles can be detrimental to hair retention. Similarly, hair relaxing should be avoided too, firstly because the chemicals on a sensitive scalp should be completely avoided, but also because it will cause further drying to your hair. It is no problem to wear a wig if it makes you feel more comfortable, but make sure you use a method that will avoid additional tension or friction on the roots of your hair.

Well done for getting through chemotherapy and scalp cooling. Here are the things you need to be aware of now that you are on the other side of the scalp cooling process.

Shedding can continue for some time 

Don’t expect shedding to stop on the final day of your chemotherapy. It can take a while for the drugs to work their way out of your body, and many people will continue to shed for a number of weeks. If you are still seeing elevated levels of shedding 12 weeks after your final chemotherapy treatment, it might be worth speaking to your doctor, as additional factors (such as low haemoglobin/anaemia) can contribute to hair loss. 

Regrowth is stronger, faster and healthier with the cold cap 

By scalp cooling you have done everything you could to ensure the best possible regrowth. Depending on the drug regimen, some people may see regrowth before the end of their chemotherapy, for others it can take a little while. But it does come. There will be fluffy new hairs sprouting before you know it. It is completely normal to experience shedding and regrowth at the same time.

Losing brows and lashes post chemotherapy 

This is really common. They hold on throughout chemotherapy treatment and then when you’ve finally finished, they drop out. Nobody entirely knows why, but it is believed to be associated with the shorter growth cycle (around 100) days of lashes and brows. The good news is they tend to grow back quickly, just be aware that losing lashes and brows is a possibility.

Don’t make a snap decision and cut your hair off

Lots of people get through scalp cooling then feel like they can’t handle a combination of patchy hair loss, retained hair, and regrowth. But try to be patient for a little while before going for a style change you don’t really want. You’d be amazed how quickly hair can grow back in and what suddenly works as a style option again. For example, a bob may be possible rather than a pixie crop or some smart shaping by a hairdresser can keep your hair at a longer length. 

What’s normal shedding? 

After focusing on your hair so intensely, it can be easy to forget what ‘normal’ shedding looks like. The average healthy person will lose around 100 hairs a day. There may not be a lightning bolt moment where your suddenly realize your hair has returned to normal shedding, but you may get to a point where you just don’t notice it so much, which means you are probably back to normal shedding. 

Return to your normal haircare routine once shedding returns to a normal rate post-final chemotherapy 

Once you reach normal shedding you can go back to your normal haircare routine and introduce heated styling tools again. Just be gentle and go carefully, as your scalp may still be sensitive and the hair you have retained has gone through a lot. You should also be mindful that your hair may now be much drier and more fragile than it was before chemo, which may mean you need different products than those you used before. If your hair is really dry you should avoid straighteners and curling tongs until your hair is in better condition. It is also recommended to patch test any products you are introducing after chemotherapy as your skin and scalp may be sensitive to products, even those you used before treatment.

Retained hair is likely to be very dry 

It’s time to start focusing on improving the condition of your hair. Try masks, deep conditioning treatments, oils and products developed for dry and damaged hair. Give it some love! You may also see an improvement if you get a trim to remove any really damaged hair. Hang on in there, it will get better. 

Be careful when it comes to dyeing your hair 

A lot of people are desperate to get rid of roots or greys, but you may want to take your time. You certainly shouldn’t be dyeing your hair before shedding returns to normal and ideally you would be waiting another couple of months after that. If you do decide to take the plunge, please follow the advice of an experienced hairdresser who is familiar with your situation. They will be able to tell you if your hair is in good enough condition, and it is imperative that they patch test in advance.