Hair loss, also called alopecia, could be a side effect of chemotherapy, targeted therapy, radiotherapy or stem / bone marrow transplants. These treatments can cause hair loss by damaging the cells that help the hair grow. Hair loss (and hair) can occur throughout the body, including the head, face, arms, legs, armpits and pubic area. Hair can fall out completely, slowly or in parts. A person's hair could also simply become thin and dull or dry out. Usually, hair loss related to cancer treatment is temporary. Most of the time, the hair will grow back. In a few cases, it could remain fine.
The management of side effects, such as hair loss, is an important aspect of cancer care and treatment. This is called palliative care or supportive care. Consult your health care team about controlling hair loss or how to cope with it from cancer treatment.
Causes of hair loss
The types of cancer treatments that could cause hair loss are listed below. Talk to your health care team before starting your cancer treatment to find out the chances of such treatment causing hair loss. Sometimes, there could be another reason for hair loss other than cancer treatment, such as thyroid problems or low iron levels.
Chemotherapy. Not all chemotherapies cause hair loss. The following drugs are more likely to cause hair loss or thinning:
- Altretamine (Hexalen)
- Carboplatin (Paraplatin)
- Cisplatin (Platinol)
- Cyclophosphamide (Neosar)
- Docetaxel (Taxotere)
- Doxorubicin (Adriamycin, Doxil)
- Epirubicin (Ellence)
- Fluorouracil (5-FU)
- Gemcabeno (Gemzar)
- Idarubicin (Idamycin)
- Ifosfamide (Ifex)
- Paclitaxel (multiple brands)
- Vincristine (Marqibo, Vincasar)
- Vinorelbine (Alocrest, Navelbine)
Hair does not usually fall out immediately after the start of chemotherapy. Most of the time, it begins to fall off after several weeks or cycles of treatment. Hair loss tends to increase between 1 and 2 months from the beginning of treatment.
The amount of hair that falls varies from person to person. Even in people who take the same drugs for the same cancer the amount of hair that falls out will be different. The amount of hair that falls out will depend on the drug and the dose. It also depends on whether you receive the drug as a tablet, intravenously or on the skin.
The hair begins to grow again about 1 to 3 months after the end of chemotherapy. In general, the hair takes between 6 and 12 months to grow back completely. When new hair grows back, the texture may be different from the previous texture. You may notice that hair grows back thinner or thicker. The color of hair that grew back may also be different from the previous one. The hair usually returns to its normal appearance after several years.
Radiotherapy. Radiation therapy only affects the hair that is where the radiation is directed. For example, if you receive radiation therapy in the pelvis, your hair will fall out in the pubic area. Hair loss depends on the dose and the method of radiotherapy. Usually the hair grows back in the area where radiotherapy was received after several months, but it may be thinner or have a different texture. With very high doses of radiation therapy, the hair may not grow again.
Targeted therapy Targeted therapy does not cause complete hair loss. Although the following targeted therapies may cause the hair to become thin, it will be routed or drier than normal.
- Afatinib (Gilotrif)
- Cetuximab (Erbitux)
- Dabrafenib (Tafinlar)
- Dasatinib (Sprycel)
- Erlotinib (Tarceva)
- Ibrutinib (Imbruvica)
- Imatinib (Gleevec, Glivec)
- Nilotinib (Tasigna)
- Panitumumab (Vectibix)
- Sonidegib (Odomzo)
- Sorafenib (Nexavar)
- Trametinib (Mekinist)
- Vemurafenib (Zelboraf)
- Vismodegib (Erivedge)
Hormone therapy. A small number of people receiving hormonal therapy will have their hair sharpened. It often begins between a few months to years after starting treatment with some types of hormonal therapy. But hormonal therapy generally does not cause complete hair loss. The following hormonal therapies are more likely to cause hair loss.
- Tamoxifen (Nolvadex)
- Anastrozole (Arimidex)
- Letrozole (Femara)
- Fulvestrant (Faslodex)
- Octreotide (Sandostatin)
Hair loss control
Learning to control hair loss before, during and after treatment can help you cope with this side effect. For many people, hair loss due to cancer treatment is more than just a change in physical appearance. Hair loss can be an emotional challenge that affects the image of yourself (in English) and your quality of life.
Talking about what you feel in relation to hair loss with a counselor (in English), someone who has a similar experience, a family member or a friend could give you peace of mind. In addition, it may be helpful to talk about the potential hair loss with family and friends, especially children, before it happens. For a child, knowing what changes will occur in the physical appearance of a person they know helps them reduce anxiety and fear.
Some people recommend cutting shorter hair before starting treatment. Wearing shorter hair can make your hair look more abundant. It can also make hair loss a less drastic change. And when the hair grows back, it takes less time to reach the previous length of the short style. Allowing the hair to grow in a similar style can help you cope with the treatment and move on after it.
Cooling cap therapy. Wearing a hat or something that covers the head and refreshes the scalp before, during or after chemotherapy can help prevent hair loss due to drugs administered by vein. This is also known as scalp cryotherapy. The cold narrows the blood vessels in the skin on the head. This decreases blood flow, which could mean that less amount of drug reaches the hair follicles. Hair follicles are the small holes through which hair grows. Because of this, hair follicles are less likely to be damaged by chemotherapy.
Talk to your health care team to learn more about this approach and if it could be helpful.
Medicines. An over-the-counter topical medication, called minoxidil, may be useful for treating hair thinning due to hormonal therapy or targeted therapy. It could also be useful for people whose hair did not grow back fully after chemotherapy, stem cell transplantation or radiation therapy. Occasionally, oral medications such as spironolactone (Aldactone) or finasteride (Propecia, Proscar) may also improve hair growth in these situations.
Hair and scalp care. The following recommendations may help you take care of your hair and scalp during cancer treatment:
- Use a mild, unscented shampoo to wash your hair.
- Consider not washing your hair every day and do not scrub vigorously.
- Pat the hair dry to prevent damage.
- Choose a soft brush or a comb with wide teeth and gently comb.
- Protect the scalp from the sun with sunscreen, hat or handkerchief when outdoors.
- Cover your head in the cold months to preserve body heat.
- Avoid using a hair dryer with very hot air or pulling hair.
- Avoid curling or straightening your hair with chemicals.
- Avoid using permanent or semi-permanent tinctures.
- Use a comfortable and soft cover for the bed pillow.
- Talk to your healthcare team before using any cream or lotion for hair growth.
- Talk to your healthcare team about taking vitamin B biotin.
Wigs and hairpieces. The following tips may be useful if you choose to wear a wig or hairpiece when your hair starts to fall out:
- Try to find a store that sells wigs and hairpieces designed specifically for people with cancer. You could also schedule an appointment at your home or request through a catalog.
- There are many types of wigs and hairpieces. If you want a wig or hairpiece that looks like your own hair, it is helpful to choose a wig or hairpiece before your hair falls out. In this way, the coincidence with your hair style and color will be greater. You may also want a wig or hairpiece with a new cut that you have always wanted to try. A hairdresser can help you comb the wig or hairpiece.
- Your health insurance company may cover wigs or hairpieces. Wigs and hairpieces can also be classified as tax-deductible medical expenses. The doctor may need to prescribe the use of a wig or hairpiece so that you can present the prescription at your insurance company. There may also be wigs or hairpieces on loan or free at the center where cancer is treated or in other community organizations. Consult resources with an oncology social worker (in English) or with the nursing staff.
- Make sure the wig or hairpiece fits well in the store. This will help prevent your scalp from getting irritated.
- Hair care that grows again. When the hair begins to grow again, it will be much thinner and will be damaged more easily than your original hair. It is also possible to grow back with a different texture or with a different color from your original hair. The following tips may be useful for caring for regrowth hair:
- Wash your hair only twice a week.
- Massage the scalp to remove scales and dry skin.
- Use a comb with wide teeth, instead of a brush, for hair. When combing, avoid picking up and holding the hair, curling it or using the hair dryer with very hot air.
- Avoid curling or straightening hair with chemicals, such as solutions for permanent waving, until the hair grows back. Some people may need to wait up to a year to curl or straighten their hair with chemicals. Before trying again with chemicals, try a small strand of hair to see how it reacts. You can also ask your hairdresser for suggestions.
- Avoid using permanent or semi-permanent dyes for at least 3 months after treatment.
