Hair Loss (Alopecia) from Chemotherapy

A side effect of some chemotherapy medications is hair loss (alopecia). This article answers questions about hair loss and offers tips for coping with this condition. Are you looking for information on Radiation therapy and hair loss?

Why does chemotherapy cause hair loss?

Chemotherapy attacks cells in our body that grow and multiply quickly, such as cancer cells. Some normal cells that also grow quickly, like hair cells, are also affected. The damage to these normal cells is what causes loss of hair.

Do all chemotherapies cause hair loss?

Many chemotherapy drugs do not affect your hair. Others cause mild hair thinning or total hair loss. Your care team can tell you if you will lose any hair. Scalp hair is the most often affected. Loss of eyelashes, eyebrows, facial hair, pubic hair, and body hair can also happen. How much hair you lose depends on the chemotherapy drug(s) and dose, how it is given, and other treatments.

When will the hair loss occur?

Hair loss often begins 2 weeks after your first treatment. Some people notice achiness or tingling of the scalp as the hair loss begins. If you lose all of your hair it may come out in big chunks and is usually done in 3-7days.

Is the hair loss permanent?

Your hair will often start to regrow after your treatment is done. Some people have a small amount of regrowth during treatment. Most people have significant hair re-growth 3-5 months after treatment is done. Your hair may grow back curlier and a slightly different color.

Can I apply cold caps to my scalp to decrease hair loss?

Talk to your provider about this option. Small studies have shown that products marketed as "cold caps" can reduce or prevent hair loss from chemotherapy in some patients. These work by decreasing the blood flow to the scalp, preventing the chemotherapy from affecting the hair follicles (where your hair is attached to your scalp). Some providers are concerned that this may also prevent the chemotherapy from reaching cancer cells that may be in the scalp area. 

How should I care for my hair while receiving chemotherapy?

If hair thinning is expected, you can do these things to lessen the damage to your hair:

• Use a soft bristle hairbrush.
• Use a gentle, pH-balanced shampoo.
• Avoid using hairdryers, hot rollers, or curling/flat irons too often.
• Avoid bleaching or coloring your hair.
• Avoid permanent waves.
• Avoid braiding or placing hair in a ponytail.
• Sleep on a satin pillowcase to decrease friction.
• If your hair is long, cutting it shorter may help lessen the impact of your hair loss when it occurs.
• Some people find it easier to deal with hair loss by shaving their heads before hair loss starts.
• Protect your head with a hat to prevent sun exposure on sunny days- and not just in the summer months! This is important for men who are less likely to wear a wig or turban/scarf.

Should I get a wig?

Each person reacts differently when learning that they may have partial or total hair loss. There is no right or wrong response. Do what's comfortable for you. If you choose to purchase a wig:

• Make an appointment with a wig stylist before the hair loss is expected so that the color, style, and texture of your hair can be matched to a wig. If hair loss begins before your appointment with the wig stylist, save some pieces of your hair and take them with you. Or you can choose to get a brand new style.
• Learn about the types of wigs:
  • Natural hair: Cost more and need more care.
  • Synthetic: Less expensive.

Can I get help paying for a wig for when I lose my hair from chemotherapy?

Some health insurance policies cover the cost of wigs. They are called "cranial hair replacement" or "cranial hair prosthesis.” You should contact your insurance company first to see if you have any coverage. You may need to ask your healthcare provider for a prescription to get reimbursement.

Secondly, the American Cancer Society in some areas can help cover some or all of the cost of a wig. You should also see if your oncology office has a copy of the  "TLC" catalog from the American Cancer Society. They offer affordable wigs, turbans, and head coverings.

Consider scarves, turbans, and hats.

They are cooler, can be more comfortable, and need less care than wigs. There are many attractive, stylish, and creative headcovers available.

Why am I so upset about my hair loss?

It is normal to be upset about hair loss from cancer treatment. It may affect how you feel about yourself. It is a reminder of your cancer. Share your feelings with your care team, family, and friends. There are many educational and supportive programs available.