Chemotherapy, a cornerstone in cancer treatment, often brings concerns about hair loss. This comprehensive article addresses common questions and provides a timeline of what to expect before, during, and after chemotherapy concerning hair loss.
Most hair loss during cancer treatment is caused by chemotherapy because chemo targets rapidly growing cells, damaging hair follicles and causing hair to fall out. Radiation therapy, when used to treat head and neck cancers, can also cause hair loss.
It's important to note that not all chemotherapy drugs list hair loss as a side effect. The likelihood and degree of hair loss depend on the specific drugs, dosages, and individual patient factors.
Everyone responds differently to chemotherapy. Some may experience complete hair loss, while others may only notice thinning. The extent of hair loss depends on factors such as the type, combination, and dose of chemotherapy medicines, other medical conditions (such as thyroid disease), nutrition status, and stress. The timing of chemotherapy treatments also affects hair loss. Some types of chemotherapy are given weekly and in small doses, which may minimize hair loss. Other types of chemotherapy are scheduled every three to four weeks in higher doses and may be more likely to cause more hair loss.
Hair loss generally becomes noticeable about three weeks after starting chemotherapy. Head hair usually goes first, followed by hair from other areas of the body.
Read also: Lasting Hair Graft Results
Some patients try wearing cold caps, which reduce blood flow to the scalp. The idea is to slow down the circulation there during an infusion, so the hair follicles won’t be exposed to as much chemotherapy. Scalp hypothermia involves using closely fitted caps cooled by chilled liquid during chemotherapy infusions to slow blood flow to the scalp.
Cold caps and scalp cooling systems are tightly fitting hat-like devices filled with a cold gel or liquid coolant. Cold caps and scalp cooling systems have helped many people keep some or quite a bit of their hair during chemotherapy. People who have curly or textured hair may want to take extra steps to improve the likelihood that scalp cooling will be effective for them.
Minoxidil (Rogaine) is a medicine used for hair loss. Applying minoxidil to your scalp before and during chemotherapy isn't likely to prevent hair loss. However, some research shows that it may speed up your hair regrowth.
Be gentle to your hair. Get in the habit of being kind to your hair. Don't bleach, color, relax or perm your hair. This can weaken it. Air-dry your hair as much as possible. Try to avoid heating devices such as curling irons and hot rollers. Consider cutting your hair. Short hair tends to look fuller than long hair. As your hair falls out, it won't be as noticeable if you have short hair.
Plan for a head covering. Now is the time to start thinking about wigs, scarves or other head coverings. Whether you choose to wear a head covering to hide your hair loss is up to you. But it's easier to plan for it now rather than later. Ask your healthcare professional to write a prescription for a wig.
Read also: Managing Hair Loss from Chemo
Baby your remaining hair. Continue your gentle hair routine throughout your chemotherapy treatment. Use a soft brush. Wash your hair only as often as necessary. Consider shaving your head. Some people report that their scalps feel itchy, sensitive and irritated during their treatments and while their hair is falling out. Protect your scalp. 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.
It's essential to address the emotional impact of hair loss. Finding support through friends, family, mental health professionals, or cancer support groups can be invaluable.
Many people find that wearing a wig is a good solution for them if they experience hair loss from breast cancer treatment. A wig can provide a sense of normalcy, consistency, and privacy during cancer treatment. Experimenting with different wig styles and colors can also be quite fun!
Many people find that scarves, hats, and turbans are the easiest, most comfortable, and versatile solutions for managing hair loss from breast cancer treatment. They can hide your hair loss, help keep you warm, protect you from the sun, and they can be stylish and fun to wear.
If you've lost your hair from chemotherapy, or it’s just starting to grow back, the most important thing during the summer is to protect the skin on your head from the sun. Beyond that, do whatever is most comfortable for you in the heat of summer. Read more tips about dealing with hair loss during the summertime.
Read also: Does Ozempic Cause Hair Loss?
Both chemotherapy itself and the hair loss it causes can make your scalp feel rough and itchy. Using fewer chemicals may be prudent.
How long it takes for the hair on your head to grow back after chemotherapy (and other body hair, such as pubic hair, eyelashes, and eyebrows if you lost those, too) varies a lot from person to person.
Here's a typical timetable for hair regrowth on the head:
After the last treatment, it takes time for chemotherapy drugs to leave the body altogether and stop attacking healthy dividing cells. Therefore, the hair does not start to grow back immediately.
Most people undergoing chemotherapy will begin seeing some thin, fuzzy hair a few weeks after their last treatment. Real hair may start to grow properly within 4 to 6 weeks.
The following timeline indicates what most people can expect to happen after chemotherapy:
It can take several years for hair to return to its previous style, particularly for people who once had very long hair.
A 2019 study involved 1,470 people who underwent chemotherapy as part of their breast cancer treatment. A survey of the participants revealed that:
The hair on your head may be a different color, texture, or volume when it grows back. If you were dyeing or chemically treating your hair before you started chemotherapy, you might be surprised to see what your natural hair looks like when it grows back.
In many cases, hair eventually returns to the way it used to be after the effect of chemotherapy on the hair follicle wears off. But some people have incomplete hair regrowth. Sometimes permanent baldness and loss of eyebrows and eyelashes can occur, particularly in people who received Taxotere.
After chemotherapy, hair initially regrows as thin fuzz. It may stick straight up or be difficult to style. Very fine hair may also not be visible from a distance.
Some hair follicles may enter the active growth period before others. When this happens, the length of hairs can vary, which may make the hair look patchy overall. It will likely also be more difficult to style. Over time, the hair should settle into a more regular growth pattern. However, its texture might be different than before the treatment.
Some people talk about “chemo curls,” which occur when the hair grows back curlier, more brittle, or less manageable than before. In some cases, the hair may also grow back a different color.
The 2019 study previously mentioned discovered that:
Doctors still do not fully understand why hair texture sometimes changes after chemotherapy. It could be that the treatment damages hair follicles or affects the genes that control hair growth.
People can take certain steps to keep their hair healthy as it regrows:
Some drugs encourage hair regrowth after chemotherapy, but the results vary. Most hair regrowth drugs aim to treat hair loss from causes other than chemotherapy.
Doctors may, for example, recommend Rogaine for people who have had tamoxifen therapy for breast cancer. However, it can be messy and expensive. Pharmacies usually offer other forms of minoxidil that are cheaper.
A person should discuss the risks and benefits of hair regrowth treatments with their doctor before using them.
Research suggests that Minoxidil (Rogaine) is effective in helping hair grow after chemo.
They are exploring other therapies, such as platelet-rich plasma, Spironolactone, and photobiomodulation. However, more studies need to be conducted to confirm their effectiveness in helping hair growth.
Some hormonal therapies used to treat breast cancer can cause mild to moderate hair loss, or hair thinning, often at the frontal hairline, the middle part, or the crown of the head. These medicines include:
Hormonal therapies work either by lowering estrogen levels or by blocking the effects of estrogen in breast tissue. Researchers don’t know exactly why hormonal therapies cause hair loss. But experts say one of the reasons is that lowering estrogen levels reduces the growth of hair follicles.
If you experience hair loss as a side effect of hormonal therapy, it may take between six months and two years before the hair loss is significant enough for you to notice it. Often the hair loss will level off after the first year or so. But the thinning will last as long as you keep taking the medicine, which is often from five to 10 years. Hair will usually start growing back a few months after you stop taking hormonal therapy.
Some targeted therapies that are used to treat breast cancer can cause changes to the texture and color of your hair, or hair loss that is usually mild. These include:
If you experience some hair loss, it is likely to start soon after you start taking the targeted therapy. Your hair probably won’t start growing back until several months after you stop taking the medicine. Taking an aromatase inhibitor (Arimidex, Aromasin, or Femara) and certain targeted therapies at the same time increases the risk that you’ll develop hair loss.
Immunotherapy generally doesn’t cause hair loss, but hair loss has occurred in a small percentage of the people who take the immunotherapy Tecentriq (chemical name: atezolizumab).
Radiation therapy uses a high-energy beam to damage quickly growing cells in your body. The goal is to target cancer cells, but some normal cells (including those of the hair follicles) get damaged as well.
Radiation only causes hair loss on the particular part of the body treated. If radiation is used to treat the breast, there is no hair loss on your head. But there might be loss of hair around the nipple, if you have hair there.
Radiation to the brain, used to treat breast cancer that has spread (metastasized) to the brain, can cause hair loss on your head. Depending on the dose of radiation, your hair may be patchier when it grows back or it may not grow back.
Breast cancer treatments such as hormonal therapy, targeted therapy, and chemotherapy can cause some people to have ongoing mild to moderate hair loss. If you’re concerned that your hair isn’t growing back or is noticeably thinner than in the past, it’s a good idea to see a dermatologist. If possible, seek out one who specializes in hair loss or an onco-dermatologist who focuses on problems with the hair, skin, and nails that can develop during cancer treatment. The dermatologist will order blood tests to check whether there are other reasons for your hair loss besides the effects of breast cancer treatments.
For mild to moderate hair loss, dermatologists often recommend Rogaine (chemical name: minoxidil), an over-the-counter medication that promotes hair growth. It’s safe for people with a history of breast cancer and moderately effective. But check with your oncologist before you start using minoxidil. In most cases, you can use it while you take hormonal therapy or targeted therapy, but not during chemotherapy treatment. Look for products labeled “5% minoxidil foam” (generic versions are fine) that you apply to your scalp when your hair and scalp are dry. It’s ok for women to use minoxidil products labeled for men. Minoxidil is thought to stimulate hair growth by improving blood flow in the scalp and prolonging the growth phase of each hair follicle.
Some dermatologists may recommend certain nutritional supplements to help speed up hair growth, such as Nutrafol and Viviscal Hair Growth supplements. Always check with your oncologist before you start taking a nutritional supplement. Biotin supplements should be avoided because they can cause you to have incorrect results from lab tests, such as cardiovascular diagnostic tests and hormone tests.
Some of the other products you might want to try for mild to moderate hair loss include:
Eileen Posner, a cancer survivor who lost all her hair to chemotherapy, kept a year-long photo diary showing her changing appearance as she went through recovery.
A 41-year-old mother of two, Posner had long, flowing locks before she was diagnosed with aggressive breast cancer. She went bald as a result of her life-saving chemotherapy treatment.
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