Hair Loss or Alopecia

Approved by the Cancer.Net Editorial Board, 03/2015

Hair loss, also called alopecia, is a potential side effect of chemotherapy and radiation therapy. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. Hair may fall out entirely, gradually, or in sections. In some cases, hair will simply become thin—sometimes unnoticeably—and may become duller or dryer. Hair loss related to cancer treatment is usually temporary. Most of the time, hair will grow back.

Relieving side effects is an important part of cancer care and treatment. Treatment to manage side effects is called symptom management, palliative care, or supportive care. Talk with your health care team about managing or coping with hair loss from cancer treatment.

Causes

Radiation therapy and chemotherapy can cause hair loss by harming the cells that help hair grow.

Chemotherapy. Not all chemotherapy causes hair loss. The following drugs are more likely to cause hair loss or thinning of your hair:

  • Altretamine (Hexalen)
  • Carboplatin (Paraplatin)
  • Cisplatin (Platinol)
  • Cyclophosphamide (Neosar)
  • Dactinomycin (Cosmegen)
  • Doxorubicin (Adriamycin, Doxil)
  • Epirubicin (Ellence)
  • Gemcitabine (Gemzar)
  • Idarubicin (Idamycin)
  • Ifosfmide (Ifex)
  • Paclitaxel (multiple brand names)
  • Vincristine (Marqibo, Vincasar)
  • Vinorelbine (Alocrest, Navelbine)

Talk with your doctor before chemotherapy begins to find out if it is likely to cause hair loss. When hair loss occurs because of chemotherapy, it does not often fall out right away. Most of the time, hair begins to fall out about seven to 10 days after chemotherapy starts. After that, hair loss tends to increase one to two months into treatment.

The amount of hair loss varies from person to person. Even people taking the same drugs for the same cancer will have a different amount of hair loss. How much hair you lose depends on the drug and the dose. It also depends on whether you receive the drug as a pill, into a vein, or on the skin. Hair starts to regrow about one to three months after chemotherapy ends. It often takes about six to 12 months for your hair to regrow completely.

When new hair regrows, its texture may feel different than before. You may notice that your hair grows back thinner or coarser. The color of regrown hair may also be different than before.

Radiation therapy. Radiation therapy only affects the hair found where the radiation is aimed. For example, if you receive radiation therapy to the pelvis, you could lose hair in the pubic area. Hair loss depends on the dose and method of radiation treatment. Hair tends to grow back in the area of radiation therapy after several months. However, it may be thinner or of a different texture. With very high doses of radiation therapy, hair may not grow back or may grow back thinner.

Targeted therapy. Targeted therapy does not cause complete hair loss. However, the following targeted therapies may cause the hair to thin, become curlier or drier than usual.

  • Cetuximab (Erbitux)
  • Erlotinib (Tarceva)
  • Panitumumab (Vectibix)
  • Sorafenib (Nexavar)
  • Vemurafenib (Zelboraf)

Hormonal therapy. A small number of people receiving hormonal therapy will have noticeable hair thinning.

Managing hair loss

Learning how to manage hair loss before, during, and after treatment may help you cope with this side effect. For many people, hair loss because of cancer treatment is more than just a change in physical appearance. Losing your hair can be an emotionally challenging experience that affects your self-image and quality of life. Talking about feelings related to losing your hair with a counselor, someone with a similar experience, family member, or friend may also provide comfort. It may also be helpful to talk about potential hair loss with family and friends, especially children, before it occurs. Expecting changes in the physical appearance of someone they know helps lower a child’s fear or anxiety.

Some people recommend cutting the hair shorter before beginning treatment. This provides fullness for a shorter hairstyle and makes hair loss a less dramatic change. Then, when your hair begins to regrow, it takes less time to grow into the shorter hairstyle. Letting your hair grow into a similar hairstyle can help you cope and move forward after treatment.

Cold cap therapy. Wearing a cap or head covering with cold packs before, during, or after chemotherapy may help prevent hair loss. The cold narrows the blood vessels in the skin on your head. This may mean that less of the drug reaches the hair follicles. The cold caps are generally available to rent online throughout your treatment.  Talk with your health care team to find out if this approach may work for you.

Hair and scalp care. The following tips may help you care for your hair and scalp during cancer treatment:

  • Choose a mild shampoo, such as a baby shampoo, to clean the hair.
  • Consider not washing every day and do not scrub vigorously
  • Pat the hair dry to prevent damage
  • Choose a soft hairbrush and gently style the hair.
  • Use sun protection on the scalp when outdoors, such as sunscreen, a hat, or a scarf.
  • Cover the head during the cold months to prevent loss of body heat.
  • Avoid blow-drying the hair with high heat.
  • Avoid curling or straightening the hair with chemical products.
  • Avoid permanent or semi-permanent hair coloring.
  • Choose a soft, comfortable covering for the bed pillow.
  • Talk with your health care team before using any hair-growth creams or lotions.
  • Talk with your health care team about taking a type of B vitamin called biotin

Wigs and hairpieces. The following tips may be helpful if you choose to wear a wig or hairpiece once hair loss begins:

  • There are shops that sell wigs and hairpieces. There are also wig and hairpiece shops designed just for people with cancer. Or, you can schedule a home appointment or place an order through a catalog.
  • There are many kinds of wigs and hairpieces. Some people want a wig or hairpiece that looks similar to their own hair. It helps to choose a wig or hairpiece before your hair falls out so it most closely matches your hair color and style. Other people may want a wig or hairpiece that gives them a new hairstyle they have always wanted to try. A hairdresser can help you style the wig or hairpiece.
  • Your health insurance company may cover wigs or hairpieces. Wigs and hairpieces may also be classified as a tax-deductible medical expense. Your doctor may have to prescribe a wig or hairpiece so you can submit it to your insurance company. Free or loaner wigs or hairpieces may also be available through your cancer center or other organizations in your community. Ask an oncology social worker or your nurse for resources.
  • Have your wig or hairpiece fitted properly at a wig or hairpiece shop. This will help keep it from irritating your scalp.

Caring for regrown hair. Hair may grow back a different texture or color than your original hair. When your hair begins to regrow, it is important to care for it carefully. At first, new hair will be much finer and more easily damaged than your original hair. The following tips may be helpful if you are caring for regrown hair:

  • Limit washing the hair to twice a week.
  • Massage the scalp to remove dry skin and flakes.
  • Avoid hard brushing of hair. Instead, gently use a wide-tooth comb. When styling the hair, limit the amount of pinning, curling, or blow-drying with high heat.
  • Avoid curling or straightening the hair with chemical products, such as permanent wave solutions, until the hair has regrown. Some people may need to wait for up to one year before they can chemically curl or straighten their hair. Before trying chemical products again, test a small patch of hair to see how it reacts. Or, ask your hairdresser for suggestions.
  • Avoid permanent or semi-permanent hair coloring for at least three months after treatment.

More Information

Side Effects of Chemotherapy

Side Effects of Radiation Therapy