Hair Loss or Alopecia

Approved by the Cancer.Net Editorial Board, 11/2016

Hair loss, also called alopecia, may be a side effect of chemotherapy, targeted therapy, radiation therapy, and stem cell transplants. These treatments can cause hair loss by harming the cells that help hair grow. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. Hair may fall out entirely, slowly, or in sections. Or, 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, although rarely, it may remain thin.

Managing side effects such as hair loss is an important part of cancer care and treatment. This is called symptom management or palliative care. Talk with your health care team about managing or coping with hair loss from cancer treatment.

Causes of hair loss

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

  • Altretamine (Hexalen)

  • Carboplatin (Paraplatin)

  • Cisplatin (Platinol)

  • Cyclophosphamide (Neosar)

  • Docetaxel (Taxotere)

  • Doxorubicin (Adriamycin, Doxil)

  • Epirubicin (Ellence)

  • Fluorouracil (5-FU)

  • Gemcitabine (Gemzar)

  • Idarubicin (Idamycin)

  • Ifosfamide (Ifex)

  • Paclitaxel (multiple brand names)

  • Vincristine (Marqibo, Vincasar)

  • Vinorelbine (Alocrest, Navelbine)

Talk with your doctor before chemotherapy, targeted therapy, or radiation begins to find out if it is likely to cause hair loss. You may also want to discuss the following questions about hair loss from chemotherapy:

  1. When would hair loss from chemotherapy start? Hair does not often fall out right away. Most of the time, hair begins to fall out after several weeks or cycles of treatment. Then, hair loss tends to increase 1 to 2 months into treatment.

  2. How much hair will fall out? 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.

  3. When will my hair start growing again? Hair starts to regrow about 1 to 3 months after chemotherapy ends. It often takes about 6 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. Hair will usually go back to normal after several years.

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 at all.

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

  • Afatinib (Gilotrif)

  • Cetuximab (Erbitux)

  • Dabrafenib (Tafinlar)

  • Dasatinib (Sprycel)

  • Erlotinib (Tarceva)

  • Ibrutinib (Imbruvica)

  • Imatinib (Gleevec, Glivec)

  • Nilotinib (Tasigna)

  • Panitumumab (Vectibix)

  • Sonidegib (Odomzo)

  • Sorafenib (Nexavar)

  • Trametinib (Mekinist)

  • Vemurafenib (Zelboraf)

  • Vismodegib (Erivedge)

Hormonal therapy. A small number of people receiving hormonal therapy will have noticeable hair thinning. It often begins several months to years after starting treatment with drugs such as tamoxifen (Nolvadex), anastrozole (Arimidex), letrozole (Femara), fulvestrant (Faslodex), and octreotide (Sandostatin). However, hormonal therapy does not usually cause complete hair loss.

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 from 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, a family member, or a friend may 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 and anxiety.

Some people recommend cutting hair shorter before beginning treatment. A shorter hairstyle may make your hair look fuller. It may also make 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 from drugs given through a vein. The cold narrows the blood vessels in the skin on your head. This means that less of the drug could reach 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.

Medications. A topical medication available over the counter, minoxidil, may be helpful to treat hair thinning from hormonal therapy or targeted therapy. It may also be useful for people whose hair did not fully grow back after chemotherapy, stem cell transplant, or radiation therapy. Sometimes, oral medications such as spironolactone (Aldactone) or finasteride (Propecia, Proscar) may also improve hair growth in these situations.

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

  • Choose a fragrance-free gentle shampoo, to clean your hair.

  • Consider not washing every day, and do not scrub vigorously.

  • Pat your hair dry to prevent damage.

  • Choose a soft hairbrush or wide-toothed comb and gently style your hair.

  • Use sun protection on your scalp when outdoors, such as sunscreen, a hat, or a scarf.

  • Cover your head during the cold months to retain body heat.

  • Avoid blow-drying your hair with high heat or pulling it.

  • Avoid curling or straightening your hair with chemical products.

  • Avoid permanent or semi-permanent hair coloring.

  • Choose a soft, comfortable covering for your bed pillow.

  • Talk with your health care team before using any hair-growth creams or lotions.

  • Talk with your health care team about taking the B vitamin biotin.

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

  • Try finding a shop that sells wigs and hairpieces designed just for people with cancer. Or, schedule a home appointment or order through a catalog.

  • There are many kinds of wigs and hairpieces. If you want a wig or hairpiece that looks similar to your own hair, it helps to choose a wig or hairpiece before your hair falls out. This way it most closely matches your hair color and style. Or, you may want a wig or hairpiece that gives you a new hairstyle you 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 community organizations. 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. 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. It may also grow back a different texture or color than your original hair. The following tips may be helpful if you are caring for regrown hair:

  • Limit washing your hair to twice a week.

  • Massage your scalp to remove dry skin and flakes.

  • Use a wide-tooth comb instead of a brush for your hair. When styling your hair, limit the amount of pinning, curling, or blow-drying with high heat.

  • Avoid curling or straightening your hair with chemical products, such as permanent wave solutions, until your hair has regrown. Some people may need to wait for up to 1 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. You can also ask your hairdresser for suggestions.

  • Avoid permanent or semi-permanent hair coloring for at least 3 months after treatment.

More Information

Side Effects of Chemotherapy

Side Effects of Radiation Therapy