Chemotherapy and hair loss: What to expect during treatment

You might not think about how important your hair is until you face losing it. And if you have cancer and are about to undergo chemotherapy, the chance of hair loss is very real. Both men and women report hair loss as one of the side effects they fear most after being diagnosed with cancer.

For many, hair loss is a symbol to the world that you have cancer. If you aren't comfortable sharing this information with others, you may fear this side effect more than other chemotherapy complications. Talking to your cancer care team about your concerns and preparing for the possibility of hair loss may help you cope with this difficult side effect of treatment.

Why does it occur?

Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body -- including those in your hair roots.

Chemotherapy may cause hair loss all over your body -- not just on your scalp. Sometimes your eyelash, eyebrow, armpit, pubic and other body hair also falls out. Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness.

Talk to your doctor or nurse about the medication you'll be taking. They can tell you what to expect.

Fortunately, most of the time hair loss from chemotherapy is temporary. You can expect to regrow your hair three to six months after your treatment ends, though your hair may temporarily be a different shade or texture.

What should you expect?

Hair usually begins falling out two to four weeks after you start treatment.

It could fall out very quickly in clumps or gradually. You'll likely notice accumulations of loose hair on your pillow, in your hairbrush or comb, or in your sink or shower drain. Your scalp may feel tender.

Your hair loss will continue throughout your treatment and up to a few weeks afterward. Whether your hair thins or you become completely bald will depend on your treatment.

People with cancer report hair loss as a distressing side effect of treatment. Each time you catch a glimpse of yourself in a mirror, your changed appearance is a reminder of your illness and everything you've experienced since your diagnosis.

When will your hair grow back?

It may take several weeks after treatment for your hair to recover and begin growing again.

When your hair starts to grow back, it will probably be slightly different from the hair you lost. But the difference is usually temporary.

Your new hair might have a different texture or color. It might be curlier than it was before, or it could be gray until the cells that control the pigment in your hair begin functioning again.

Can hair loss be prevented?

No treatment exists that can guarantee your hair won't fall out during or after chemotherapy. Several treatments have been investigated as possible ways to prevent hair loss, but none has been absolutely effective, including:

-- Scalp cooling caps (scalp hypothermia). During your chemotherapy infusions, a closely fitted cap that's cooled by chilled liquid can be placed on your head to slow blood flow to your scalp. This way, chemotherapy drugs are less likely to have an effect on your hair.

Studies of scalp cooling caps and other forms of scalp hypothermia have found they work somewhat in the majority of people who have tried them. However, the procedure also results in a very small risk of cancer recurring in your scalp, as this area doesn't receive the same dose of chemotherapy as the rest of your body. People undergoing scalp hypothermia report feeling uncomfortably cold and having headaches.

-- Minoxidil (Rogaine). Applying minoxidil -- a drug approved for hair loss -- to your scalp before and during chemotherapy isn't likely to prevent your hair loss, although some research shows it may speed up your hair regrowth. More research is needed to understand whether minoxidil is effective in regrowing hair after cancer treatment.

How to make the best of it

Your hair loss generally can't be prevented or controlled, but it can be managed. Take the following steps throughout your treatment to minimize the frustration and anxiety associated with hair loss.

Before treatment

-- Be gentle to your hair. Get in the habit of being kind to your hair. Don't bleach, color or perm your hair -- this can weaken it. Air-dry your hair as much as possible and avoid heating devices such as curling irons and hot rollers. Strengthening your hair now might make it more likely to stay in your head a little longer during treatment.

-- Consider cutting your hair. Short hair tends to look fuller than long hair. So as your hair falls out, it won't be as noticeable if you have short hair. Also, if you have long hair, going short might help you make a better transition to total hair loss.

-- 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 conceal your hair loss is up to you. But it's easier to plan for it now rather than later. Ask your doctor to write a prescription for a wig, the cost of which may be covered by your health insurance.

During treatment

-- Baby your remaining hair. Continue your gentle hair strategies throughout your chemotherapy treatment. Use a soft brush. Wash your hair only as often as necessary. Consider using a gentle shampoo.

-- 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. Shaving your head can reduce the irritation and save the embarrassment of shedding.

-- 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, so extreme cold or sunshine can easily irritate it. Having no hair or having less hair can make you feel cold, so a head covering may make you more comfortable.

After treatment

-- Continue gentle hair care. Your new hair growth will be especially fragile and vulnerable to the damage caused by styling products and heating devices. Hold off on coloring or bleaching your new hair until it grows stronger. Processing could damage your new hair and irritate your sensitive scalp.

-- Be patient. It's likely that your hair will come back slowly and that it might not look normal right away. But growth takes time, and it also takes time to repair the damage caused by your cancer treatment.

Covering your head

Covering your head as your hair falls out is a purely personal decision. For many people, hair is associated with personal identity and health, so they choose to maintain that look by wearing a wig. Others choose hats and scarves. Still others choose not to cover their heads at all.

Ask your doctor or a hospital social worker about resources in your area to help you find the best head covering for you.

Look Good Feel Better is a free program that provides hair and beauty makeovers and tips to women with cancer. These classes are offered throughout the United States and in several other countries. Many classes are offered through local chapters of the American Cancer Society.

Look Good Feel Better also offers classes and a website for teens with cancer, as well as a website and a guide with information for men with cancer.

Radiation therapy also can cause hair loss

Radiation therapy also attacks quickly growing cells in your body, but unlike chemotherapy, it affects only the specific area where treatment is concentrated. If you have radiation to your head, you'll likely lose the hair on your head.

Your hair usually begins growing back after your treatments end. But whether it grows back to its original thickness and fullness depends on your treatment. Different types of radiation and different doses will have different effects on your hair. Higher doses of radiation can cause permanent hair loss. Talk to your doctor about what dose you'll be receiving so that you'll know what to expect.

Radiation therapy also affects your skin. The treatment area is likely to be red and may look sunburned or tanned. If your radiation treatment is to your head, it's a good idea to cover your head with a protective hat or scarf because your skin will be sensitive to cold and sunlight. Wigs and other hairpieces might irritate your scalp.

Source: Mayo Clinic