Coping with cancer - hair loss

Many chemotherapy drugs attack fast-growing cells. This is because cancer cells divide rapidly. Since the cells in hair follicles also grow rapidly, cancer treatment drugs that go after cancer cells often attack hair cells at the same time. With chemo, your hair might get thinner, but not all fall out. You also may lose your eyelashes, eyebrows, and pubic or bodily hair.

Like chemo, radiation kills fast-growing cells. While chemo can cause hair loss all over your body, radiation only affects the hair in the area being treated.

Hair loss mostly happens 1 to 3 weeks after the first chemo or radiation treatment.

The hair on your head may come out in clumps. You will probably see hair in your brush, in the shower, and on your pillow.

If your provider has told you treatment may cause hair loss, you might want to cut your hair short before your first treatment. This could make losing your hair less shocking and upsetting. If you decide to shave your head, use an electric razor and be careful not to cut your scalp.

Some people get wigs and some cover their heads with scarves or hats. Some people do not wear anything on their heads. What you decide to do is up to you.

Wig options:

• If you think you will want to have a wig, go to the salon before your hair falls out so they can set you up with a wig that matches your hair color. Your provider may have names of salons that make wigs for people with cancer.
• Try different wig styles to decide what you like best.
• If you want, you can also try a different hair color. The stylist can help you find a color that looks good with your skin tone.
• Find out if the cost of the wig is covered by your insurance.

Other suggestions:

• Scarves, hats, and turbans are comfortable options.
• Ask your provider if cold cap therapy is right for you. With cold cap therapy, the scalp is cooled. This causes the hair follicles go into a state of rest. As a result, hair loss may be limited.
• Wear soft material next to your skin.
• On sunny days, remember to protect your scalp with a hat, scarf, and sunblock.
• In cold weather, do not forget a hat or head scarf to keep you warm.

If you lose some, but not all of your hair, there are many ways you can be gentle with the hair you have.

• Wash your hair two times a week or less.
• Use gentle shampoo and conditioner.
• Pat your hair dry with a towel. Avoid rubbing or pulling.
• Avoid products with strong chemicals. This includes permanents and hair colors.
• Put away things that will put stress on your hair. This includes curling irons and brush rollers.
• If you blow-dry your hair, put the setting at cool or warm, not hot.

It may take a while to adjust to not having hair. Lost hair may be the most visible sign of your cancer treatment.

• If you feel self-conscious about going out in public, ask a close friend or family member to go with you the first few times.
• Think ahead about how much you want to tell people. If someone asks questions you do not want to answer, you have the right to cut the conversation short. You might say, "This is a hard subject for me to talk about."
• A cancer support group might help you feel less alone knowing that other people are going through this too.

Hair often grows back 2 to 3 months after your last chemo or radiation treatment. It may grow back a different color. It may grow back curly instead of straight. Over time, your hair may go back to the way it was before.

When your hair starts to grow back, be gentle with it so it can get strong again. Consider a short style that is easy to care for. Continue to avoid things like harsh dyes or curling irons that can damage your hair.

Cancer treatment - alopecia; Chemotherapy - hair loss; Radiation - hair loss

American Cancer Society website. Coping with hair loss. www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/hair-loss/coping-with-hair-loss.html. Updated December 10, 2020. Accessed January 18, 2023.

American Cancer Society website. Cooling caps (scalp hypothermia) to reduce hair loss. www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/hair-loss/cold-caps.html. Updated August 3, 2022. Accessed January 18, 2023.

Matthews NH, Moustafa F, Kaskas N, Robinson-Bostom L, Pappas-Taffer L. Dermatologic toxicities of anticancer therapy. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 41.

Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.