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Hair Loss (Alopecia)


This section has been reviewed and approved by the PLWC Editorial Board, 02/05

A potential side effect of radiation therapy and chemotherapy is hair loss (alopecia). Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin—sometimes unnoticeably—and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience, and can affect a person's self-image and quality of life. However, the hair loss is usually temporary, and the hair grows back.

Causes

Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth.

Chemotherapy. Not all chemotherapy causes hair loss. (A doctor can provide more information regarding which drugs are most likely to cause hair loss.) When hair loss does occur, it is usually not immediate, and the amount of hair loss varies from person to person, even among those taking the same medication. Hair loss most often starts after the first several weeks or rounds of chemotherapy treatment and tends to increase one to two months into treatment. The amount of hair loss depends on the type of drug, dose, and how the drug was given (orally, intravenously, or topically). Hair regrowth following chemotherapy usually occurs one to three months after maintenance treatment starts or intensive chemotherapy ends.

Radiation therapy. Radiation therapy only affects the portions of hair that are in the field of radiation. Hair loss depends on the dose and method of radiation treatment. When very high doses of radiation are used to treat cancer, the hair may become permanently lost or thinned in the treated area. If regrowth does occur, patients may find the regrown hair to be different in texture and thickness than the original hair.

Management

In some cases, hair loss due to cancer treatment is not preventable or treatable with stimulants, solutions, or special shampoos. Therefore, learning to deal with hair loss before it occurs can help a person better adjust to this change in physical appearance. Talking about feelings with a counselor, someone with a similar experience, family member, or friend may also provide comfort. Also, it may be helpful to talk about inevitable hair loss with family and friends, especially children, before it occurs. If children know to expect changes in the physical appearance of someone they are familiar with, it helps reduce feelings of anxiety.

Some people recommend cutting the hair shorter before treatment. This not only helps create volume and fullness for the shorter hairstyle, but also is less dramatic of a change when the hair falls out. Furthermore, when the hair begins to regrow, it takes less time to reach the shorter hairstyle. Having a hairstyle similar to the one before chemotherapy can help a person cope with the end of treatment and move forward.

Hair and scalp care. The following recommendations may help when caring for the hair and scalp during cancer treatment:

  • Choose a mild shampoo, such as a baby shampoo, to clean the hair.
  • Choose a soft hairbrush and gently style the remaining hair.
  • Use sun protection on the scalp when outdoors, including sunscreen, hats, or a scarf.
  • Cover the head during the cold months to prevent loss of body heat.
  • Avoid blow-drying the hair with high heat.
  • Avoid curling or straightening the hair with chemical products.
  • Avoid permanent or semi-permanent hair coloring.
  • Choose a soft, comfortable covering for the bed pillow.

Wig and hairpieces. The following information may be helpful if a patient chooses to wear a wig or hairpiece:

  • Select the wig or hairpiece before the hair falls out if you prefer to match the current hair color and style. A hairdresser can style the wig/hairpiece to the your liking.
  • If shopping for a wig/hairpiece in a retail store is not appealing, there are wig and hairpiece shops specially designed for people with cancer. A home appointment can also be scheduled, or an order can be placed through a catalog or the Internet.
  • If finances are a concern, ask the patient's insurance provider if wigs/hairpieces are covered with cancer treatment or classified as a tax-deductible medical expense. To be covered by insurance, the doctor may have to prescribe the use of a wig/hairpiece with proper documentation. Free or loaner wigs/hairpieces may also be available. Ask an oncology social worker or nurse for resources within the hospital or local community.
  • Be sure to have the wig/hairpiece fitted properly, so that it does not irritate the scalp.

Caring for regrown hair. Complete hair regrowth often takes six to 12 months. When new hair regrows, at least temporarily, the texture may feel thinner than the hair that was lost. Pigment cells usually restore themselves, however, and hair usually returns to its original color. When caring for regrown hair:

  • Limit washing the hair to twice a week.
  • Massage the scalp to remove dry skin and flakes.
  • Style hair with care and limit the amount of hard brushing, pinning, curling, or blow-drying with high heat, as new hair will initially be much finer and more prone to breaking than the original hair.
  • Gently use a wide-tooth comb to style the regrown hair.
  • Avoid curling or straightening the hair with chemical products (as in permanent wave solutions) until the hair is at least 3 inches long, or until it is comfortable. Some individuals may need to wait for up to one year before they can chemically curl or straighten their hair.
  • Avoid permanent or semi-permanent hair coloring for at least three months following treatment.

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