Chemotherapy and hair loss: What to expect during treatment

You might not think about how important your hair is until you face losing it. And if you have cancer and are about to undergo chemotherapy, the chance of hair loss is very real. Both men and women report hair loss as one of the side effects they fear most after being diagnosed with cancer.

For many, hair loss is a symbol to the world that you have cancer. If you aren’t comfortable sharing this information with others, you may fear this side effect more than other chemotherapy complications. Talking to your cancer care team about your concerns and preparing for the possibility of hair loss may help you cope with this difficult side effect of treatment.

Why does it occur?

Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body — including those in your hair roots.

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.

Talk to your doctor or nurse about the medication you’ll be taking. They can tell you what to expect.

Fortunately, most of the time hair loss from chemotherapy is temporary. You can expect to regrow your hair three to six months after your treatment ends, though your hair may temporarily be a different shade or texture.

What should you expect?

Hair usually begins falling out two to four weeks after you start treatment.

It could fall out very quickly in clumps or gradually. You’ll likely notice accumulations of loose hair on your pillow, in your hairbrush or comb, or in your sink or shower drain. Your scalp may feel tender.

Your hair loss will continue throughout your treatment and up to a few weeks afterward. Whether your hair thins or you become completely bald will depend on your treatment.

People with cancer report hair loss as a distressing side effect of treatment. Each time you catch a glimpse of yourself in a mirror, your changed appearance is a reminder of your illness and everything you’ve experienced since your diagnosis.

When will your hair grow back?

It may take several weeks after treatment for your hair to recover and begin growing again.

When your hair starts to grow back, it will probably be slightly different from the hair you lost. But the difference is usually temporary.

Your new hair might have a different texture or color. It might be curlier than it was before, or it could be gray until the cells that control the pigment in your hair begin functioning again.

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, 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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How to make the best of it

Your hair loss generally can’t be prevented or controlled, but it can be managed. Take the following steps throughout your treatment to minimize the frustration and anxiety associated with hair loss.

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.

Covering your head

Covering your head as your hair falls out is a purely personal decision. For many people, hair is associated with personal identity and health, so they choose to maintain that look by wearing a wig. Others choose hats and scarves. Still others choose not to cover their heads at all.

Ask your doctor or a hospital social worker about resources in your area to help you find the best head covering for you.

Look Good Feel Better is a free program that provides hair and beauty makeovers and tips to women with cancer. These classes are offered throughout the United States and in several other countries. Many classes are offered through local chapters of the American Cancer Society.

Look Good Feel Better also offers classes and a website for teens with cancer, as well as a website and a guide with information for men with cancer.

Radiation therapy also can cause hair loss

Radiation therapy also attacks quickly growing cells in your body, but unlike chemotherapy, it affects only the specific area where treatment is concentrated. If you have radiation to your head, you’ll likely lose the hair on your head.

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Your hair usually begins growing back after your treatments end. But whether it grows back to its original thickness and fullness depends on your treatment. Different types of radiation and different doses will have different effects on your hair. Higher doses of radiation can cause permanent hair loss. Talk to your doctor about what dose you’ll be receiving so that you’ll know what to expect.

Radiation therapy also affects your skin. The treatment area is likely to be red and may look sunburned or tanned. If your radiation treatment is to your head, it’s a good idea to cover your head with a protective hat or scarf because your skin will be sensitive to cold and sunlight. Wigs and other hairpieces might irritate your scalp.

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Feb. 26, 2022 See more In-depth
— Update: 31-12-2022 — cohaitungchi.com found an additional article Persistent Alopecia in a Breast Cancer Patient Following Taxane Chemotherapy and Adjuvant Endocrine Therapy: Case Report and Review of Post-treatment Hair Loss in Oncology Patients with Breast Cancer from the website www.ncbi.nlm.nih.gov for the keyword breast cancer hair loss.

Case presentation

A 59-year-old woman presented for evaluation of scalp alopecia. Her past medical history was significant for PT1cN1mi estrogen receptor (ER)+, progesterone receptor (PR)+, human epidermal growth factor receptor (HER)2+ g3 invasive ductal carcinoma of the right breast diagnosed 15 months earlier. She had been treated with bilateral lumpectomy with right-sided sentinel lymph node biopsy and started chemotherapy nine months earlier; she received pertuzumab, docetaxel, carboplatin, and trastuzumab every three weeks for six cycles and was maintained on trastuzumab 6 mg/kg every three weeks for one year. Three weeks after completing taxane chemotherapy, she began treatment with anastrozole 1 mg daily (which was switched to tamoxifen 20 mg daily due to joint pain). She was also treated with radiation therapy and is currently on neratinib 240 mg daily; neratinib is a tyrosine kinase inhibitor anticancer drug used to prevent recurrence in patients with early-stage HER2+ breast cancer who have finished at least one year of post-surgery trastuzumab therapy.

She noted hair loss beginning after her first course of systemic chemotherapy. It became more extensive throughout the remainder of her treatment. She had not experienced any regrowth of scalp hair since the completion of chemotherapy nor during her current hormonal therapy.

Cutaneous examination revealed alopecia of the scalp. The clinical presentation was most consistent with female pattern alopecia with diffuse and nearly complete hair loss on the central and vertex region with retention of hair on the occipital scalp. There was partial, diffuse hair loss – to a lesser degree – on the parietal scalp bilaterally (Figure ​(Figure1).1). There was also loss of hair on the eyebrows, axillae, pubic region, and upper lip. However, these areas had already slowly started to show regrowth.

Biopsies from the right and left sides of her parietal scalp, in areas of alopecia with some preservation of follicles, were performed for horizontal and vertical sectioning. Both showed similar pathologic changes of a non-scarring alopecia. The predominant feature noted was extensive miniaturization of the hair follicles; this change was most suggestive of androgenetic alopecia. However, other findings – present to a lesser extent – included pigment casts in hair follicles, increased catagen to telogen ratio, and empty fibrous tracks; these changes may be observed in alopecia areata.

Correlation of the patient’s history, clinical presentation, and pathologic findings supported a diagnosis of antineoplastic (chemotherapy and hormonal) treatment-associated alopecia. Specifically, her features were consistent with those previously reported in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy who developed permanent alopecia [1]. Treatment was initiated with minoxidil 5% foam to be topically applied to the scalp twice daily.

The patient returned for follow up four months later. She was pleased with the clinical outcome and had noticed increased scalp hair growth; however, she commented that she always used minoxidil once daily and occasionally twice daily. In addition, hair growth on the eyebrows, axillae, and pubic area continued to demonstrate clinical improvement. She decided to continue treating her scalp in a similar manner.

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Her subsequent follow-up visit, six months later (after ten months of topical minoxidil therapy), showed additional hair regrowth. Specifically, the central and vertex area of her scalp had thickening of her hair; in addition, there was new hair growth on the parietal regions bilaterally (Figure ​(Figure2).2). She continues to use 5% minoxidil foam once daily.


— Update: 31-12-2022 — cohaitungchi.com found an additional article A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients from the website www.ncbi.nlm.nih.gov for the keyword breast cancer hair loss.

Materials and methods

We conducted a multicenter, cross-sectional questionnaire survey. Breast cancer patients who had completed adjuvant chemotherapy regimens were recruited from hospitals and clinics in Japan from April to October 2013. The following subjects were considered to meet the inclusion criteria; 1) Breast cancer patients who had completed adjuvant chemotherapy regimens containing anthracycline and/or taxanes within the prior 5 years, 2) Disease-free patients, 3) Patients who are living in Japan and able to understand Japanese, 4) Patients 20 years of age or older. There were no exclusion criteria.

The questionnaire was developed for this survey based on the opinions of members of our Working Group. We initially solicited questions from each member. Items related to scalp hair, head coverings, eyebrows / eyelashes, nails and the severity of side effects were collected. Regarding the severity of side effects, we chose items based on reports in the relevant literature [8–10]. After several meetings, we reached consensus and finalized the questionnaire (S1 Fig (Japanese version), S2 Fig (English version)). It contained 65 questions concerning the patients’ perceptions of physical and non-physical side effects (15 questions) and chemotherapy-induced hair loss or appearance issues (50 questions). The 50 questions concerning chemotherapy-induced hair loss or appearance issues were about scalp hair (13 questions), eyebrows (2), eyelashes (2), nails (4), equipment used such as wigs and caps (13), information acquisition (8), and the use of makeup (8). In this questionnaire, we asked about the conditions of scalp hair, eyebrows, eyelashes and nails at 3 different time points: before chemotherapy, 6 months after the beginning of scalp hair regrowth, and at the time of filling out the questionnaire survey.

At the outpatient clinic, the attending physician explained this research to the patients. They then filled out the first page of the questionnaire, writing the medicines that they had been administered. The patients were given the questionnaires and returned home with them. Only patients who agreed to participate in the study mailed the questionnaire directly to the data center after responding to the items surveyed. Descriptive statistics were obtained in this study. The Kaplan-Meier method was used to plot graphs of the wig usage period. Since some patients did not respond to all items, the total number of responses differed among items. In this study, the temporal changes in hair regrowth and nail condition were analyzed using patient groups classified according to number of years after completing chemotherapy.

Ethics approval was given by the ethics committee of Sendai Medical Center. Furthermore, the institutional review boards or the ethics committees of the 46 facilities participating in this survey (please see Acknowledgments below) approved this questionnaire survey. Since this trial did not use human biological specimens, written informed consent was not required according to the ethical guidelines for epidemiological research in Japan (Ministry of Health, Labour and Welfare, Japan. 2012) [11]. However, verbally-provided informed consent was required for this study. An explanatory document pertaining to this study was given to the patients with a brief explanation. Verbally-provided informed consent was documented in each patient’s medical chart. Patients who did not agree to participate in the study did not mail in the questionnaire form. The study is reported according to the STROBE criteria [12].

References

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About the Author: Tung Chi