Hair loss is one of the most well-known and often distressing side effects of cancer treatment. While not everyone undergoing cancer treatment experiences hair loss, it is a common concern that can significantly impact a person's self-esteem and overall well-being. This article provides information about the causes of cancer-related hair loss, ways to manage it, and coping strategies to help individuals navigate this challenging experience.
Certain cancer treatments can lead to hair loss, also known as alopecia. The extent and nature of hair loss vary depending on the type of treatment, dosage, and individual factors. It is important to understand how treatment could affect your hair.
Chemotherapy drugs work by targeting rapidly dividing cells, which is a characteristic of cancer cells. Unfortunately, this process also affects other fast-growing cells in the body, including those in hair follicles. Chemotherapy can cause your hair to fall out, but not all chemotherapy drugs make your hair fall out. This hair loss doesn’t just affect the hair on your head (scalp). Some chemotherapy drugs can make other hair from your body fall out, such as facial hair and pubic hair.
The likelihood of hair loss with chemotherapy depends on the specific drugs used, the dosage, and the frequency of treatment. For most people, low-dose chemo, oral (pill) chemo, and IV chemo given every week are less likely to cause hair loss compared to high or moderate doses and IV chemo given every three weeks. Many chemo regimens are given every 2 to 3 weeks. Whether or not your hair will grow back after chemo depends largely on how much damage was done to the hair follicle.
Hair loss due to chemotherapy typically begins within 2 to 3 weeks of starting treatment. The hair on your head may come out in clumps. You'll likely notice hair on your pillow, in your hairbrush or comb, or in your sink or shower drain. It could fall out very quickly in clumps or gradually. Hair loss typically continues throughout treatment and up to a few weeks afterward. Complete hair loss can happen gradually. Hair loss or thinning can also affect your eyelashes, eyebrows and other body hair.
Read also: Lasting Hair Graft Results
Radiotherapy, also known as radiation therapy, can also cause hair loss, but only in the area being treated. If you are having radiotherapy to your head, you’ll probably lose hair from your scalp. You might also have some hair loss on the opposite side of the head, where the radiotherapy beams pass through. Hair does not always grow back after radiotherapy. Hair re-growth after radiotherapy depends on the type and number of treatments you had, and the area of the body that was affected. If your hair grows back, it usually starts 3 to 6 months after treatment. Sometimes hair loss can be permanent.
Whether or not your hair grows back depends on the type of radiotherapy you're having. For example, if you're having whole brain radiotherapy to treat your symptoms it's likely that your hair will grow back. It might take more than 6 months after radiotherapy for your hair to grow back.
Immunotherapy and targeted drug therapy can also cause hair loss, but it happens less often than with chemotherapy. If it does happen, it’s more likely to be incomplete (partial) hair loss or hair thinning than total hair loss.
Certain types of hormone therapy for cancer can cause hair loss or thinning. But hormone therapy in general is more likely to cause thinning rather than total hair loss. The hormone therapies most likely to cause hair loss or thinning are tamoxifen and other aromatase inhibitors (such as Arimidex or Aromasin). About 1 in 4 people taking hormone therapy for cancer develop hair loss or thinning.
A type of targeted cancer drug called epidermal growth factor receptor (EGFR) inhibitors can cause permanent hair loss. Instead of hair loss, some targeted cancer drugs cause hair growth in unexpected areas of the body.
Read also: Managing Chemo Hair Loss
Graft-versus-host-disease (GVHD) is a complication that can happen after transplant which can also lead to hair loss.
While there is no guaranteed way to prevent hair loss during cancer treatment, several strategies can help manage it and minimize its impact.
Scalp cooling is a technique that can reduce hair loss caused by chemotherapy. It works by reducing the amount of chemotherapy drugs reaching the hair follicles. You will need to keep your head cold before, during and after treatment. The cold helps slow blood flow to your scalp.
There are different types of scalp cooling: cold cap and refrigerated cooling system. You can ask your doctor or nurse if your hospital has scalp cooling and which type they use. You might feel cold during your treatment, but the chemotherapy staff will try to make you as comfortable as possible. Your nurse might ask you to dampen or wet your hair before you put on the cap or cooling system. This is to improve contact between the scalp and cap and lower the temperature of the skin on your scalp.
Scalp cooling is not suitable for everyone. You would not have scalp cooling with continuous chemotherapy through a pump or with chemotherapy tablets. Scalp cooling only blocks certain chemotherapy drugs and doesn't work for everyone. So you might still have hair thinning, or lose your hair completely. Your doctor might not suggest scalp cooling if they are worried about the risk of cancer cells being left on the scalp. Research suggests that scalp cooling with Afro Caribbean hair is not as successful. Using scalp hypothermia also results in a very small risk of cancer happening in your scalp. This is because this area doesn't get the same dose of chemotherapy as the rest of your body.
Read also: Managing Hair Loss from Chemo
If you don’t lose all your hair, but it thins or becomes dry or brittle, it’s important to treat your hair carefully. Be gentle to your hair. Get in the habit of being kind to your hair. Wash your hair two times a week or less. Use gentle shampoo and conditioner. Pat your hair dry with a towel. Avoid rubbing or pulling. Avoid products with strong chemicals. This includes permanents and hair colors. Put away things that will put stress on your hair. This includes curling irons and brush rollers. If you blow-dry your hair, put the setting at cool or warm, not hot.
Many people decide to prepare themselves for losing their hair by cutting it short. Losing smaller clumps of hair can be easier to cope with than losing longer clumps. It can also give your family and friends the chance to get used to seeing you with less hair. If you want a hairdresser or barber to cut your hair, you can ask your own. There are also places that specialise in styling hair for people affected by cancer.
Some people choose to shave their heads completely before they start losing their hair. If your hair is long enough, you may wish to donate it to the Little Princess Trust. If you do want to remove all your hair, use clippers. If you have never used clippers before, talk to a hairdresser or barber first. Remove most of your hair with scissors first. Then use a set of clippers with a cutting guard or attachment to prevent cuts. Some clippers have a power cord, and some are cordless. The head of the clippers may swivel or be fixed in place. It is easier to use clippers on clean, dry hair with no products in it. Make sure you feel comfortable using the clippers before you start. Leave a very short layer of hair.
Your scalp will be more sensitive to cold, windy or sunny weather. There are different options for keeping your head warm or protected. Wear soft material next to your skin. On sunny days, remember to protect your scalp with a hat, scarf, and sunblock. In cold weather, do not forget a hat or head scarf to keep you warm. If your head is going to be exposed to the sun or to cold air, protect it with sunscreen or a head covering. Your scalp may be sensitive as you go through treatment. This means extreme cold or sunshine can easily irritate it. Having no hair or having less hair can make you feel cold.
Avoid using deodorants, soaps, perfumes and lotions if you’re having radiotherapy.
Hair loss can be a devastating experience, serving as a constant reminder of cancer and its treatment. It can impact self-esteem, body image, and social interactions. It is important to acknowledge these feelings and find healthy ways to cope.
There are many ways to cover up hair loss. Some hats, headbands or bandanas have optional fringe or hair attachments. You may want to wear a head covering while your hair is falling out.
If you think you would like to wear a wig, it is a good idea to get one before you start treatment. You may feel that everyone will notice that you are wearing a wig. But wigs are often very good and can be cut and styled so people may not realise. You will probably not want to wear a wig all the time.
Wig options: If you think you will want to have a wig, go to the salon before your hair falls out so they can set you up with a wig that matches your hair color. Your provider may have names of salons that make wigs for people with cancer. Try different wig styles to decide what you like best. If you want, you can also try a different hair color. The stylist can help you find a color that looks good with your skin tone. Find out if the cost of the wig is covered by your insurance.
Scarves, hats, and turbans are comfortable options.
Some people may feel uncomfortable and be unsure what to say. It can help to talk to people about it before you lose your hair. This can help them know how you feel and how they can help support you. You may find it helpful to talk to your hairdresser or barber. They may have clients who have lost their hair due to cancer treatment. They may be able to offer advice and support.
If you have children, you may worry that they will be scared if they see you without hair. Cancer Hair Care has dolls in a variety of skin tones to help explain hair loss to children. You may find it helpful to talk to other people who have, or have had, hair loss.
Think ahead about how much you want to tell people. If someone asks questions you do not want to answer, you have the right to cut the conversation short. You might say, "This is a hard subject for me to talk about."
You can also contact Macmillan for free on 0808 808 00 00 and talk to a cancer support specialist. A cancer support group might help you feel less alone knowing that other people are going through this too.
Look Good Feel Better is a free program that provides hair and beauty makeovers and tips to women with cancer. These classes are offered throughout the United States and in several other countries.
It may take a while to adjust to not having hair. Lost hair may be the most visible sign of your cancer treatment. If you feel self-conscious about going out in public, ask a close friend or family member to go with you the first few times.
Hair usually grows back after chemotherapy. It may be curlier, finer or a different colour. You might find that it grows unevenly or in patches. Hair re-growth after radiotherapy depends on the type and number of treatments you had, and the area of the body that was affected. If your hair grows back, it usually starts 3 to 6 months after treatment. Sometimes hair loss can be permanent.
Hair often grows back 2 to 3 months after your last chemo or radiation treatment. It may grow back a different color. It may grow back curly instead of straight. Over time, your hair may go back to the way it was before.
When your hair starts to grow back, be gentle with it so it can get strong again. Consider a short style that is easy to care for. Your new hair growth will be especially fragile. It may be more easily damaged by styling products and heating devices. Hold off on coloring, relaxing or bleaching your new hair until it grows stronger. Try to be patient. It's likely that your hair will come back slowly and that it might not look the same right away. But growth takes time.
Good general nourishment and the avoidance of extra chemicals - such as minoxodil - may help the healing process. Both chemotherapy itself and the hair loss it causes can make your scalp feel rough and itchy, too. So, anything you can do to use fewer chemicals there would probably be prudent. First, don’t panic. Everyone’s body chemistry is different, of course, but it’s unusual for changes like that to be permanent. I would say to stay away from any products that chemically curl or straighten hair. We’d also never recommend dyeing or coloring it.
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