Hair Loss or Alopecia

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2011

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. In most cases, hair will grow back.

Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. If you are concerned about hair loss related to your cancer treatment, talk with your doctor or another member of your health care team.

Causes

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

Chemotherapy. Not all chemotherapy causes hair loss; your doctor or another member of your health care team can provide more information about which drugs are most likely to cause hair loss. When hair loss does occur because of chemotherapy, it is usually not immediate. Most of the time, hair begins to fall out about two to three weeks after beginning chemotherapy and tends to increase one to two months into treatment.

The amount of hair loss varies from person to person, even among people taking the same medication for the same form of cancer. The amount of hair loss depends on the type of drug, the dose, and how the drug was given (by pill, through an IV [(a small needle and tube that is inserted directly into the vein], or on the skin). Hair regrowth after chemotherapy usually begins about one to three months after chemotherapy ends. Complete hair regrowth often takes about six to 12 months.

When new hair regrows, its texture may feel different from the hair that was lost; sometimes hair may grow back thinner, other times hair grows back coarser. The color of regrown hair may also be different from the hair that original hair.

Radiation therapy. Radiation therapy only affects the hair that is located within the field of radiation. For example, if you are treated with 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 typically grows back in the area of radiation therapy after several months, although it may be thinner or of a different texture. When very high doses of radiation are used to treat cancer, the hair may not grow back or it may grow back thinner in the area where radiation therapy was received.

Managing hair loss

Learning how to manage hair loss before, during, and after treatment occurs may help you better adjust to 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 a psychologically and emotionally challenging experience that may affect 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. If children know to expect changes in the physical appearance of someone they know and love, it helps reduce feelings of fear or anxiety.

Some people recommend cutting the hair shorter before beginning treatment. This not only helps create volume and fullness for a shorter hairstyle, but it is is less dramatic of a change when the hair falls out. Then, when your hair begins to regrow, it takes less time to grow into the shorter hairstyle. Having a hairstyle similar to the one before hair loss can help you cope with the end of treatment and move forward.

Hair and scalp care. The following recommendations may help you caring 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
  • 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.

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 specifically sell wigs and hairpieces. If shopping for a wig or hairpiece in a retail store is not appealing, there are wig and hairpiece shops designed for people with cancer. You may also 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 original hair. If this is the case, choose a wig or hairpiece before your hair falls out so it most closely matches your original 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.
  • Sometimes wigs or hairpieces are covered by health insurance companies or classified as a tax-deductible medical expense. To be covered by insurance, your doctor may have to prescribe the use of a wig or a hairpiece with proper documentation. 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 so that it does not irritate 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. 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, because this may change after cancer therapy. Or, ask your hairdresser for suggestions.
  • Avoid permanent or semi-permanent hair coloring for at least three months after treatment.

More Information

Look Good...Feel Better

Side Effects of Chemotherapy

Side Effects of Radiation Therapy

Additional Resources

Dana-Farber Cancer Institute: Video – Choosing a Wig

Dana-Farber Cancer Institute: Video – Tips for Tying a Headscarf