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Treatment Tips

Dealing with Hair Loss During Cancer Treatments

One possible side effect of cancer treatments and one that is often feared by patients -- especially women -- is hair loss (or alopecia). Not every cancer treatment will cause hair loss. Your cancer care team will know if your specific treatment plan has a known side effect of hair loss.

Common questions that we hear from our patients include: 

Do all chemotherapies (or cancer treatments) cause hair loss?

It's most common with some chemotherapies but could also be experienced by taking certain cancer medications or having radiation therapy administered directly at your head.

Some, not all, chemotherapy drugs may cause hair loss. The type of chemotherapy treatment and doses prescribed will affect your chances of hair loss. Radiation therapy only causes hair loss in the area being treated. Hair loss typically starts 2-4 weeks after your treatments have started. You may experience thinning of the hair or complete hair loss. If you are receiving chemotherapy, you should ask your cancer care team whether or not the drugs you are receiving might cause hair loss.

Why do cancer treatments cause hair loss?

During some of these treatments, there can be damage done to healthy cells that help grow hair. Hair loss can affect different areas throughout the body including the head, face, arms, underarms, legs, and pubic area. Not all patients experience hair loss in the same way, even when they are undergoing the same kind of cancer treatment. For some, hair may slowly thin over time, but for others, it may come out more rapidly in clumps.

Fortunately, hair loss is usually temporary and will typically grow back after your cancer treatment is complete. However, it is not uncommon for the color and texture of the hair to be slightly different when it first begins to grow back.

Coping with Hair Loss

Each person responds differently when learning that they may experience partial or total hair loss. There is no right or wrong response. Talking with your cancer care team regarding hair loss may help you cope better with this side effect. It may also help to talk about your feelings with family and friends or even a counselor.

Wearing a Wig

One way you can gain some control over the situation is by wearing a wig or hairpiece. If you choose to do this, getting your wig prior to beginning cancer treatment makes it easier to match your natural hair color, style, and texture. When hair loss begins, it often progresses quickly and the wig stylist may have only your description of your hair and/or pictures as a guide. If hair loss begins before your appointment with your wig stylist, save some pieces of your hair and take them with you. If possible, have your wig or hairpiece fitted properly at the shop to avoid scalp irritation. You may also want to consider buying two wigs -- one for everyday wear and another for special occasions. Your cancer care team can direct you on where to find wig shops in your area. 

If a custom wig is too expensive, consider purchasing a less expensive, standard wig and having it professionally styled. Many wig salons offer this service, and the combined cost may be significantly less expensive than a custom wig. The Virginia chapter of the American Cancer Society and Cancer Action often have free wigs for patients. 

Be sure to ask your doctor or nurse practitioner/physician assistant for a prescription. Some insurance companies provide coverage for the purchase of wigs, but you'll need to check with your insurance company regarding coverage and limits. Keep in mind that the costs of wigs, scarves, false eyelashes, etc. needed due to cancer treatments are tax-deductible medical expenses. 

Other Options to Consider for Managing Hair Loss

For some patients, wearing hats, turbans, or scarves is a better alternative for them than wearing a wig. Some people even prefer to leave their head uncovered.

If wearing a wig isn't something that you want to do, some other steps you can take to manage hair loss during cancer treatments may include:

  • Cutting your hair shorter before beginning treatment. A shorter hairstyle can make hair loss look less dramatic when it starts. Some people choose to shave their head. (Remember: baldheads are in style!)
  • Treating your hair and scalp gently. Consider using a hairbrush with soft bristles or a wide-tooth comb. Styling tools, such as hair dryers, flat irons, and clips, as well as hair products with harsh chemicals, can be hard on your scalp. Wash your hair less often, with a mild, pH-balanced shampoo and pat it dry with a soft towel. If outdoors, protect your scalp with sunscreen, a hat, or a scarf. If your scalp feels itchy, treat it with a fragrance-free lotion. In cold weather, wear a hat or scarf to trap in body heat. 
  • Taking medications. Certain medications may be helpful to treat thinning hair or for hair that did not fully grow back after cancer treatment. These medications may include a topical medicine called minoxidil, or spironolactone (Aldactone) and finasteride (Propecia, Proscar), which are taken orally.
  • Trying cold cap therapy. Cooling the scalp (scalp hypothermia) with ice packs or cooling caps (cold caps) before, during, and after chemotherapy treatments may reduce hair loss. The theory behind this is that the cooling tightens up or constricts blood vessels in the scalp, reducing the amount of chemo that reaches hair follicle cells. The cold also decreases the activity of the cells, making them less attractive to chemotherapy, which targets cells that rapidly divide.
  • Silk or satin pillowcase. Pillowcases made of these fabrics are gentler on a balding scalp and can decrease hair tangles.

Hair often grows back within 2 to 6 months after treatment has ended. Some patients may notice that their hair is different than it was prior to cancer treatment (curlier, straighter, different color). In time, it may go back to how it was before. If you received a very high dose of radiation, your hair may grow back thinner or not at all on the part of your body that received the cancer treatment.

As your hair grows back after you complete your cancer treatments, continue to be gentle with it. Avoid too much brushing, curling, and blow drying. You may not want to wash your hair as frequently until it has fully returned.

Talk with your cancer care team if you have any additional questions regarding hair loss.