Because chemotherapy drugs inhibit the growth of all cells, not just cancer cells, the chemicals can cause a number of distressing side effects, not least of which is hair loss. Like cancer cells, the cells that make up hair follicles divide extremely quickly, making them even more sensitive to the effects of chemo.
When Does Hair Loss Start In Chemotherapy?
For the majority of cancer patients, hair loss (or alopecia) doesn’t begin immediately. Usually, the process starts after several treatments, around two to four weeks after the first dose, according to the Mayo Clinic. Once it begins, hair loss can proceed slowly or be very abrupt, and while some patients will lose all of their hair, and become completely bald, others will notice clumps falling out, leaving a “patchy” appearance. Most patients first notice hair on their pillow when they wake up. Lots of people switch to satin or silk pillowcases, which can be gentler on the scalp, after beginning chemotherapy.
Hair loss isn’t always confined to the crown of a patient’s head. Many patients will notice a thinning of their eyebrows, lashes, pubic hair and body hair. The extent and rate of hair loss depends on what type of chemotherapy a patient is administered, and what dosage. Timing is also important. Chemotherapy agents that are administered in smaller doses at weekly intervals may minimize hair loss, Breast Cancer.org says. For patients who continue to have some, albeit thinner, hair, the remaining strands may be dryer or stiffer than before.
Will Hair Grow Back?
The vast majority of chemotherapy agents cause only temporary hair loss.
While it may take time, usually between three and six months after the end of treatment, most patients’ hair will begin to grow back, although many people notice a difference in color or texture from their hair pre-chemo. Perhaps most common is a change in the hair’s curliness. Patients who previously had straight hair may find themselves growing curly hair, and people who used to have curly hair can regrow looser curls than before.
Do All Chemotherapy Agents Cause Hair Loss?
No, and every chemo drug will affect a patient’s hair in different ways. If you’re about to start chemotherapy, speak to your doctor about whether or not the particular drug you’ll be getting puts you at risk of hair loss, and how you can manage the transition.
Studies have shown that hair loss may be more likely with the following chemo drugs, as reported by Penn Medicine’s OncoLink:
- altretamine (sold as Hexalen) – a drug used to treat ovarian cancers
- carboplatin, used for a wide variety of cancers, usually doesn’t cause hair loss on its own. But in combination with cyclophosphamide, around 50% of patients experience some degree of alopecia.
- ifosfamide, used to treat breast and testicular cancer, among other malignancies, commonly causes full-body hair loss.
- paclitaxel (sold as Taxol), a taxane-class drug used most often in the treatment of breast cancer, appears to cause temporary hair loss in a majority of patients.
Many other chemo drugs carry a lower risk of hair loss. Some drugs, on the other hand, have been linked to permanent hair loss, a side effect once thought impossible.
Chemo Drugs That May Cause Permanent Hair Loss
Reports of permanent chemotherapy-induced alopecia are still exceedingly rare, and in the medical literature, you will almost always see the side effect linked to bone marrow and stem cell transplantation, procedures performed to restore the body’s supply of immature cells after aggressive courses of high-dose chemotherapy.
Busulfan, a drug used today almost exclusively to prepare leukemia patients for bone marrow transplants, is often implicated as the cause of this permanent hair loss. There has, however, been some evidence within the last decade (including this 2007 study published in the journal Bone Marrow Transplantation) that permanent alopecia can occur in patients who undergo stem cell transplants but don’t receive busulfan. Several reports of patients experiencing permanent hair loss after undergoing treatment with etopisode, a chemo agent used for conditioning purposes prior to bone marrow or stem cell transplants, have also surfaced.
Beyond regimens used before transplantation, only one drug has been linked in the medical literature to a risk for permanent alopecia: docetaxel, a chemotherapy agent sold as Taxotere. Used today as an adjuvant treatment for operable breast cancer, Taxotere may cause permanent hair loss in anywhere from 6% to 15% of patients, as estimated by studies published over the last decade.
Does Radiation Cause Alopecia?
Radiation therapies usually cause hair loss, but only where treatment is directed. In most patients, only radiation to the head will cause hair loss on a patient’s scalp. At higher doses, radiation has been found to cause permanent hair loss.
How Should I Prepare For Losing My Hair?
Many patients find it helpful to shave their hair short prior to undergoing chemotherapy. It’s a way of getting used to the look, and helping family and friends become accustomed to what you look like without the hair they’re used to. The women at ChemoChicks.com suggest keeping a clipping of your pre-chemo hair to help make selecting a wig, if you choose to wear one, easier.
Note that a wig will fit differently after you’ve lost hair, so while visiting a specialist to try on wigs can be helpful prior to treatments, buying one beforehand might not be the best idea. Check with your insurance company to see if wigs are covered by your policy. Some people choose to wear hats, or scarves, instead of, or in addition to, a wig after losing their hair.
Lots of people don’t realize how important their hair is until they face the real prospect of losing it, and dealing with the change is highly personal. Talking to a counselor, and figuring out what role your hair plays in your self-image, might help, as can discussing the possibility of hair loss with family members and friends.
Hair Care During Chemotherapy
WebMD suggests avoiding any chemical hair treatments while you’re receiving chemotherapy. Coloring your hair or getting a perm can damage hair further, and may actually accelerate any hair loss caused by chemo. Patients should switch to a gentle shampoo, like baby shampoo, according to the National Cancer Institute, and use a gentle rubbing motion to dry hair, rather than vigorous rubbing.
Some hair care products can hurt your scalp, and should generally be avoided during chemotherapy, including:
- curling irons
- brush rollers
- electric hair dryers
- hair clips, bands and scrunchies
Hair loss might be accompanied by pain in your scalp, and you’ll probably notice an increased sensitivity to temperature. Protecting your head from the elements, with a hat or scarf, can help.
The evidence is still out on whether or not drugs like minoxidil, sold over-the-counter as Rogaine, can help regrow hair lost due to chemotherapy, so speak with your doctor about whether using a regrowth treatment is right for you.