Chemotherapy hair loss
Can hair loss be prevented?
Which chemotherapy drugs cause hair loss?
How can I prevent my hair from falling out during chemo?
What percentage of chemo patients lose their hair?
Can chemotherapy cause permanent hair loss?
Chemotherapy hair loss
Hair loss is one of the more dreaded side effect of chemotherapy for cancer, but not all chemotherapy drugs have the same effect. Some medications almost always result in hair loss, whereas others cause minimal hair loss. We will look at the particular drugs most likely to cause hair loss (alopecia), but there are other factors that can affect hair loss as well, such as the dose of the drug, the timing of administration, and the combination of drugs you receive. Fortunately, there are options available to help people cope with this symptom, ranging from a wide array of hats, wigs, and scarves, to the relatively recent approach of using cooling to attempt to prevent hair loss partially or completely.
Chemotherapy may cause hair loss all over your body not just on your scalp. Sometimes your eyelash, eyebrow, armpit, pubic and other body hair also falls out. Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness.
In addition to chemotherapy, some targeted therapies and hormonal therapies for cancer can cause hair changes as well, such as thinning, curling, and dryness.
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Can hair loss be prevented?
No treatment exists that can guarantee your hair won't fall out during or after chemotherapy. Several treatments have been investigated as possible ways to prevent hair loss, but none has been absolutely effective, include:
Before treatment
- Be gentle to your hair. Get in the habit of being kind to your hair. Don't bleach, color or perm your hair this can weaken it. Air-dry your hair as much as possible and avoid heating devices such as curling irons and hot rollers. Strengthening your hair now might make it more likely to stay in your head a little longer during treatment.
- Consider cutting your hair. Short hair tends to look fuller than long hair. So, as your hair falls out, it won't be as noticeable if you have short hair. Also, if you have long hair, going short might help you make a better transition to total hair loss.
- Plan for a head covering. Now is the time to start thinking about wigs, scarves or other head coverings. Whether you choose to wear a head covering to conceal your hair loss is up to you. But it's easier to plan for it now rather than later. Ask your doctor to write a prescription for a wig, the cost of which may be covered by your health insurance.
During treatment
- Baby your remaining hair. Continue your gentle hair strategies throughout your chemotherapy treatment. Use a soft brush. Wash your hair only as often as necessary. Consider using a gentle shampoo.
- Consider shaving your head. Some people report that their scalps feel itchy, sensitive and irritated during their treatments and while their hair is falling out. Shaving your head can reduce the irritation and save the embarrassment of shedding.
- Protect your scalp. If your head is going to be exposed to the sun or to cold air, protect it with sunscreen or a head covering. Your scalp may be sensitive as you go through treatment, so extreme cold or sunshine can easily irritate it. Having no hair or having less hair can make you feel cold, so a head covering may make you more comfortable.
After treatment
- Continue gentle hair care. Your new hair growth will be especially fragile and vulnerable to the damage caused by styling products and heating devices. Hold off on coloring or bleaching your new hair until it grows stronger. Processing could damage your new hair and irritate your sensitive scalp.
- Be patient. It's likely that your hair will come back slowly and that it might not look normal right away. But growth takes time, and it also takes time to repair the damage caused by your cancer treatment.
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Timing of hair loss
Hair loss often begins around the time of your second chemotherapy infusion, though this varies widely. It may start slowly, but increases rapidly around 1 month to 2 months after starting treatment. Some people do not lose all of their hair until they have nearly completed chemotherapy. Hair re-growth typically begins within 3 months of concluding chemotherapy. When your hair does grow back, many people find they have what's been coined chemo curls. If your hair was straight prior to chemotherapy it will likely become straight again, but this process can take up to several years.
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Which chemotherapy drugs cause hair loss?
Chemotherapy medications which cause hair loss, or at least significant hair thinning in the majority of people include:
- Adriamycin (doxorubicin)
- Cytoxan or Neosar (cyclophosphamide)
- Taxol (paclitaxel)
- Taxotere (docetaxel)
- Cerubine (daunorubicin)
- Ellence (epirubicin)
- VePesid (etoposide)
- Hexalen (altretamine)
- Idamycin (idarubicin)
- Ifex (ifosfamide)
- Ixempra (exabepilone)
- Camptosar (irinotecan)
- Hycamtin (topotecan)
- Navelbine (vinorelbine)
- Ixempra (Ixabepilone)
- Vincristine (vinorelbine)
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How can I prevent my hair from falling out during chemo?
Several treatments have been investigated as possible ways to prevent hair loss, but none has been absolutely effective, including:
- Scalp cooling caps (scalp hypothermia).During your chemotherapy infusions, a closely fitted cap that's cooled by chilled liquid can be placed on your head to slow blood flow to your scalp. This way, chemotherapy drugs are less likely to have an effect on your hair.
Studies of scalp cooling caps and other forms of scalp hypothermia have found they work somewhat in the majority of people who have tried them. However, the procedure also results in a very small risk of cancer recurring in your scalp, as this area doesn't receive the same dose of chemotherapy as the rest of your body. People undergoing scalp hypothermia report feeling uncomfortably cold and having headaches.
- Minoxidil (Rogaine).Applying minoxidil a drug approved for hair loss to your scalp before and during chemotherapy isn't likely to prevent your hair loss, although some research shows it may speed up your hair regrowth. More research is needed to understand whether minoxidil is effective in regrowing hair after cancer treatment.
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What percentage of chemo patients lose their hair?
Approximately 65% of individuals undergoing chemotherapy will experience chemotherapy-induced hair loss, which is usually temporary and completely reversible when therapy ends.3 The use of molecularly targeted agents in cancer treatment has also been associated with hair loss rates as high as 60%. Chemotherapy-induced hair loss has been shown to lower patient self-esteem and deprive patients of their privacy because the public commonly associates hair loss with cancer. Forty-seven percent of female cancer patients consider hair loss to be the most traumatic aspect of chemotherapy, with 8% of them stating they would decline treatment for fear of hair loss.
Can chemotherapy cause permanent hair loss?
Many people lose some of their hair if they undergo chemotherapy. However, this hair loss is rarely permanent, and it should grow back once treatment is over. When hair loss occurs, it usually starts within 2 weeks of treatment and becomes more severe for 1–2 months. Hair does not start to grow back immediately after the last chemotherapy treatment. This is because it takes time for chemotherapy drugs to completely leave the body and stop attacking healthy dividing cells.
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