Dealing with Cancer Therapy Hair Loss

a hair brush with hair

Hair loss can be one of the most difficult side effects of cancer treatments to deal with for both women and men. Talk with your doctor or nurse about your treatment plan and whether it may cause hair loss.

Hair loss occurs because many cancer treatments affect cancer cells and normal cells. This includes the cells that make hair grow.

Hair loss from cancer treatment is most often not permanent. Hair loss may affect all the hair on your body. Hair grows back once therapy has been completed. The amount of hair loss depends on the cancer treatment, the dose of treatment, and how it is given. If your treatment affects the hair, your hair may start falling out between seven to 21 days after you start your treatment.

In radiation, only hair that is in the area of radiation will be affected by hair loss. Only if radiation is given to the head will one lose hair on the head. Radiation given to other parts of the body will not cause hair on the head to fall out. Very rarely with radiation there might be an area where the hair is permanently thinner.

Patients often ask if there is anything that can be done to prevent hair loss because of chemotherapy. Generally, nothing can stop hair loss if you are taking a drug that causes hair loss. However, not all chemotherapy drugs will cause hair loss. Some drugs may only cause a small amount of hair loss or thinning. Most of the time, hair loss because of chemotherapy is temporary and will grow back. The hair may grow back a different color or texture. This change may be temporary or permanent. Hair will start to grow once you finish treatment. It may take six to 12 months see the hair grow completely back.

Tips for Women and Men

To avoid making hair fall out faster:

  • Use a gentle shampoo and conditioner to lessen the pull on hair while combing. Try to stay away from shampoos with lots of chemicals that can dry out your scalp. Avoid shampoos and conditioners with strong fragrances, alcohol or salicylic acid.
  • Using or sleeping in hair curlers can pull on the hair and cause it to fall out quicker.
  • Try to avoid coloring, bleaching or perming your hair at this point--it could weaken it and make it fall out faster.
  • Lower your use of hair dryers, straightening irons and curling irons. Try air-drying your hair.

When hair is falling out:

  • Consider getting a shorter hair cut. Shorter hair is easier to manage under a wig. A shorter style will make your hair look thicker and fuller because it does not lay as flat against the head. It may also make your hair loss less upsetting.
  • Some people choose to shave their head once hair starts falling out. If so, do not use a razor. A razor may cause nicks and cuts, which may lead to infection.
  • Wear a hair net, soft cap or turban around your head at night to collect any loose hair.
  • Be aware that during the period of time you lose hair, the scalp may be tender or sensitive. Some people tell of having a tingling feeling of the scalp during hair loss.
  • If the eyebrows start to thin, try using a clear or colored brow gel. These can be found at any discount or department store. A brow pencil can also be used to fill in gaps. Another option is to use eyeglasses with heavy colored frames. You can find these with or without a prescription.

To lessen scalp irritation:

  • Use a soft hair brush to lessen scalp irritation and tugging on the hair shaft.
  • Permanent wave solution-for perms-may irritate the scalp and speed up hair falling out.
  • Use low heat when using a hair dryer to lessen dryness and irritation of the scalp.
  • Use a satin, polyester or cotton pillow case, rather than a nylon pillow case, which can cause irritation.
  • Wear sunscreen or make sure to cover the scalp with a hat at all times outside. Cloudy days can expose that tender skin to possible sunburns just as much as a sunny day.

Caring for new hair:

  • Shampoo only twice a week.
  • Thoroughly massage scalp to remove any scaly or dry skin.
  • Avoid high heat from hair dryers.
  • Keep hair styling to a low, as new hair is more likely to break.
  • Avoid vigorous brushing, hair pins, curlers and curling irons. Use wide tooth combs to style the hair.
  • Chemical curling is best avoided until hair is 3 inches long. Many people find permanent wave solution painful on their scalp for up to a year following chemotherapy or radiation.
  • Hair coloring can be irritating to the scalp. Permanent hair coloring is the most damaging to the hair shaft. Semi-permanent hair coloring products—those that wash away—may be less harsh to the hair shaft. Most experts say to wait six months after the last treatment before using any type of hair coloring products.

Wigs

Many people suggest buying a wig before you lose your hair. However, the wig may not fit as well when your hair is completely gone, if fitted while hair is still present. Shop for the wig while you still have hair if you would like to match the color of your hair, but have it fitted after the hair has been lost.

  • There are full service wig salons that fit and style wigs.
  • Wig salons also sell turbans and scarves that come in a variety of colors and fabrics so you can look good even when you are lounging at home or at bedtime.
  • The lining of a wig can sometimes irritate the scalp. It may be helpful to wear a thin cotton scarf or skull cap under the wig. These are usually available from wig suppliers.
  • It may be helpful to use double-sided tape to keep the wig in place. Some wigs may already have tabs in place that use the tape. Most wig salons will have a hypoallergenic tape for purchase.
  • Patients at University of Iowa Hospitals and Clinics who can not afford a wig should contact the Fourth Floor Salon. Staff of the Fourth Floor Salon are trained Look Good Feel Better consultants. To make an appointment at the Fourth Floor Salon, call 319-356-1996 or 6-1996 within the hospital. The Fourth Floor Salon is located in E424 General Hospital.
  • Look Good Feel Better is a free program that helps all cancer patients improve their appearance and self image by teaching hands on techniques to overcome appearance-related side effects of chemotherapy and radiation treatments. There are Look Good Feel Better sites located across the United States. Call 1-800-227-2345 to find a location near you.
  • The American Cancer Society (800-227-2345) and Cancer Care, Inc. (800-813-4673) are organizations that assist those with cancer therapy hair loss to obtain wigs at no cost.
  • Some insurance plans cover the cost of wigs. Check with your insurance company. You may need your doctor to write you a prescription for the insurance company to cover it.
  • If you buy a wig, save the receipt. It can be a medical tax deduction.

Drugs that usually cause hair loss

  • Cyclophosphamide (Cytoxan)
  • Daunorubicin
  • Docetaxel (Taxotere)
  • Doxorubicin (Adriamycin)
  • Epirubicin
  • Etoposide (VP-16)
  • Idarubicin
  • Ifosfamide
  • Irinotecan
  • Ixabepilone
  • Mechlorethamine
  • Paclitaxel (Taxol)
  • Paclitaxel protein bound (Abraxane)
  • Vinblastine (Velban)
  • Vincristine (Oncovin)

Drugs that may cause hair loss or thinning

  • Busulfan
  • Cytarabine (ARA-C)
  • Capecitabine (Xeloda)
  • Decitabine (Dacogen)
  • Doxorubicin liposomal (Doxil)
  • Fluorouracil (5-FU)
  • Gemcitabine (Gemzar)
  • Mitomycin
  • Mitoxantrone
  • Oxaliplatin
  • Pemetrexed (Alimta)
  • Temozolomide (Temodar)
  • Topotecan
  • Vinorelbine

Drugs that usually do not cause hair loss

  • Carmustine (BCNU)
  • Carboplatin
  • Cisplatin
  • Fludarabine
  • Procarbazine
  • 6-Mercaptopurine
  • Streptozotocin