Introduction

Cancer treatment can cause serious side effects. Many find it especially troubling that chemotherapy can lead to hair loss on their scalp and body.

There are ways to try to prevent this from happening, but there hasn't been enough research on whether they really work. Hair loss due to chemotherapy is usually temporary, though: The hair usually grows back after the end of the treatment. In the meantime, many people use wigs or hats to cover their head.

This information is about chemotherapy-related hair loss in adults with cancer.

At a glance

• Hair loss is a typical side effect of chemotherapy for the treatment of cancer.
• It affects the hair on your head and on your body – including your eyebrows, eyelashes and facial hair.
• It generally becomes noticeable one to three weeks after the start of treatment.
• In most cases, the hair grows back after the end of the chemotherapy.
• Until then, many people wear wigs, hats or scarves on their head. In Germany, statutory health insurers often cover some of the costs of wigs.

Symptoms

The hair may thin out overall, but it often falls out completely within days or weeks of the start of chemotherapy. It can also fall out bit by bit, in clumps. This doesn’t just affect the hair on your scalp, but also your eyebrows, eyelashes and facial hair, as well as body hair and pubic hair.

If the hairs break off close to the scalp, they can leave behind stubble. That can feel itchy or unpleasant. And sometimes the scalp can be tender even before the hair falls out, or it may hurt when the hair is touched.

Causes

The roots of the hair are made up of living cells that become hardened. The cells that constantly grow from the root to replace them push the hair out of the skin. Many of the medications used in chemotherapy (cytostatic drugs) disrupt the way that the cancer cells multiply. But these medications also damage other fast-growing cells, such as cells in the hair roots, causing the hair to break off inside the skin or close to it.

Some of the hair we have doesn't actively continue to grow. That hair isn’t harmed by chemotherapy, but makes up less than ten percent of our total hair.

Cancer medications that aren’t cytostatics may cause hair loss as well. Those include tamoxifen, which is used for breast cancer, and a number of other “targeted” cancer drugs.

Prevalence

It isn’t possible to say how often chemotherapy causes hair loss in general. For one thing, it depends on what medication is used: Some medications almost always cause hair loss, while others rarely do.

Other factors may also influence whether hair falls out and how severe the hair loss is. These include the chemotherapy dose or whether the medication is taken as a tablet or given as an infusion.

Outlook

Hair loss typically starts one to three weeks after chemotherapy is started. The hairs on the scalp fall out first, and then facial hair, body hair and pubic hair may follow a little later.

A few weeks after the end of chemotherapy, the hairs start to grow back in most people. Scarring on the scalp or other problems are rare. In some people, the hair that grows back may be a little lighter or darker, and often it's curlier than it was before. But this is usually only temporary.

Diagnosis

Hair loss is such a typical side effect of chemotherapy that it usually isn't necessary to run any special tests on the hair or the scalp. That only makes sense if the hair doesn’t grow back healthy after chemotherapy – or if doctors think that something else might be causing the hair loss, like a fungal skin infection.

Prevention

There are currently no medications that can effectively prevent chemotherapy-related hair loss. You can wear a cooling cap to cool the scalp while receiving the medication through a drip. This is supposed to reduce the damage to the roots of the hair. But there is a lack of good research on this approach.

Treatment

There is no effective treatment for chemotherapy-related hair loss. After most types of chemotherapy, though, the hair grows back on its own again.

It is not clear whether the hair-growth drug minoxidil can make hair grow back faster. But this drug can cause side effects such as an irregular heartbeat, lightheadedness, fainting or swelling due to water retention.

Everyday life

For many people, hair loss is one of the worst side effects of chemotherapy – for instance, because then others can tell that you have cancer. It can also affect how people perceive themselves as men and women. In women, the loss of hair on their scalp is the main issue; in men it is the loss of facial and body hair as well.

There are various ways to deal with these problems: If you have long hair, you could get it cut short before the start of chemotherapy, for instance. Then when hair starts to fall out, the clumps that are lost seem less alarming. Shaving the hair off yourself prevents you from feeling like you're constantly losing hair – and will save you from having to keep removing hair from your bed, clothing or bathroom.

You can cover a bare scalp with hats, scarves or caps, as well as wigs made of either artificial or real hair. Wigs made of real hair can be cut to match your previous hairstyle and look very natural. They are more expensive than wigs made of artificial hair, though. If you decide to wear a wig, the doctor who is giving you the chemotherapy can write you a prescription for one. In Germany, statutory health insurers usually cover part of the costs for artificial hair wigs.

Eyelashes and eyebrow hair that falls out can be replaced using artificial lashes and make-up. If you’ve never put on make-up before, you can find a lot of online videos offering tips and suggestions. Some hospitals and support groups even offer special courses.

Another option is to meet with others who are affected by chemotherapy-related hair loss. You could also get support from a specialist in psycho-oncology and talk with them about any worries or anxieties that you have related to the hair loss.

It is important to be very careful when washing your hair until it has grown back completely. That includes things like not washing it more than twice a week, using baby shampoo, not drying it with a hairdryer for too long or at too hot a temperature, and not using any hair dyes.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. In our "Health care in Germany" topic you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

Sources

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