Skin Reactions

Hair Loss (Alopecia)

Hair loss, also called alopecia, affects many people receiving chemotherapy, radiation or other cancer treatments. This is because many treatment options work by killing rapidly dividing cells, such as cancer cells. However, cells in the hair follicles also divide rapidly, so they too may be damaged by these treatments.

Hair loss may occur anywhere on the body, including the head, eyelashes, eyebrows, armpits, pubic area, arms and legs. Typically, however, chemotherapy drugs cause hair loss on the head and body, while radiation causes hair loss only in the area being treated. Not all people treated for cancer will lose their hair in this fashion or at all, however, even when they take the same drug or have the same treatment.

Hair loss often starts about seven to 10 days after treatment begins and progresses over time. While some drugs, such as cyclophosphamide, docetaxel and paclitaxel, may be associated with persistent hair loss, most hair loss is temporary and hair will grow back after your therapy stops—although it may have a different color or texture.

With some of the newer types of treatments, such as erlotinib, cetuximab, panitumumab, sorafenib and vemurafenib, the hair progressively can become thin, curly and dry, but it does not completely fall out. In these cases, the thinning is usually temporary.

If hair loss occurs, it can be one of the most distressing side effects because of the way it can affect your self-image. Being gentle with your hair may help make your hair loss more gradual and improve the regrowth of your hair (see box below). You also may decide to apply minoxidil (2 or 5 percent) to your scalp twice daily to reduce the duration of the hair loss, or discuss scalp cooling (also known as cold cap therapy) with your oncologist, which has been effective in preventing hair loss in as many as 80 to 90 percent of people receiving chemotherapy. (The use of cold caps will depend on what type of cancer you have.) In addition, your doctor may check blood levels of certain hormones that contribute to hair growth. Be sure to explore all of your options for managing any hair loss or thinning you might experience (Table 1).

Be gentle to your hair
Use a soft-bristle brush and avoid too much brushing or pulling of hair.
Wash your hair with mild, gentle shampoos and conditioners; rinse hair thoroughly and gently pat dry to avoid damaging your hair.
Avoid coloring, perming or relaxing the hair for two months after completing chemotherapy.
Do not use hair dryers, electric rollers or a curling iron.
Avoid clips, barrettes, elastic bands, bobby pins or hair sprays.
Sleep on a satin pillowcase.

Table 1. Options to manage hair loss

Options Details
Short hair Consider cutting your hair short if you are expecting hair loss during treatment. Hair can fall off unevenly, so cutting your hair short may be less distressing. Some individuals even shave their head before chemotherapy.
Wigs If a wig is an option, consider getting one before you begin chemotherapy. If you can, obtain a prescription from your doctor for a “skull prosthesis for hair loss caused by cancer treatment.” This will increase the chance that your insurance will cover the cost of the wig.
Caps and scarves Caps and scarves may be the easiest option for you. You probably already own some you can use.
Scalp cooling With this treatment, you wear a cap filled with cold, soft gel packs before, during and after chemotherapy for a total of eight hours. The cold temperature reduces blood flow to the head, which means drugs don’t reach the hair follicles to destroy those cells.
Lotion Apply 2-percent or 5-percent minoxidil twice a day during chemotherapy. Be aware that hair may grow in undesirable areas. Minoxidil is also available as a foam, which may be easier to apply if there is a lot of hair. If the scalp is itchy, your doctor can prescribe a topical corticosteroid as a shampoo, foam or liquid.
Vitamins Biotin (vitamin B7), 2.5 mg (or 2,500 mcg) every day.