Cancer Treatment Hair Loss 101

by Jane Ashley

Many people assume that they will lose their hair if they have chemotherapy. But not everyone does. Why? Because some chemotherapy drugs don’t cause hair loss. Your oncologist will usually tell you if hair loss is an expected side effect of your chemotherapy. 

No Right Or Wrong

One of the unexpected aspects of hair loss is that you may not only lose the hair on your head, but you may lose your eyebrows, eyelashes, armpit hair, pubic hair and hair on your legs. Everyone is different — you may lose your hair everywhere while the patient sitting next to you might not lose their eyelashes.

Hair loss is almost always temporary. Hair loss is emotional for most patients, but accepting your hair loss makes it easier to cope with the other aspects of your treatment. There are lots of creative head coverings. And if it’s not cold where you live, you might decide to “rock” your baldness.

Why does chemo cause hair loss?

Cancer cells are cells that grow rapidly and out-of-control. Chemotherapy works by attacking fast-growing cells. Unfortunately, we have healthy cells within our body that are fast-growing too, and chemotherapy also damages those cells.

Faster-growing cells include:

• Hair follicles – causing hair loss
• Cells in our digestive tract – causing nausea and vomiting
• Cells in our bone marrow – causing anemia and low white cell counts
• Cells in our mouth – causing mouth sores

Hair Loss Is Traumatic

Each person reacts differently; some people will lose all of their hair while others only experience thinning of the hair. Hair loss usually occurs after our second infusion of chemotherapy. Some lose their hair gradually over a couple of months, while others may experience large clumps of hair coming out almost overnight.

Which chemo drugs are most likely to cause hair loss?

The chemotherapy drugs that most often cause hair loss or thinning of hair are:

• Altretamine (Hexalen)
• Carboplatin (Paraplatin)
• Cisplatin (Platinol)
• Cyclophosphamide (Neosar)
• Docetaxel (Taxotere)
• Doxorubicin (Adriamycin, Doxil)
• Epirubicin (Ellence)
• Fluorouracil (5-FU)
• Gemcitabine (Gemzar)
• Idarubicin (Idamycin)
• Ifosfamide (Ifex)
• Paclitaxel (multiple brand names)
• Vincristine (Marqibo, Vincasar)
• Vinorelbine (Alocrest, Navelbine)

Short Hair

What are some other causes of hair loss during cancer treatment?

Some of the newer targeted therapies may also cause thinning, dryness, change in texture or curliness. A few targeted therapies may also cause our hair to become darker.

Hormone therapies for both breast and prostate cancer can also cause thinning of one’s hair.

Radiation therapy causes hair loss in the area of the radiation. Someone who receives pelvic radiation may lose their pubic hair. Radiation in the head or neck region may cause partial hair loss on our head or for men, thinning or loss of their beards.

How to cope with hair loss?

Hair loss is not only a physical loss — it’s an emotional loss too — sometimes causing as much emotional distress as our diagnosis. Your oncology team should tell you beforehand if they believe that you will lose your hair. Talk to a counselor or someone who has gone through hair loss to help you physically and mentally prepare.

• Cut your hair shorter. Some women find that getting a shorter hair cut helps make their hair loss easier because it’s not such a dramatic change. And once your hair starts to grow back, it’s a little easier to adjust to a cute and sassy new “do.”
• Cold cap therapy. Some chemo centers offer a cooling cap that cools your head to help prevent hair loss. Ask if this might work for you.
• Medications. Minoxidil, available over the counter, may help with thinning hair caused by hormone or targeted therapy. Minoxidil is also helpful if your hair didn’t fully grow back after chemotherapy, a stem cell transplant, or radiation therapy. Prescription medications, including finasteride (Propecia, Proscar) or spironolactone (Aldactone), may also help hair growth. Don’t take the B vitamin biotin without talking to your healthcare team first.

Tips for taking care of your hair and scalp during treatment

1. Don’t wash your hair every day. Gently wash every few days with baby shampoo.
2. Use a fragrance-free shampoo.
3. Pat your hair dry instead of vigorously drying with a towel or using a blow dryer.
4. Use a soft hairbrush.
5. Use sunscreen if you’ve lost your hair – your scalp will be very tender and vulnerable to sunburn.
6. Use a satin or silk pillowcase.
7. Don’t use hard chemicals or hair color if your hair is thinning or coming out.

Headscarves

Is a wig right for you?

Some patients are content with wearing scarves, hats or caps or going bald. If that’s your choice, be comfortable with your decision.
Other patients aren’t comfortable without their hair. If this sounds like you, then consider getting a wig. Your insurance may cover the cost of a wig (also known as a “cranial prosthesis”); your oncologist can write you a prescription for a wig. Ask your social worker or nurse for recommendations of where to shop for a wig.

The Bottom Line…

Hair loss is an unavoidable side effect of some cancer treatments. Do you best to accept this as a temporary “crisis,” knowing that “this too shall pass.” Focus on taking care of yourself — eat healthy foods, exercise when you are able, and enjoy the support and help of your loved ones and friends.

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