Hair Loss or Alopecia

Approved by the Cancer.Net Editorial Board, 01/2020

Hair loss is a common side effect of cancer treatment. Hair loss can happen as a side effect of chemotherapy, targeted therapy, radiation therapy, or a stem cell (bone marrow) transplant. These cancer treatments can harm the cells that help hair grow. It can affect hair all over your body, including your head, face, arms, legs, underarms, and pubic area. The medical term for hair loss is alopecia.

Hair loss is different for everyone. You might lose all your hair or only sections of it. It might come out slowly over time or become thin. Or you might simply notice that your hair is dryer and duller. Lost hair usually grows back after cancer and treatment. But sometimes, hair stays thin.

Hair loss can be challenging regarding both your physical appearance and emotionally. Managing side effects is an important part of your cancer care and treatment. It is called palliative care or supportive care. Talk with your health care team about coping with hair loss.

Causes of hair loss

Some cancer treatments can cause hair loss. There can also be other reasons to lose hair, such as thyroid problems or low iron levels.

The information below describes certain cancer treatments that may cause hair loss. The best way to find out if you are likely to experience hair loss due to cancer treatment is by talking with your cancer care team. They can tell you if you are likely to lose your hair, and if so, when, due to your treatment plan.

Chemotherapy

Not all chemotherapy causes hair loss, but some chemotherapy drugs are more likely to cause hair loss or thinning. They include:

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)

This category also includes chemotherapy given as part of a stem cell/bone marrow transplant.

Hair does not usually fall out as soon as you start chemotherapy. It usually takes several weeks or cycles of treatment and tends to fall out 1 or 2 months into treatment.

How much hair you lose depends on the drug and the dose. It also depends on whether you get your chemotherapy as a pill, into a vein, or on the skin. And, the amount of hair loss is different for each person. You and someone else can take the same drug for the same cancer and still lose different amounts of hair.

Hair usually starts to grow back 1 to 3 months after chemotherapy ends. It often takes 6 to 12 months to grow back completely. It may grow back thinner, coarser, curly, or a different color. Hair usually goes back to normal over time.

Radiation therapy

Radiation therapy only affects the hair on the body part where the radiation is aimed. For example, if you have radiation therapy to the pelvis, you could lose pubic hair. Hair loss depends on the dose and method of radiation therapy. It usually grows back after several months, but it may be thinner or a different texture. With very high doses of radiation therapy, hair may not grow back.

Targeted therapy

Cancer medications called targeted therapy do not cause complete hair loss. But the following targeted therapies may cause hair to become thinner, 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

Sometimes, hormonal therapy for cancer can cause a person's hair gets thinner. This may happen several months to years after starting therapy. Hormonal therapy does not usually cause complete hair loss. The following hormonal therapies are more likely to cause hair loss.

Anastrozole (Arimidex)
Fulvestrant (Faslodex)
Letrozole (Femara)
Octreotide (Sandostatin)
Tamoxifen (Nolvadex)

Managing your hair loss

Losing your hair can cause more than a change in your physical appearance. It can be an emotional challenge that affects your self-image and quality of life. It is important to be kind to yourself during this stressful time.

People cope with hair loss in different ways. Thinking about how you feel most comfortable in managing hair loss before, during, and after treatment may help. And, your choices may change over time.

Talking about your feelings with a counselor, a family member, or a friend may provide comfort. It may also be helpful to connect with other people who have experienced hair loss, such as through an online support group, and find out what worked best for them in coping with it.
It may be helpful to prepare your family and friends about you possibly losing hair. This is especially true for children. They may feel less fearful and anxious if the change in your appearance is something they expect. This, in turn, can help you feel better.
You may choose to cut your hair shorter. A shorter hairstyle may make thin hair look fuller. Any hair loss may also look less dramatic. And when your hair starts growing back, it takes less time to grow into the shorter hairstyle.
Some people decide to shave their head in advance or once hair loss begins. This can help wigs or other head coverings fit better. Hairdressers can help with this.
If you want to wear a scarf, hat, or other head coverings, get some of those items in advance. This can make you feel more prepared for when hair loss starts happening. Select those made from soft materials that don't itch. It may be helpful to have items in both lighter and heavier materials, for your comfort and different temperatures.
Some people choose to not cover their thinning hair or bald head, finding it more comfortable or easier to manage in daily life.

Cold cap therapy

Wearing a cap that cools the scalp can help prevent hair loss from drugs given through a vein. This treatment is called scalp cryotherapy. You wear the cap before, during, and after chemotherapy.

The cold makes the blood vessels in the skin of your head narrower. Less blood and less of the chemotherapy drug reaches your hair follicles through the blood vessels. Keeping your scalp very cold also helps prevent damage to the hair follicles.

Talk with your health care team to learn if cold cap therapy is available and might work for you.

Medications

An over-the-counter medication called minoxidil may help thinning hair from hormonal therapy or targeted therapy. It may also help if your hair does not grow back completely after chemotherapy, radiation therapy, or a stem cell/bone marrow transplant.

There are also other medications you can take by mouth. These include spironolactone (Aldactone) and finasteride (Propecia, Proscar).

Hair and scalp care

Here are some tips to take care of your hair and scalp during cancer treatment.

Choose a gentle, fragrance-free shampoo. Avoid washing your hair every day. Wash gently. If your hair tangles, consider using products like a gentle conditioner or detangler spray.
Pat your hair dry to prevent damage. Avoid pulling on your hair as much as possible. Style it gently with a soft brush or wide-toothed comb.
When outdoors, use sun protection on your scalp, such as sunscreen, a hat, or a scarf.
Avoid high-heat styling, chemical curling or straightening, and permanent or semi-permanent hair color.
Choose a soft, smooth pillowcase.
Talk with your health care team if you are interested in taking biotin, a type of B vitamin.

Talk with your health care team before using any products, including creams or lotions, that claim to help hair grow back.

Wigs and hairpieces

You may choose to wear a wig or hairpiece when you start losing your hair. Here are some tips that might help.

Try finding a shop that sells wigs and hairpieces specifically for people with cancer. You might also schedule a home appointment or order through a catalog.
Have your wig or hairpiece fitted properly. This will help keep it from irritating your scalp.
If you want one that looks like your natural hair, it's best to choose a wig or hairpiece before your hair falls out. Or you may want a wig or hairpiece in a different style or color you have always wanted to try. A hairdresser can help you style the wig or hairpiece.
Check with your health insurance company, to see if your insurance plan covers the cost of a wig or hairpiece. Wigs and hairpieces may also be classified as a tax-deductible medical expense. Your doctor may have to write a prescription for a wig or hairpiece so you can submit it to your insurance company.
Free or loaner wigs or hairpieces may be available through your cancer center or other community organizations. Ask an oncology social worker or your nurse for resources.

Caring for hair that grows back

When your hair begins to grow back, it will be much thinner and more easily damaged than your original hair. It may also be a different texture or color. The following tips may help you take care of the hair that grows back.

Limit washing your hair to twice a week.
Massage your scalp gently 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 permanent or semi-permanent hair color for at least 3 months after treatment ends.
Avoid curling or straightening your hair with chemical products such as permanent wave solutions until it all grows back. You may need to wait up to a year before you 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.

Questions to ask the health care team

You may want to ask your cancer care team the following questions.

Is my specific cancer treatment plan likely to cause hair loss?
If so, when will my hair loss happen? Will I lose hair over time or all at once?
How should I care for my hair and scalp during hair loss?
When will my hair grow back? What can I expect when my hair does return?
Is there a counselor, oncology social worker, or other team member who can help me cope with hair loss?
Are there any programs that provide free or low-cost wigs or other head coverings?