Chemotherapy and Hair Loss
Hair loss is one of the side effects people fear most after a cancer diagnosis. It affects both men and women. Some cancer treatments such as chemotherapy can cause hair loss. Most cancer patients who receive chemotherapy will experience at least some hair loss during their treatment.
Why does chemotherapy cause hair loss?
Chemotherapy drugs target fast-growing cells in the body, but they cannot tell the difference between cancer cells and other cells in the body, such as cells found in hair follicles. This can result in hair loss. While chemotherapy-induced hair loss most often occurs at the scalp, it can affect other areas of the body as well. It is possible to lose your eyelashes, eyebrows, underarm hair, arm/leg hair and pubic hair.
Hair loss depends on the type of chemotherapy you receive as well as the dose and schedule of the chemotherapy. You may experience mild hair thinning or complete hair loss. Not all chemotherapy causes hair loss. To date, there has been no connection between the amount of hair loss or speed of hair regrowth with a patient’s race, ethnicity or hair type.
Ask your care team if your chemotherapy treatment will result in hair loss.
What to expect
Hair loss is usually temporary. Hair should regrow after chemotherapy treatment ends. It may fall out quickly or gradually. Hair loss from the scalp usually occurs first. This is followed by hair loss from other parts of the body. You may notice hair on your pillow or in the shower drain. It may come out in clumps when washing or brushing your hair. This can be distressing to see. It is normal for people to feel upset about losing their hair.
Your scalp may feel tender, sensitive, rough or itchy. You should use gentle hair products such as baby shampoos or products made for sensitive skin, as they tend to cause less irritation.
Hair loss from chemotherapy usually begins one to three weeks after starting treatment. For chemotherapy regimens that are given every two to three weeks, hair loss may start around the second or third week. Hair may be completely gone by the end of the second cycle of chemotherapy. If you are receiving weekly chemotherapy, hair loss may be slower and can start to grow back even while you are still on treatment. If you are receiving a high-dose chemotherapy regimen, such as the type given before a stem cell transplant, it is typical to lose hair quickly and you will likely experience complete hair loss.
Hair loss continues through treatment and even up to a few weeks after treatment ends. Hair regrowth usually starts about six to eight weeks after treatment is completed. You may notice some regrowth during treatment. The new hair may have a different texture or color. This is usually temporary. It is extremely rare for hair not to grow back.
Prevention and Treatment
Currently, there is no treatment that can fully prevent hair loss from chemotherapy. Scalp cooling, also known as scalp hypothermia, has shown some effectiveness with certain chemotherapy drugs. It may prevent some (but not all) hair loss during certain types of chemotherapy treatment.
Some people may consider supplements such as biotin, also known as vitamin B7. This is not recommended during treatment, since supplements may interact with your treatment. Discuss any supplements you may want to take with your care team.
Minoxidil (Rogaine)
Minoxidil (Rogaine) is a drug approved for hair loss. This drug is not likely to prevent hair loss if used before and during chemotherapy. It may speed up hair regrowth after chemotherapy, but data is currently limited, and more research is needed to understand if it is effective. If you are thinking of trying minoxidil, please discuss potential risks, benefits and limitations with your care team.
Scalp cooling
Scalp cooling may reduce hair loss by cooling the scalp using a cold cap before, during and after each chemotherapy treatment. There are several reasons this may work.
Cooling the scalp may constrict (tighten) blood vessels in the scalp and may reduce the amount of chemotherapy that reaches the cells in the hair follicles. The cooling may also reduce the activity of the hair follicles and make them less of a target to chemotherapy, which normally affects rapidly dividing cells. Therefore, this may reduce the effect of chemotherapy on the hair follicle and reduce hair loss from the scalp.
Some controlled studies of scalp cooling have shown its effectiveness. While there is more substantial evidence for scalp cooling in breast cancer patients receiving certain types of chemotherapy, it has also been successfully used in patients with other solid tumors who are receiving chemotherapy. However, there is no guarantee that scalp cooling will prevent hair loss. Most patients still experience some level of hair loss and hair thinning.
Scalp cooling effectiveness is partly related to the type of chemotherapy drug used and the dose of chemotherapy. It can also be affected by the fit of the cold cap and the thickness of your hair. The most common side effects of scalp cooling include headaches, cold intolerance, chills, lightheadedness, and scalp pain. There are unanswered questions about the safety of scalp cooling. Potential drawbacks include side effects mentioned above, the amount of time people must wear the cold cap, cost and effectiveness.
If you want to consider using scalp cooling during your chemotherapy treatment, please discuss the potential risks, benefits, and limitations of scalp cooling with your care team.
Coping with hair loss from chemotherapy
It is normal for people to feel upset about losing their hair. Hair loss can be an outward symbol to others that you have cancer and are undergoing treatment. Talking with your care team about your concerns and taking steps to prepare for the possibility of hair loss may be helpful. There are ways to help minimize the distress losing your hair during chemotherapy treatment causes.
Some people choose to cut their hair very short or even shave their head before hair starts falling out. If you choose to shave, use an electric razor to avoid cuts. Head coverings such as scarves, hats and wigs are also an option. Some people alternate wearing wigs and other head coverings such as scarves. You may also decide to buy multiple wigs. Additionally, some people choose not to cover their head after their hair falls out.
If you are considering a wig, it is best to buy it before or early in treatment. You can ask your care providers about local wig buying options, search online for local wig boutiques or ask a support group for recommendations. There are also some online retailers that sell wigs and other head coverings.
Wigs may be created from human hair or synthetic materials. Each type has different costs and requires different maintenance. When selecting a wig color, use natural light such as outdoor sunlight or light through a window to better match your hair color. Make sure your wig is adjustable as your head size may measure smaller when you lose your hair.
Need assistance?
Some insurance plans help cover the cost of wigs. Your care team can write a prescription for a wig to provide to your insurance company. Medicare Parts A and B do not cover the cost of a wig. If you cannot afford a wig, contact your social worker. There may be organizations that can help.
Quick tips for dealing with hair loss:
- Don’t bleach, color or perm your hair. These techniques can weaken hair follicles and strands.
- Avoid blow dryers, curling irons, straighteners and other styling tools that use heat.
- Consider cutting your hair short or shaving your head before starting treatment or once hair loss begins.
- Use head coverings such as wigs, scarves or hats.
- Make sure your headwear is not too tight or irritating to your scalp. Use mild shampoos and a soft hairbrush.
- Wash your hair only as needed instead of daily.
- Keep your scalp clean and moisturized to prevent skin problems.
- Protect your scalp from the sun with sunscreen and a head covering.
- Protect your scalp from the cold with a head covering such as a hat.
Hair loss after chemotherapy: 10 things to know
If you need chemotherapy as a part of your cancer treatment, you might have some concerns about losing your hair. But does every chemotherapy drug cause hair loss? And is there anything you can do to prevent this possible side effect?
We talked to Deepti Chopra, M.B.B.S., a body image specialist in our Psychiatric Oncology Center. Here’s what she wants patients to know.
What are the most common causes of hair loss during cancer treatment?
Most hair loss during cancer treatment is caused by chemotherapy. That’s because chemo targets rapidly growing cells, which damages hair follicles and makes the hair fall out. But radiation therapy can sometimes cause hair loss, too, when it’s used to treat head and neck cancers. It depends on the area that’s receiving radiation.
Do all chemotherapy drugs cause hair loss?
No. Not all chemotherapy drugs have hair loss as a possible side effect. Check with your care team to find out if it’s a potential side effect for the drugs you’ll be taking.
Will every patient who receives chemotherapy lose their hair?
No. Everyone has a different response. Some people might lose all of their body hair, while others experience only mild thinning.
How soon does hair loss usually appear after cancer treatment begins?
It generally becomes noticeable after about three weeks. Head hair usually goes first, followed by hair from other areas of the body. But again, everyone responds differently, so it could be sooner or later, depending on the individual.
Is there any way of preventing or minimizing hair loss caused by cancer treatment?
No, not really. Some patients try wearing cold caps, which reduces 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. But cold caps aren’t always very effective, and many patients still lose at least some of their hair anyway.
How long will it take my hair to start growing back?
Patients usually start seeing regrowth about six to eight weeks after they’re done with treatment.
Is there anything I can do to make my hair grow back more quickly?
I tend to shy away from supplement recommendations, because you don’t want to run the risk of anything you ingest having a negative interaction with the drugs you’re already taking to treat the cancer. This is particularly true for cancer patients who are still in active treatment.
That being said, once they get the green light from their care team, many patients consider a biotin supplement, also known as vitamin B-7.
What about natural oils or hair growth products?
It’s hard to say what products will help with hair regrowth. Good general nourishment and the avoidance of extra chemicals — such as minoxodil — may help the healing process. Applying extra chemicals like minoxidil to your body may make you feel even more uncomfortable while your hair is growing back.
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. I’d even consider using baby shampoos and cleansing products made for sensitive skin for a while, since they tend to be milder and cause less irritation.
What should I do if my hair grows back a different texture or color?
First, don’t panic. Everyone’s body chemistry is different, of course, but it’s unusual for changes like that to be permanent. It’s also pretty rare for hair to never grow back.
I would say to stay away from any products that chemically curl or straighten hair. We’d also never recommend dyeing or coloring it. But if you’re determined to do something, at least run it by your care team first, to make sure it won’t interfere with your treatment.
Is there anything else patients should know about cancer treatment and hair loss?
A lot of patients ask me if they should buy a wig. I tell them that’s certainly one option, but wigs can be expensive as well as hot, particularly here in Texas and especially during the summer months.
Protecting your skin from the sun with a head covering is important, but I can’t tell you the number of times patients have admitted to me that even after investing a bunch of time and money in getting a wig, they didn’t touch it once they had it. So, you might find scarves to be both a more comfortable and practical option. The most important thing is to figure out what works best for you.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Scalp cooling and chemotherapy hair loss: what to know
Hair loss is a side effect of cancer treatment that can be physically and emotionally challenging.
"When patients lose their hair from chemotherapy, it can be very traumatic for them,” says Susan Ferguson, clinical administrative director of MD Anderson’s Breast Center. “It can lower their self-esteem, how they feel about themselves, how they feel about their intimate relationships and how they see themselves. All of that lowers the quality of someone's life.”
Chemotherapy-related hair loss may also impact a patient’s work and family, adds Brenda Brown, executive director of MD Anderson’s Ambulatory Treatment and Clinical and Translational Research centers.
To help ease some of these impacts, MD Anderson offers a technology called scalp cooling which helps prevent chemotherapy-related hair loss in some patients.
Read on for answers to frequently asked questions about how scalp cooling works and which patients may benefit.
How does scalp cooling work?
Chemotherapy kills rapidly dividing cells in the body. While chemotherapy targets cancer cells, it also attacks other, non-cancerous cells in the body such as the ones in hair follicles. This is why hair loss can occur during cancer treatment.
That’s where scalp cooling comes in. While receiving chemotherapy, a patient wears a silicone cold cap over their hair. The cold cap is connected to a system that cools the scalp to between 64- and 72-degrees Fahrenheit.
“It reduces the blood flow to the hair follicles, so it makes the follicles less susceptible to damage from the chemo,” Ferguson explains.
Who is eligible for scalp cooling?
Patients who are interested in scalp cooling will work with their doctor to determine if scalp cooling is right for them.
Scalp cooling eligibility depends on factors such as:
- Cancer type
- Chemotherapy type
- Age
- Medical conditions
This year, MD Anderson began offering scalp cooling for patients with all types of solid tumors.
Scalp cooling isn’t the best choice for every patient, however.
For example, Brown says scalp cooling is not recommended for those who:
- Are under age 18
- Have skin cancers, such as melanoma, squamous cell carcinoma and Merkel cell carcinoma
- Have blood cancers, such as leukemia, lymphoma and non-Hodgkin lymphoma
- Have head and neck cancers
- Have squamous cell carcinoma of the lung or small cell lung cancer
- Have cancer that affects the central nervous system
- Had or may have scalp metastasis, or cancer that has spread to the scalp
- Have severe liver or kidney disease
- Have cold sensitivity, cold agglutinin disease or other conditions affected by cold temperatures
- Have or will have radiation therapy on the skull
- Will have bone marrow ablation chemotherapy
How effective is scalp cooling?
While scalp cooling can lessen the amount of hair loss during chemotherapy, it doesn’t prevent hair loss altogether.
Scalp cooling may reduce the amount of hair lost during chemotherapy by about 50%, Brown says.
However, there is no way to ensure that scalp cooling will prevent hair loss. Many factors can impact how well scalp cooling works for each patient. These include:
- Type and dose of chemotherapy
- How long a patient needs chemotherapy
- How long it takes the body to metabolize chemotherapy drugs
- Patient’s hair type
- Patient’s age and health
Scalp cooling is still a relatively new technology, with the first scalp cooling system receiving Food and Drug Administration (FDA) approval in 2015.
“It’s in the beginning stages of being studied,” Ferguson says. “The jury's still out for how effective it is in certain tumors.”
Are there any side effects of scalp cooling?
Scalp cooling can also have short-term side effects, Brown says. These include:
- Chills
- Headaches
- Dizziness
- Nausea
- Numbness
- Burning sensation
- Sinus pain
While Brown says these side effects are usually tolerable for patients, scalp cooling may be uncomfortable for patients who are sensitive to cold temperatures.
“I put it on my head for a few minutes,” she says. “It is very, very, very cold.”
Does insurance cover scalp cooling?
While each situation is unique, the FDA’s approval of scalp cooling systems means that insurance may cover scalp cooling in some cases. However, Ferguson notes that even if a patient is eligible for scalp cooling, it may not always be covered by insurance.
She recommends patients start by talking to their doctor to see if they are a candidate for scalp cooling. If so, the patient should reach out to their insurance company to see if scalp cooling is covered. Then, they can contact the clinic to move forward.
“We're encouraged that people who come through the Breast Center who want scalp cooling are having success with their insurance coverage, but there are plenty that aren't," she says.
Patients whose insurance doesn’t cover scalp cooling may consider paying for the service out of pocket.
What happens at an appointment?
Before they begin chemotherapy, patients who choose to use scalp cooling are fitted for a cooling cap that they bring with them to each appointment.
Patients who use scalp cooling should plan to spend longer at each chemotherapy appointment than those who don’t. This is because scalp cooling adds several additional steps to the chemotherapy process.
“It could add anywhere from one and a half to two hours to their appointment,” Brown says.
A typical chemotherapy appointment for a patient who chooses to undergo scalp cooling includes:
Hair preparation
Before each chemotherapy appointment, patients will wet their hair, apply conditioner and brush back their hair before they put on the cooling cap.
Pre-chemotherapy scalp cooling
During the pre-cooling process, patients spend at least 30 minutes connected to the cooling system before starting their chemotherapy.
Chemotherapy
Patients wear the scalp cooling cap and are connected to the scalp cooling system the entire time chemotherapy is infusing.
Post-chemotherapy scalp cooling
After chemotherapy is completed, patients continue scalp cooling for up to 90 more minutes.
Who should I talk to if I am interested in scalp cooling?
MD Anderson patients who are interested in scalp cooling should speak with their care team.
Providers can help patients determine if they are candidates for scalp cooling and whether it is right for them.
Request an appointment at MD Anderson online or call 1-877-632-6789.
How I dealt with permanent hair loss and other side effects
When I first lost my hair due to breast cancer treatment, I often heard people say, “Don’t worry. It’s only hair.” The implication was that it would grow back — eventually. But after a while, I began to notice that it was always the people with a full head of hair who said it. And I am one of the very small percentage of women whose hair didn’t grow back after chemotherapy. So, I am still bald to this day.
It doesn’t feel like “just hair” when you’re the only one who doesn’t have any — especially when you’re a woman, and you realize that yours is probably never going to grow back. But I’m OK with being bald now, three years after my breast cancer diagnosis. Because I am cancer-free, too, and that matters far more to me than having hair.
Most unexpected treatment side effect: permanent hair loss
At first, I couldn’t believe I had to give up both my right breast and my hair to be free of cancer. Because here I was, thinking at least I was going to get my hair back, and it turns out the regrowth I’d experienced after treatment was only due to the steroids I’d been taking. It was totally temporary.
I sat in my dermatologist’s office and cried when she told me.
It turns out I’d developed alopecia areata, a condition that makes hair fall out in patches. It can be caused by chemotherapy, but it’s usually reversible. I’ve tried a few things since then to get my hair to grow back, but nothing’s really worked. So, I’ve accepted the fact that I’m probably always going to be bald.
My worst side effect: nausea and vomiting
Permanent hair loss was obviously the most unexpected side effect of my breast cancer treatment. But the worst side effect I experienced was probably nausea and vomiting. Mine was so severe that I had to be hospitalized twice, just to be rehydrated.
The first round of chemotherapy containing doxorubicin, or “the red devil,” hit me really hard. The second round was even worse. I couldn’t keep food or water down, so I had to go to the MD Anderson Emergency Center.
You’d think that in light of that, I would run from the place today, instead of returning to MD Anderson regularly as a volunteer. But if I avoided every building where I’d ever felt bad, I’d have to sell my house. Because I was godawful sick in my home, and MD Anderson fixed me up.
Most pleasant surprise: acupuncture resolved my neuropathy
Another temporary side effect I experienced was neuropathy. For me, that meant pain in the tips of my fingers and toes.
I teach for a living, so I’ve got to be able to use my fingers to type, and I’ve got to be able to stand on my feet for three to five hours in a row to lecture. I simply cannot function professionally otherwise, so I was willing to do whatever it took to fix it.
I ended up going with acupuncture, through MD Anderson’s Integrative Medicine Center. Looking back, it’s kind of funny, because if you’d told me 10 years ago that one day I’d think letting people stick needles all over my body was good idea, I’d have said you were crazy.
But you change your mind about a lot of things when you have cancer. And sometimes, you’ll do anything to stop the pain and suffering.
I did acupuncture twice a week for six weeks. And the neuropathy not only got better — it went away completely. The trick was that we caught it early, when it was still mild. My acupuncturist said if I’d waited until it was more severe, I might have still had some residual pain. But I believe in making the right decision quickly. So, I jumped on it. And it worked for me.
The side effect I avoided and what I still deal with today
One side effect I managed to avoid completely was mouth sores. I’d heard about the horrors of those, so I rinsed my mouth out with a mixture of baking soda and water multiple times a day during chemotherapy. I still have boxes of baking soda left over. I use it to clean my house now.
The only side effects I still deal with today are joint pain from anastrozole, a type of hormone therapy, and sometimes leg cramps. But I made it through the roughest parts of my treatment, so I’m not worried about those.
My doctor told me recently that my follicles are still alive, so theoretically, they could still grow hair again someday. If they ever do, it’s going to have to happen spontaneously, because I’m done trying to force it. In the meantime, no wigs for me. I rock it bald.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
How to support a friend through hair loss
When a friend faces cancer, she will probably endure many experiences that are unique to cancer patients. The uniqueness of these experiences can make it difficult to know how to support her. One such experience is the hair loss caused by some chemotherapy treatments.
I know friends are eager to provide compassionate support when someone loses her hair. I’ve been the friend wanting to give support, and I’ve been the one staring at my shaved head in the mirror when I battled angiosarcoma in 2010. Here are some tips for loving your friend through the experience of hair loss.
1. Understand and empathize with her grief.
When I lost my hair, I was in the midst of a battle to see my 35th birthday. In a way, being bald was the least of my worries. But the grief I felt was still intense.
I struggled with my grief. It seemed superficial in light of all I was facing. And yet, the loss was real and painful. I needed friends to understand and acknowledge the loss and the emotions that accompanied it. You can support your friend through her hair loss by empathizing with her sadness, acknowledging the magnitude of her loss, and letting her know it’s OK to grieve.
2. Prepare yourself to respond with support when you see her.
Prior to her hair loss, your friend may not look sick. You probably haven’t been shocked by the sight of her.
But I know from experience that the first time you see a friend who has lost her hair, it is upsetting. It’s emotional for you, and it may feel intimidating for your friend. She may feel self-conscious and wonder how you will react.
During this first encounter, try to match your friend’s emotions. If she cries, cry with her. If she’s upbeat and wants to just act normally, smile and follow her lead.
If you have lost someone you care about to cancer, seeing your friend’s hair loss may bring up difficult memories. It’s important to prepare yourself emotionally so that when you see your friend, you are ready to respond with support and encouragement. Show her with your words and actions that you’re in this fight with her, no matter what.
3. Don’t say, “It will grow back!”
These words are meant to be encouraging, but it can feel to your friend as though you are minimizing what she’s going through. It’s true, once your friend finishes chemo, her hair will grow back. However, it may take several years for her hair to return to it’s pre-chemo length.
When her hair grows back, her curly hair may grow back in straight; her straight hair may come back curly. You don’t realize until you’ve been bald that it takes years for the hair growing from the top of your head to reach your shoulders.
So while it is true that her hair will grow back, she will be living with this visible reminder of her illness for a long time. And she needs you to acknowledge the pain of that reality.
Your support makes a difference
I hope these suggestions give you some ideas for how to support your friend through her hair loss. Ask questions and find out how your friend is feeling about this aspect of her cancer journey. Whether she’s showing off a colorful wig or weeping as she shaves her head, your friend will benefit from your compassion and care.