Hair Loss (Alopecia)

Learn how to handle this common side effect

Alopecia is the term for abnormal loss of hair on the head and elsewhere on the body, such as eyelashes, eyebrows, hair in the armpit and pubic area, and hair on arms and legs. Hair on the head often falls out in clumps during shampooing or brushing, or even during sleep.

Why does hair loss occur?

Chemotherapy and radiation work by killing rapidly dividing cells, such as cancer cells. Because cells in the hair follicles also divide rapidly, they may be damaged by these treatments.

Who is most likely to be affected?

Alopecia occurs most commonly among people receiving chemotherapy and/or radiation therapy. Chemotherapy drugs can cause loss of hair on the head, while radiation causes hair loss only in the area being treated. Some immunotherapy and targeted therapy drugs may also cause hair loss. Not every person treated for cancer will lose his or her hair, even when they take the same drug or have the same treatment.

When does hair loss occur?

Hair loss from chemotherapy usually begins within 10 to 14 days after the start of treatment and gets worse within one to two months. In some instances, depending on the chemotherapy drugs, hair loss may begin with a sensation of the scalp itching, and within a few hours, hair begins to fall out. Hair loss typically continues throughout treatment but usually begins to grow back four to six weeks after the end of treatment. In general, hair grows back at a rate of about one-quarter inch per month. It takes longer for hair to be lost during radiation therapy. Hair loss in the area being treated usually begins two to three weeks after the first treatment. All hair in that area falls out within about one week and may begin to regrow three to six months after treatment has ended. However, the hair loss may be permanent.

How is hair loss managed?

It is difficult to prevent the loss of hair related to chemotherapy. However, one technique – scalp cooling – has been effective in preventing hair loss in as many as 80 to 90 percent of people receiving chemotherapy. With scalp cooling, also known as cold cap therapy, a person wears a helmet-shaped cap filled with soft gel packs that are cooled to -27 F. The cap is worn before, during and after chemotherapy for a total of eight hours. The cold temperature reduces blood flow to the head, which means the chemotherapy drugs don’t reach the hair follicles to destroy those cells. Cancer recurrence in the scalp after using the cold cap is extremely rare. It is important to note that the method does not work with all chemotherapy drugs and that the caps are not covered by insurance.

Being gentle with your hair may help make your hair loss more gradual and improve the regrowth of your hair (see below). The best way to manage alopecia is to think about what will make you feel most comfortable with your appearance. Most people with cancer have found that it is easier to make that decision before treatment starts. Many women choose to wear a wig, but some women find wigs to be irritating or itchy. If you decide to get a wig, consider several factors (see below). Wearing a scarf, hat or other type of head covering is also a choice. Your scalp may be tender from treatment (especially radiation therapy to the head), and a head covering can protect your scalp against cold and sunlight.

If you do not wear a head covering, make sure to use sunscreen on your scalp when you will be outside. Some people choose to cut their hair short so that the hair loss will not be as traumatic once it happens. Others shave their head completely before treatment begins. How you handle hair loss is a personal decision and the right choice is the one that makes you feel most comfortable.

Hair loss, for most patients, is the symbol that the person has cancer. It draws attention when in public, and can cause individuals to feel depressed or distressed about their body image, and to avoid socialization. Hair loss for most patients has a beginning and an end, however, prepare for it by learning when to anticipate the hair loss will actually occur. Get a wig, turban, or other head covering in preparation for it happening.

This is a great time to engage younger children into helping their parent by making special hats for their parent to wear once the hair is gone. Even having children help plan a “coming out party” for their parent’s hair is a fun and engaging way to let them help, as well as prepare them for their parent to look different.

Be gentle to your hair

• Use a soft-bristle brush and/or a wide-toothed comb.
• Wash hair with a gentle, pH-balanced shampoo (avoid shampoos with strong detergents, chemicals or fragrances).
• Do not use hair dryers, hot rollers or curling irons.
• Do not bleach or color your hair or get a permanent.
• Avoid hair styles that pull on the hair, such as braids or ponytails.
• Sleep on a satin pillowcase or put a hair net on to decrease friction.

Tips on wigs

• Buy the wig before treatment begins or at the beginning of treatment. You can better match your hair color and texture.
• Try on several different wigs to find one that you really like.
• Consider buying two wigs, one for everyday use and one for special occasions.
• If you can’t afford a custom wig, buy a standard (less expensive) wig and have it professionally styled
• Ask if the wig can be adjusted — your wig size can shrink as you lose hair
• Get a prescription from your doctor for the wig because it is often covered by health insurance (prescription must state “skull prosthesis for hair loss caused by cancer treatment”)
• Contact your local branch of the American Cancer Society to learn about free wigs that have been donated by patients after they have completed treatment

When should I talk to my doctor about hair loss?

Talk to your doctor about the possibility of hair loss when discussing treatment options. Although it is challenging to cope with hair loss, this condition is temporary and not life-threatening, so there are no situations in which you need to contact your doctor immediately.