Hair Loss/Alopecia

Last Modified: November 1, 2001

An OncoLink visitor asks about hair loss due to chemotherapy:  
Why does chemotherapy cause hair loss? Do all chemotherapy drugs cause hair loss? Which chemotherapy drugs cause hair loss? Is the hair loss permanent? What can I do if hair loss is expected with my chemotherapy treatment? How do I care for my wig?

Why does chemotherapy cause hair loss?

Chemotherapy kills both cancerous cells and other normal cells in your body. The normal cells in your body that are most at risk for being killed by chemotherapy are those that are growing at a fast rate. Because the cells responsible for hair growth are dividing at a rapid rate, they are sometimes destroyed by chemotherapy. Thinning of hair and, in some cases, complete hair loss may result.

Do all chemotherapy drugs cause hair loss?

No. In fact, many chemotherapy drugs have no effect of your hair. Many others cause only thinning of your hair, which is often not detected by many persons.

Which chemotherapy drugs cause hair loss?

Of the chemotherapy drugs commonly used to treat cancer, several are known to cause hair loss. It is important to keep in mind, however, that many factors such as the dose, route of administration, combination of drugs, and other individual characteristics will all impact on whether or not hair loss occurs as well as the degree of hair loss experienced. The chemotherapy drugs most often associated with hair loss are:

Adriamycin (doxorubicin), which often causes hair loss. When administered in as an injection every three to four weeks, hair loss is usually total including eyebrows, eyelashes and pubic hair. Weekly injections of lower doses are associated with minimal or no hair loss;

Carboplatin, which, when used alone rarely causes hair loss. When used in combination with Cytoxan (cyclophosphamide), hair loss occurs about half of the time;

Cisplatin, which may cause hair loss; however, this side effect is uncommon;

Cytoxan (cyclophosphamide), which commonly causes hair loss;

Dactinomycin, may cause hair loss which is not limited to the scalp;

Etoposide, which may cause mild hair loss in some patients, although some patients develop total baldness;

Hexamethamelamine (HMM, altretamine), which may cause hair loss; however, this side effect is uncommon;

Ifosfamide, which commonly causes hair loss;

Taxol, which causes hair loss in almost 100% of patients. Hair loss usually occurs 14 to 21 days after treatment and often affects all body hair including eyebrows, eyelashes, and pubic hair;

Vincristine, which causes hair loss in less than half of patients.

Other chemotherapy durgs which are less frequently associated with hair loss, either because the frequency of hair loss or degree of hair loss is less, include: bleomycin, 5-fluorouracil (5-FU), and methotrexate.

Is the hair loss permanent?

No, the hair loss caused by chemotherapy is temporary. In fact, even with total hair loss, regrowth of hair often may start after several cycles of chemotherapy and will continue even with additional treatments. When regrowth occurs, there may be changes in color and texture. It is common for hair to grow back curlier than it was; however, a change of color is uncommon.

What can I do if hair loss is expected with my chemotherapy treatment?

Each person responds differently to the information that they are going to experience partial or total hair loss. There is no right or wrong response. What's important is to do what you feel comfortable with, to do what is right for you.

Some options to consider include:

  • If you plan on purchasing a wig, make an appointment as soon as possible. It is much easier for a wig stylist to match the color and texture of your hair to a wig when your own hair is intact. When hair loss begins, it often progresses rapidly and the wig stylist may have only your description of your hair and/or pictures as a guide when trying to suggest a wig. If hair loss begins prior to your appointment with a wig stylist, save a sample of your hair and take it with you.
  • If a custom wig is too expensive, consider purchasing a less expensive wig and having it professionally styled. Most wig salons offer this service and the combined cost is significantly less expensive than a custom wig.
  • If your hair is longer, cutting it shorter may help to decrease the impact of your hair loss at the time it occurs.
  • In addition to or instead of buying a wig, consider scarves, turbans and hats to conceal hair loss.
  • Use a soft-bristle brush and a gentle, pH balanced shampoo.
  • Avoid the use of dryer, hot rollers, and curling irons because they may damage your hair and make hair loss more severe.
  • Do not bleach or color your hair, and do not get a permanent. All of these make your hair brittle and may cause your hair to fall out faster.
  • Sleep on a satin pillow case to decrease friction.
  • Buy false eyelashes

Some insurance companies provide coverage for the purchase of wigs. Check with your insurance company regarding coverage and limits. Keep in mind that the cost of wigs, scarves, false eyelashes, etc. are tax-deductible medical expenses.

How do I care for my wig?

Most wig salons will provide you with specific instructions on the care of your wig. Some things to do to maintain your wig include:

  • Only wash your wig with wig shampoo and cool water. Wig shampoo not only cleans the wig, but it also conditions it which helps to maintain its shine, curl pattern and elastic.

    • DO NOT wash your wig in Woolite or in a conditioning or cream shampoo
    • DO NOT scrub or rub your wig - just swish it repeatedly in the sudsy water
    • If there is a build-up of makeup on the inside of your wig, rub it gently with a terry cloth to remove

  • Dry your wig properly for the best look and longer wear

    • lay your wig on a clean towel and pat out the excess water
    • spray your wig lightly with a wig conditioner and fluff to distribute it all through your wig
    • turn your wig wrong-side out. This will prevent the water from collecting on the ends and causing the curl pattern to straighten

  • After your wig is completely dry, use a wire brush or pick and light, short strokes to fluff you wig

  • Use only specially formulated wig hair spray for styling. Regular hair spray will leave a white film on the fiber that will not wash out properly.

  • When not wearing your wig, DO NOT place it on a Styrofoam head because they tend to stretch the elastic band on your wig, altering the fit. In addition, Styrofoam heads absorb perspiration odors. Instead, your can purchase a special wig stand, or simple place it over a tall bottle. Either will not stretch the elastic and will allow for airing of your wig between wearing.

From the National Cancer Institute