Side Effect Management - Hair Loss

One possible side effect of cancer, and one that is often feared by patients -- especially women -- is hair loss.

Not every treatment will cause hair loss. Your cancer care team will know if your specific treatment plan has a known side effect of hair loss. It's most common with some chemotherapies but could also be experienced by taking certain cancer medications or having radiation therapy administered directly at your head. During some of these treatments there can be damage done to healthy cells that help grow hair. Hair loss can affect different areas throughout the body including the head, face, arms, underarms, legs, and pubic area.

Not all patients experience hair loss in the same way, even when they are undergoing the same kind of cancer treatment. For some, hair may slowly thin over time, but for others, it may come out more rapidly in clumps.

Fortunately, hair loss is usually temporary and will typically grow back after your cancer treatment is complete. However, it is not uncommon for the color and texture of the hair to be slightly different when it first begins to grow back.

Coping with Hair Loss

Talking with your cancer care team regarding hair loss may help you cope better with this side effect. It may also help to talk about your feelings with family and friends or even a counselor.

One way you can gain some control over the situation is by wearing a wig or hairpiece. If you choose to do this, getting your wig prior to treatment makes it easier to match your natural hair color, style, and texture. If possible, have your wig or hairpiece fitted properly at the shop to avoid scalp irritation. You may also want to consider buying two wigs -- one for everyday wear and another for special occasions. Your cancer care team can direct you on where to find wig shops in your area.

For some patients, wearing hats or scarves is a better alternative for them. Some people even prefer to leave their head uncovered.

Some other steps you can take to manage hair loss may include:

Cutting your hair shorter before beginning treatment. A shorter hairstyle can make hair loss look less dramatic when it starts. Some people choose to shave their head.
Treating your hair and scalp gently. Consider using a hairbrush with soft bristles or a wide-tooth comb. Styling tools, such as hair dryers, flat irons, and clips, as well as hair products like gel, can be hard on your scalp. Wash your hair less often, with a mild shampoo and pat it dry with a soft towel. If outdoors, protect your scalp with sunscreen, a hat, or a scarf. If your scalp feels itchy, treat it with a fragrance-free lotion. In cold weather, wear a hat or scarf to trap in body heat.
Taking medications. Certain medications may be helpful to treat thinning hair or for hair that did not fully grow back after cancer treatment. These medications may include a topical medicine called minoxidil, or spironolactone (Aldactone), finasteride (Propecia, Proscar) and Latisse (used for eyelashes), which are taken orally.
Trying cold cap therapy. Cooling the scalp (scalp hypothermia) with ice packs or cooling caps (cold caps) before, during, and after chemotherapy treatments may reduce hair loss. The Paxman Scalp Cooling System, for example, has been widely used among cancer patients for over 20 years. The theory behind this is that the cooling tightens up or constricts blood vessels in the scalp, reducing the amount of chemo that reaches hair follicle cells. The cold also decreases the activity of the cells, making them less attractive to chemotherapy, which targets cells that rapidly divide.
Silk or satin pillowcase. Pillowcases made of these fabrics are gentler on a balding scalp and can decrease hair tangles.

Hair often grows back within 2 to 6 months after treatment has ended. Some patients may notice that their hair is different than it was prior to cancer treatment (curlier, straighter, different color). In time, it may go back to how it was before. If you received a very high dose of radiation, your hair may grow back thinner or not at all on the part of your body that received treatment.

As your hair grows back after you complete your cancer treatments, continue to be gentle with it. Avoid too much brushing, curling, and blow drying. You may not want to wash your hair as frequently until it has fully returned.

Talk with your cancer care team if you have any additional questions regarding hair loss.

Insurance doesn’t often cover the entire cost of wigs, medication or scalp cooling therapy and often there is some out of pocket cost for all these services. Each insurance plan is different, check with your insurance provider for details on coverage.

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