Chemotherapy and hair loss: What to expect during treatment

You might not think about how important your hair is until you face losing it. If you have cancer and are about to start chemotherapy, the chance of hair loss is very real. People with cancer report hair loss as one of the side effects they fear most as they face cancer treatment.

Talk to your cancer care team about any fears or concerns you have about losing your hair. Ask about how you can prepare. Planning for hair loss may help you cope with this difficult side effect of treatment.

Chemotherapy uses powerful medicines that attack fast-growing cancer cells. The medicines also hurt other fast-growing cells in your body. These include cells 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 medicines are more likely than others to cause hair loss. Different doses also can cause anything from a slight thinning to complete hair loss.

Hair usually begins falling out 2 to 4 weeks after you start treatment.

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

Hair loss typically continues throughout treatment and up to a few weeks afterward. Whether your hair thins or you become completely bald will depend on your treatment. Talk to your healthcare team about the chemotherapy medicines you’ll receive. They can tell you what to expect.

It may take several weeks after treatment for your hair to recover and begin growing again. You can expect to regrow your hair 3 to 6 months after your treatment ends.

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. It also could be gray until the cells that control the pigment in your hair begin working again.

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. However, none have been completely effective.

Studies of scalp cooling caps and other forms of scalp hypothermia have found they work somewhat in most people who have tried them. Scalp hypothermia is treatment to make your scalp very cold. During your chemotherapy infusions, a closely fitted cap that’s cooled by chilled liquid can be placed on your head. The cold helps slow blood flow to your scalp. This way, chemotherapy medicines are less likely to affect your hair.

However, using scalp hypothermia also results in a very small risk of cancer happening in your scalp. This is because this area doesn’t get the same dose of chemotherapy as the rest of your body. People undergoing scalp hypothermia report feeling very cold and having headaches.

Some studies have shown that cooling caps might not work well on hair with tight curls and coils. This type of hair is more common in Black people. Tight curls and coils might prevent the cap from getting the scalp cold enough. Getting the cap to fit close to your head might require changing how you style your hair.

Minoxidil (Rogaine) is a medicine used for hair loss. Applying minoxidil to your scalp before and during chemotherapy isn’t likely to prevent hair loss. However, some research shows that it may speed up your hair regrowth. More research is needed to understand whether minoxidil is effective in regrowing hair after cancer treatment.

Your hair loss generally can’t be prevented. However, it can be managed. Consider the following actions to help you cope with hair loss during treatment.

Before chemotherapy

• Be gentle to your hair. Get in the habit of being kind to your hair. Don’t bleach, color, relax or perm your hair. This can weaken it. Air-dry your hair as much as possible. Try to 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. 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 ease the 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 hide your hair loss is up to you. But it’s easier to plan for it now rather than later. Ask your healthcare professional to write a prescription for a wig. In the United States, the cost of a wig may be covered by health insurance.

During chemotherapy

• Baby your remaining hair. Continue your gentle hair routine 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 you from 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. This means extreme cold or sunshine can easily irritate it. Having no hair or having less hair can make you feel cold. Wearing a head covering may make you more comfortable.

After chemotherapy

• Continue gentle hair care. Your new hair growth will be especially fragile. It may be more easily damaged by styling products and heating devices. Hold off on coloring, relaxing or bleaching your new hair until it grows stronger. Processing could damage your new hair and irritate your sensitive scalp.
• Try to be patient. It’s likely that your hair will come back slowly and that it might not look the same right away. But growth takes time. It also takes time for your body to repair the damage caused by your cancer treatment.

Covering your head as your hair falls out is a personal decision. For many people, hair is associated with personal identity and health. 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 healthcare professional or a hospital social worker about resources in your area to help you find the head covering that’s best 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 a website for teens with cancer and a guide with information for men with cancer.