Does Chemo Cause Hair Loss?
Hair loss is one of the most common concerns for people starting chemotherapy.
Chemo hair loss is “one of the hardest side effects” to talk about with patients who have recently been diagnosed with cancer, says Veena John, the system head for gynecologic and medical oncology at the Northwell Cancer Institute.
“As soon as patients hear they’re going to lose their hair from chemotherapy, it’s traumatic for them,” John says. “On top of the diagnosis that they receive and now with the changes in their appearance, it can cause low self-esteem.”
How quickly you might lose your hair depends on several things, including the type of chemo you have, the amount given, and how often you get it.
No two people have exactly the same experience with chemo hair loss. Your hair may thin, become patchy or discolored, and fall out in strands or clumps. It can happen slowly or quickly. You may notice more hair on your pillow, in the shower drain, and on your brush or comb.
“I do discuss with patients what we can do to mitigate the hair loss,” John says. “When I started as an oncologist, I didn’t have anything to offer my patients to say, ‘Hey, we can do this to minimize hair loss.’”
Medical progress has greatly improved the outlook for chemo hair loss. Doctors have more and better options to offer patients, and newer drugs have become game changers. These drugs specifically target cancer cells without causing hair loss.
“What I am excited about is we are offering patients treatment that does not cause hair loss and is a better outcome for the cancer,” John says. “Emotionally, it does make a lot of difference when we offer patients something that can mitigate hair loss.”
In most cases, hair loss is temporary. Hair growth after chemotherapy is common, with your hair returning within three to six months after your final chemo session.
Can You Prevent Chemotherapy Hair Loss?
There’s no guaranteed way to save your hair during chemo. Not all drugs that treat cancer cause hair loss, but many of them do.
The reason?
Most older chemotherapy drugs attack all cells that grow rapidly in your body, not just cancer cells. Hair usually grows about half an inch every month on your head. This is because your hair follicles, which are tiny openings on the surface of your skin, divide more quickly than most cells in your body. Hair follicles are rapidly dividing, so that leads to hair loss, John says.
You may hear your doctor use the word alopecia — the clinical term for hair loss.
Handling Chemotherapy Hair Loss
Imagine a future when chemo hair loss is a thing of the past. John says she is optimistic that this possibility will soon become reality. Until then, you need to know what you might face. Here are 12 things you can do while you wait for your locks to grow back.
1. Get informed.
Not all drugs will affect your hair the same way. Some only cause gradual hair thinning. Others may cause your hair to fall out in clumps. Make hair loss less scary by asking your doctor what exactly will happen.
2. Set expectations for your family.
Children and other members of your family will likely have questions about your hair loss. Be honest with them. Let them know what to expect and why your treatment is so important. Prepare them for the possible physical changes. The more positive you can be, the better they’ll react and the more you will feel supported.
3. Treat your hair gently.
To slow down hair loss, try to avoid shampoos that have strong fragrances, alcohol, or salicylic acid. Also, stay away from perms, color, or chemical straighteners. Avoid rollers, curling irons, or straightening irons. Use a soft-bristle hairbrush, and instead of using a blow-dryer, let your hair air-dry.
4. Try a shorter style.
Shorter hair doesn’t lie flat against your head, so it can make your hair look thicker and fuller. (It’s also easier to manage under wigs.) If you choose to shave your head, use an electric shaver or have it done by a professional. Plastic razors can injure your scalp.
5. Take care of your scalp.
As you lose your hair, your scalp may get tender or itchy. Some people even have a tingling feeling. A moisturizing shampoo and conditioner can help, as will a gentle lotion you massage into your scalp.
A scarf or hat when you go outside will shield you from the cold. If you choose not to wear one, don’t forget to apply sunscreen to your scalp to protect against sunburn.
6. Rest easy.
Wearing a soft cap or turban around your head at night can help collect loose hair as it falls out. Don’t braid your hair or put it into a ponytail since both can tug on it. A silk pillowcase will also reduce friction when you’re asleep.
7. Consider a wig or hairpiece.
If you decide to wear a wig or hairpiece, do your shopping at the start of your treatment so you can match the natural color, texture, and style of your hair. A hairpiece is a tax-deductible expense, and many health insurers will cover some of the cost if your doctor writes you a prescription for a “hair prosthesis.” Sometimes, you can even rent them. Check with your treatment center.
8. Experiment with how you look.
Buy a new pair of earrings or a pretty, colorful scarf. Embracing your new look can build confidence and self-esteem.
9. Ask your doctor about “scalp cooling.”
Cold caps or scalp cooling systems use caps filled with cold gel or liquid that may reduce hair loss for some people. The science behind the cooling is that when you apply something very cold to your scalp, it narrows the blood vessels in that area, lowering the amount of chemotherapy drugs that reach the hair follicles. “So, the hair that is covered by the cap is less likely to fall out,” John says.
Manual scalp cooling involves several caps, usually rented and stored in dry ice. You take them with you to your chemo sessions. The cap will start to thaw once you put it on, so it has to be replaced with a new one every 30 minutes or so. The FDA doesn’t regulate cold caps, so your insurance is less likely to cover them.
Automated cooling systems are FDA-approved for treating chemo hair loss. They’re hooked up to a machine that cools liquid or gel in the cap. The temperature is kept the same, so you don’t need to change caps during your chemo.
Whether you opt for manual or automated, cooling caps must stay on throughout chemo treatments — whether it’s for one hour or six hours.
“It’s not the most comfortable feeling because you are putting an ice-cold cap on your scalp for the duration of chemotherapy,” John says.
Also, not all health insurance companies cover the systems. So, you pay out of pocket, usually in the range of $1,000-$3,000, depending on how long your treatments last.
“It’s a difficult thing to tell a patient: ‘We have the technology to avoid hair loss, but guess what? You have to pay for it.’ That can be worse than telling them they’re going to have hair loss,” John says.
10. Talk about it.
It’s normal to feel anxious, depressed, or self-conscious about losing your hair. And women often have a harder time with it than men. A support group can connect you with others going through the same thing. They can share feelings and offer advice.
11. Document your journey.
Chemo hair loss can trigger tough emotions. Be gentle with yourself. Journaling or keeping a record of your journey can empower you and help ease some of your emotions. Give yourself room to feel and work through whatever comes up. Remember, in almost all cases, the hair loss is temporary.
12. Try giving it some time.
Be patient. Most people notice their hair growing back within a few weeks to months after finishing chemotherapy. Sometimes, it’s a different color or texture, but this change usually doesn’t last.
Hair Regrowth After Chemo
For most people, chemo-related hair loss is temporary. After chemo stops and your follicles are healthy, your hair should start to grow back. Hair growth after chemotherapy normally starts within three to six months after your last treatment. You may even see a bit of regrowth while you’re still in treatment.
If you choose to wear a scarf or wig, you can continue to do so for as long as you want – it won’t damage your new hair or keep it from growing.
New hair needs lots of TLC. It may show up in patches, with a different color or texture (curly rather than straight, or vice versa) than it had before.
Try to resist the urge to color, bleach, perm, or straighten your new hair. Much like the rest of your body, it’s best if you give it a chance to grow healthy and strong.
Takeaways
It can be “traumatic” to hear that you might lose your hair from chemotherapy. Talk with your doctor about the best ways to reduce hair loss. Unlike traditional chemotherapy, newer drugs target cancer cells without attacking your hair follicles. Cooling caps offer some relief from your hair falling out. Be patient. In most cases, your hair will return.
Chemo Hair Loss FAQs
Why does chemo cause hair loss?
Most older chemotherapy drugs attack all cells that grow rapidly in your body, whether they’re cancer cells or not. That means your hair follicles also get targeted, causing your hair to fall out.
Do all cancer treatments cause hair loss?
No, newer generation drugs target the specific cancer cells without destroying your hair follicles.
Do chemo pills cause hair loss?
It depends. If the pill is a chemo drug that targets all cells that grow fast, then, yes, you probably will lose your hair.
How long after beginning chemo will hair start to fall out?
Your hair usually falls out within the first two to four weeks after you begin chemotherapy. It can depend on things such as how high your dose is and how often you get chemo.
Does chemotherapy cause permanent hair loss?
Your body usually regrows hair, although its texture may change. Hair growth after chemotherapy can start within three to six months after your final treatment.