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.