May 18th, 2017 Written by Dr. Christine Traxler, MD and the medical writers at Hairlossinwomen.org
It is difficult enough to be diagnosed with cancer, especially if the type of cancer you have is life-threatening. Additionally, there are lots of decisions to make in a short period of time as most people want to have their cancer treated as soon as possible. Chemotherapy, radiation therapy, and surgery are the first line agents in the treatment of most types of cancer. Besides the unwanted diagnosis of cancer, you may be wondering what will happen to your hair once you begin treatment for your condition.
Table of Contents
About the Author
Christine Traxler graduated as a Doctor of Medicine from the University of Minnesota Medical School in 1988. She is also a published author.
Key Things to Remember During Chemotherapy
Before Treatment – Start planning for hairloss. Consider keeping your hair shorter and looking at different types of head coverings that you may be comfortable with.
During Treatment – Protect your hair and scalp. Being gentle with your hair care and avoiding extreme temperatures can be helpful.
After Treatment – It is normal for hair to start coming back slowly. Focus on preventing irritation around the scalp. The hair that may start coming in will likely not due well with color, heavy styling or other possible irritants.
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Am I Going to Lose M Hair?
Whether or not you lose your hair depends on the drug, the dosage, and your system’s response to the drug. Below we list many of the drugs that commonly cause hair loss, may cause hair loss, and don’t cause hair loss. According to Medscape, chemotherapy-induced hair loss is estimated to occur in 65% of all patients. The good news though is that once the therapy has stopped, your hair eventually will start growing back after 3 to 6 months. For some time it may grow back a different color or texture, but only in rare cases does hair continue to be thin.
Whether or not you lose your hair depends on the drug, the dosage, and your system’s response to the drug.
How Does Chemotherapy Cause Hair Loss?
Chemotherapy is administered many different ways:
- Orally (by mouth)
- Subcutaneous injection (with a short needle)
- Intra-muscular injections (with a long needle)
- Intravenous (directly into the bloodstream)
- Intraventricular/Intrathecal chemo treatments (injected into the cerebrospinal fluid, the fluid that is in the brain and spinal cord)
- Intraperitoneal (a catheter that delivers the drug into the abdominal wall)
- Intra-arterial chemo treatments (delivered into the artery that’s delivering blood to the tumor)
- Intravesicular (a catheter that delivers the drug into the bladder)
- Intrapleural chemo treatments (the drug is delivered to the pleural cavity, the space between the lung and the lining of the lung)
- Implantable chemotherapy treatments (a wafer called is left after brain surgery in the cavity where the tumor was)
- Topical (put directly on the skin)
For a complete description of each of these methods, visit Chemocare.
Chemotherapy involves the giving of extremely potent medications that are designed to attack those cells of the body that are growing the most rapidly-namely the cancer cells. Unfortunately, hair comes from growing follicles, which are affected by the chemotherapy drugs. Not every chemotherapy agent causes hair loss and the hair loss tends to be dose dependent, so that the more chemotherapy drugs you take, the greater will be the amount of hair lost.
Chemotherapy just doesn’t cause hair loss on the scalp, although that is usually the most noticeable hair loss. You can lose hair in the pubic area, the eyelashes, and the eyebrows. Body hair can be suddenly lost as well. You might get just a thinning of the hair you have or you can lose it all. It depends on the person and on the type of chemotherapeutic agent used.
How a Doctor Chooses a Chemotherapy Drug
There isn’t one option when it comes to which drug your doctor chooses for dealing with your cancer. There may be several good options, and the treatment may change over time.
According to Chemocare, chemotherapy was first used in the 1940’s, and for the next 20 years as an investigational treatment. Over time, a lot of data was collected about the effectiveness of different drugs, helping to establish protocols (types of drugs, doses of drugs and schedule of drugs) based on the type of cancer, stage of cancer, and other specifics about a person’s cancer. Now, most types of cancer have some standard protocols that help guide the doctors in selecting the right chemotherapy for an individual with cancer. Over time, as more data is collected and more drugs are developed, doctors will have more information to help make the best decision for the patient.
Doctors will consider a few factors in choosing a drug or combination of drugs:
Response rate is the number of people whose tumors have shrank or disappeared when administered a drug for a type and stage of cancer. These rates, expressed as a percentage, have been established through research. For example, if a drug has a repsonse rate of 80%, that means that 80% of patients with the same type and stage of cancer had their tumors reduced or completely disappeared.
The Health of the Patient
The patient’s age and medical condition also play a role in the decision process. Certain protocols may be too much for a patient, and these are discussed with the patient before starting treatment.
Which Drugs Cause Hair Loss?
The following chemotherapy drugs will case different degrees of hair loss, but the other factors that influence hair loss are the dose, how it’s administered, the combination of drugs, and other individual characteristics.
The brand names are listed first then the generic drug name in parenthesis. Click the drug names with links to learn more about the drug, including which cancers they treat.
Commonly Causes Hair Loss
- Adriamycin or Rubex (doxorubicin): If administered every 3 to 4 weeks, hair loss is usually complete and will affect the eyebrows, eyelashes, and pubic hair. If administered weekly at lower doses, there’s generally little to no hair loss.
- Alkaban-AQ, Velban, Vinblastine Sulfate, Vincaleukoblastine, VLB (vinblastine)
- Camptosar, Camptothecin-11, CPT-11 (irinotecan)
- Cerubidine, daunorubicin hydrochloride, daunomycin, or rubidomycin hydrochloride (daunorubicin)
- Cytoxan (cyclophosphamide)
- Ellence (epirubicin)
- Idarubicin (idarubicin)
- Ifex (ifosfamide)
- Ixempra (ixabepilone)
- Mustargen, Nitrogen Mustard, Mustine, Mechlorethamine Hydrochloride (mechlorethamine)
- Oncovin, Vincasar Pfs, Vincristine Sulfate, LCR, VCR (vincristine)
- Paclitaxel protein-bound (abraxane)
- Taxol (Paclitaxel or Onxal): Causes hair loss almost 100% of the time. Hair loss usually occurs 14 to 21 days after treatment and often affects all body hair including eyebrows, eyelashes, and pubic hair.
- Taxotere (docetaxel)
- Toposar, VePesid, Etopophos, VP-16, Etoposide phosphate, (VP-16) (etoposide)
May Cause Hair Loss
- Alimta (pemetrexed)
- Ara-C, Arabinosylcytosine (cytarabine)
- Blenoxane (bleomycin)
- Busulfex, Myleran (busulfan)
- Cosmegen or Actinomycin-D (dactinomycin): May cause hair loss which is not limited to the scalp.
- Dacogen (decitabine)
- Doxil (doxorubicin liposomal)
- Eloxatin, (oxaliplatin)
- Gemzar (gemcitabine)
- Hycamtin (topotecan)
- Mutamycin, Mitomycin-C, MTC (mitomycin)
- Navelbine (vinorelbine)
- Novantrone, DHAD (mitoxantrone)
- Platinol, Platinol-AQ, CDDP (cisplatin): May cause hair loss, but it’s not common.
- Temodar (temozolomide)
- Toposar, VePesid, Etopophos, VP-16, Etoposide phosphate (etoposide): May cause mild hair loss in some patients, although some patients develop total baldness.
- Hexalen, HMM (Altretamine): May cause hair loss; however, this side effect is uncommon.
- Otrexup, Rasuvo, Rheumatrex, Trexall, Amethopterin, Methotrexate Sodium, MTX (Methotrexate)
- Oncovin, Vincasar Pfs, Vincristine Sulfate, LCR, VCR (Vincristine): Causes hair loss in less than half of patients.
- 5-fluorouracil (5-FU), 5-fluorouracil, Adrucil
- Xeloda (capecitabine)
Chemotherapy Drugs That Usually Don’t Cause Hair Loss
- Carmustine (BCNU)
- Paraplatin (carboplatin): When used alone rarely causes hair loss. When used with Cytoxan (cyclophosphamide, listed above), hair loss occurs around 50% of the time.
- Platinol, Platinol®-AQ, CDDP (cisplatin)
- Fludara (fludarabine)
- Matulane (procarbazine)
- Purinethol, 6-Mercaptopurine, 6-MP, (mercaptopurine)
- Zanosar (streptozotocin)
When Does Hair Loss Occur?
Once you start chemotherapy, your hair will begin to fall out about 2-4 weeks afterwards. The hair can fall out in great clumps or you might just notice more hair in the hair brush, with thinning of the hair. You will notice more hair on the pillow, in the comb, in the sink or in the bathtub. Your scalp will feel more tender than normal, so you will need to brush more carefully and gently.
Hair loss happens throughout the treatment and will generally continue to fall out even a few weeks following your chemotherapy treatment. While hair loss is not dangerous, it is a sign that the chemotherapy is working to some degree and it will be an emotional shock to you whenever you see yourself in the mirror or when you run your fingers through what hair you have left.
Following chemotherapy treatment, the hair will begin to grow back, although it may take several weeks’ time. You may be surprised by the way the hair grows back. It can grow back curlier or grayer than the hair you used to have and it tends to be more brittle than your previous hair. The hair might grow back a different color altogether from the hair you used to have. Much of these changes are temporary, however, and you will gradually find that your hair normalizes to hair you recognize as being like your old hair after several months.
Once you start chemotherapy, your hair will begin to fall out about 2-4 weeks afterward.
Ways to Counteract Hair Loss During Chemotherapy
There is no method of eliminating the hair loss that occurs during chemotherapy but there are things you can do that can diminish the amount of hair lost during treatment. There have been several types of treatments proposed, yet none is fool-proof when it comes to preventing hair loss in chemotherapy. These include:
- Rogaine (minoxidil) therapy. Topical minoxidil is currently approved for hair loss in both women and men, including the normal hair lost in the aging process. It has found to be unsuccessful in preventing hair loss due to chemotherapy but works well when it comes to the speed that hair regrows after chemotherapy is over.
- Scalp cryotherapy. This involves using cold packs or cold water infusion devices that keep your head cool during chemotherapy treatments. The idea behind this form of therapy is that the cold will decrease the circulation to the scalp so less chemotherapy drug acts on the hair follicles. It should be noted that people who do this to prevent or diminish hair loss run a very small risk of getting scalp cancer. The treatment often leads to headaches, not to mention the obvious discomfort of having a cold head during treatments. If you’re considering scalp cryotherapy, check out an interesting article about one woman’s experience.
- Be kind to your hair. This is something you should begin to do even before therapy starts. Don’t use hair coloring or perm your hair as this can lead to brittle hair. Don’t use bleach on your hair and stay away from hot rollers, curlers and curling irons that keep your hair from being strong and healthy, even before chemotherapy. Use a gentle shampoo for your hair, such as a form of baby shampoo. Avoid shampoos and conditioners with strong fragrances, alcohol or salicylic acid. Make sure your hair brush is soft and won’t pull on the hair follicles. Continue to being kind to your new hair as it grows back. Don’t immediately color or perm your new hair as it tends to be fine and shouldn’t be damaged until it thickens and becomes healthy hair.
- Get a haircut. When you have short hair, the hair tends to look fuller than hair that is long. The transition from short hair to no hair is less of an adjustment and there will be less hair clogging your hair brushes and sink drains.
- Think about what hair covering you want. These should be decided upon as soon as you know you are having chemotherapy. Do you want to buy a wig to be used when you are bald? How about a collection of nice scarves that can cover your head? Certain hats can be used that will cover your balding scalp nicely. If your doctor writes a prescription for you to have a wig, your insurance company may pay for all or part of the wig’s cost.
- Think about shaving your head. Do this before you begin chemotherapy because, once the chemotherapy has started, your scalp may be too tender to allow for it to be properly shaved. A totally bald head may be preferable to you rather than having patchy bald spots.
- Take care of your skin. Some experience tingling on their scalp, and your scalp may get dry or itchy. When blow drying your hair, use low heat. Also use a moisturizing shampoo, conditioner, and hydrating lotion to reduce irritation to your skin. You can also use a satin, polyester or cotton pillow case, as opposed to a nylon pillow case, which can cause irritation.
- Wear sunscreen or cover your head. The skin on your scalp is very pale when compared to the skin on the rest of the body. Try to avoid being out in the sun or apply a high SPF sunscreen to your scalp when going outside. A hat that completely covers your scalp is also a good option. Scarves can also protect your scalp from being burned by the sun. You should also protect your scalp from extreme cold situations. You can lose a lot of body heat through a scalp that isn’t protected by hair so a warm winter hat is advisable in cold weather.
- If your eyebrows start to thin out, or you lose them, try using a clear or colored brow gel, which can be found at most drug stores, or a brow pencil. Another option is to use eyeglasses with heavy colored frames, which can be found with or without a prescription.
There is no method of eliminating the hair loss that occurs during chemotherapy but there are things you can do that can diminish the amount of hair lost during treatment.
There are so many options now for women that wish to cover their heads. Remember that many hats and headcovers that you can find online and in stores are made for women with a full head of hair. It is important to find headwear designed for a more bare scalp to reduce inflammation and ensure a proper fit. That is why we specifically recommend covering your head with specialty headwear. Some of the more common options are hats, wigs, beanies and head wraps. Another option that can be very versatile is a headscarf, but there is a bit of a learning curve to putting it on.
Below is a great instructional on how to properly put on a headscarf.[youtube id=”WDzAgRp_Sag” autoplay=”no” api_params=”” class=””]
The University of Iowa Hospitals & Clinics has some great advice regarding wigs, which includes:
- Visit a full service wig salon if possible to give you the best fit and style.
- Get your wig once you’ve lost your hair to make sure you get the best fit.
- There are many options for scarves and turbans that come in many different designs and colors. These can be purchased at wig salons as well.
- If your skin gets irritated by the wig, wear a skull cap or thin cotton scarf under the wig, which are also available at wig salons.
- Use hypoallergenic tape to keep the wig in place.
- The American Cancer Society (800-227-2345) and Cancer Care, Inc. (800-813-4673) are organizations that assist those with cancer therapy hair loss to obtain wigs at no cost.
- Save the receipt from your wig purchase – it can be a medical tax deduction.
You can also look online:
And check out our guide to the five major wig types.
Radiation and Hair Loss
You can also suffer from hair loss when you have radiation therapy; however, the hair is only lost where the radiation is being given. For example, head and neck radiation therapy causes hair loss in the areas being irradiated. Find out from your doctor exactly what part of your head will be treated with radiation therapy so you can prepare for the loss of hair in that area. Hair loss can be temporary or permanent, depending on how high a dose of radiation you will get. If your hair goes back, it may grow back in a different way (curlier or straighter, or of a different color) so you need to be prepared for that. Radiation therapy also makes the skin more irritated. This type of skin especially needs some type of hair covering and sunblock if it is to be exposed to the skin.
Keep in mind that it will most likely take your hair several months to grow back when radiation therapy is complete. The higher the dose of radiation, the most likely it is that the hair will grow back thinner. There is also a possibility that the hair will not grow back at all in the affected area. As with all concerns you may have, please make sure to discuss this with your doctor.
How to Cope With Hair Loss During Treatment
47% of female patients consider hair loss to be the most traumatic aspect of chemotherapy, and 8% would decline chemotherapy due to fears of hair loss.
Some people take losing their hair harder than others. A lot of it depends on how much your hair is tied to your self-esteem. Some have found that it’s an opportunity to remember what’s truly important in life.
There are several things that you can do to help soften the blow. A lot of patients find joining a support group helpful. Most major cities have cancer and chemotherapy support groups and a program through the American Cancer Society called “Look Good Feel Better.” Call 1-800-227-2345 to find a location near you. Others benefit from speaking to a therapist.
One thing you may want to do is to prepare your family and friends. Explain to others that it can be difficult emotionally, and ask for their support. If you have younger children this is especially important. If you explain to them before it happens, and as it happens, they’ll be less likely to be scared or embarrassed. And remember that how you approach it will affect how they see it. Explain to them that it will be temporary, and try to put a positive spin on it, such as telling them that you get to wear different coloured scarfs and hats.
Read more about how to cope with hair loss.
How to Care for Your Hair as it Begins Growing Back
Over the coming months, you will notice that your hair will likely begin coming back in. Especially in the first several months, your hair may come in a bit thinner than usual. Your straight hair may come in curly or you may find the opposite is true. Usually, hair comes back towards the appearance it had pre-treatment.
It is very important to be gentle with your hair as it grows back. The same things that we discussed earlier are even more important here. Aim to keep your scalp as irritation free as possible.
- Blow-drying should be only used on a low heat setting.
- Hair curling should be avoided if possible.
- Excessive brushing needs to be kept to a minimum. When you do brush your hair, use a brush with very soft bristles, and wide tooth combs.
- Keep your hair short if possible. Regular haircuts can be beneficial as they encourage healthier hair to grow through.
- Shampoo only once every few days.
- Reduce the amount of styling you do to your hair, as it can break hair strands.
- Don’t curl your hair until it’s 3 inches long or more. Some people find that permanent wave solution is painful on their scalp for up to a year following chemotherapy or radiation.
- Avoid hair coloring – it can be irritating to your scalp. Permanent hair coloring is the most damaging to the hair shaft. Semi-permanent hair coloring products-those that wash away-may be less harsh to the hair shaft. Most experts say to wait six months after the last treatment before using any type of hair coloring products.
Hair loss during chemotherapy or radiation can be very embarrassing and it can be a continual reminder that you are sick with an illness. Know that this type of hair loss is generally only temporary so when you no longer need radiation or chemotherapy, your hair will eventually grow back.
Do you have any experience with hair loss and chemotherapy? Please share your experience below in the comments section.
Helpful Resources for Cancer and Hair Loss
These are three helpful articles for more information related to hair loss and cancer.