Hair loss or alopecia
Hair loss, also called alopecia, could be a side effect of chemotherapy, targeted therapy, radiation therapy, or stem cell / bone marrow transplants. These treatments can cause hair loss by damaging the cells that help the hair grow. Hair loss (and hair loss) can occur throughout the body, including the head, face, arms, legs, armpits, and pubic area. Hair can fall completely, slowly or in parts. The hair of a person could also, simply, become thin and dull or dry out. In general, hair loss related to cancer treatment is temporary. Most of the time, the hair will grow back. In a few cases, it could stay fine.
Managing side effects, such as hair loss, is an important aspect of cancer care and treatment. This is called palliative care or supportive care. Ask your healthcare team about hair loss control or how to cope with it from cancer treatment.
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Causes of hair loss
The types of cancer treatments that could cause hair loss are listed below. Talk to your health care team before starting your cancer treatment to find out the likelihood that the treatment will cause hair loss. Sometimes, there may be another reason why your hair falls out other than cancer treatment, such as thyroid problems or low iron levels.
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)
- Gemcabeno (Gemzar)
- Idarubicin (Idamycin)
- Ifosfamida (Ifex)
- Paclitaxel (multiple brands)
- Vincristina (Marqibo, Vincasar)
- Vinorelbine (Alocrest, Navelbine)
Hair does not usually fall off immediately after the start of chemotherapy. Most of the time, it starts to fall after several weeks or cycles of treatment. Hair loss tends to increase between 1 and 2 months from the start of treatment.
The amount of hair that falls varies from one person to another. Even in people who take the same drugs for the same cancer, the amount of hair that falls will be different. The amount of hair that falls out will depend on the drug and the dose. It also depends on whether you receive the drug in the form of a tablet, intravenously or on the skin.
Hair begins to grow again about 1 to 3 months after the end of chemotherapy. In general, hair takes between 6 and 12 months to regrow completely. When the new hair grows back, the texture may be different from the previous texture. You may notice that the hair grows back thinner or thicker. The color of the hair that grew back can also be different from the previous one. The hair usually returns to its normal appearance after several years.
Radiotherapy. Radiation therapy only affects the hair that is located where the radiation is directed. For example, if you receive radiation therapy in the pelvis, your hair will fall off in the pubic area. Hair loss depends on the dose and the radiotherapy method. Usually the hair grows back in the area where radiotherapy was received after several months, but it may be thinner or have a different texture. With very high doses of radiation therapy, it is possible that the hair does not grow back.
Targeted therapy Targeted therapy does not cause complete hair loss. Although the following targeted therapies could cause the hair to become thin, roughened or drier than normal.
- 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)
Hormone therapy To a reduced number of people who receive hormone therapy, the hair will be clearly refined. It often starts between a few months to years after starting treatment with some types of hormone therapy. But hormone therapy usually does not cause complete hair loss. The following hormonal therapies are more likely to cause hair loss.
- Tamoxifen (Nolvadex)
- Anastrozole (Arimidex)
- Letrozole (Femara)
- Fulvestrant (Faslodex)
- Octreotide (Sandostatin)
Control of hair loss
Learning to control hair loss before, during and after treatment can help you cope with this side effect. For many people, hair loss due to cancer treatment is more than just a change in physical appearance. Hair loss can be an emotional challenge that affects the image of yourself (in English) and your quality of life.
Talking about what you feel in relation to hair loss with a counselor (in English), someone who has a similar experience, a family member or a friend could give you peace of mind. In addition, it can be useful to talk about the potential hair loss with family and friends, especially children, before it happens. For a child, knowing what changes will occur in the physical aspect of a person they know helps reduce anxiety and fear.
Some people recommend cutting shorter hair before starting treatment. Bringing shorter hair can make your hair appear more abundant. It can also make hair loss a less drastic change. And when the hair grows back, it takes less time to get to the previous long of the short style. Allowing hair to grow in a similar style can help you cope with the treatment and move on afterwards.
Cooling cap therapy. Wearing a hat or something that covers the head and freshens the scalp before, during or after chemotherapy can help prevent hair loss due to drugs that are administered by vein. This is also known as scalp cryotherapy. The cold narrows the blood vessels in the skin on the head. This decreases blood flow, which could mean that less drug reaches the hair follicles. The hair follicles are the small holes through which the hair grows. Because of this, hair follicles are less likely to be damaged by chemotherapy.
Talk to your health care team for more information about this approach and if it could be helpful.
Medicines. A topical over-the-counter medication, called minoxidil, may be helpful in treating hair thinning due to hormone therapy or targeted therapy. It could also be useful for people whose hair did not grow back completely after chemotherapy, stem cell transplantation or radiation therapy. Occasionally, oral medications such as spironolactone (Aldactone) or finasteride (Propecia, Proscar) may also improve hair growth in these situations.
Hair and scalp care. The following recommendations may help you care for hair and scalp during cancer treatment:
- Use a mild unscented shampoo to wash the hair.
- Consider not washing your hair every day and do not scrub vigorously.
- Pat your hair to prevent it from getting damaged.
- Choose a soft brush or comb with wide teeth and comb delicately.
- Protect the scalp from the sun with sunscreen, hat or handkerchief when outdoors.
- Cover your head in the cold months to preserve body heat.
- Avoid using hair dryer with very hot air or pulling hair.
- Avoid curling or straightening hair with chemicals.
- Avoid using permanent or semi-permanent dyes.
- Use a comfortable and soft cover for the bed pillow.
- Talk to your health care team before using any cream or lotion for hair growth.
- Talk to your health care team about taking vitamin B biotin.
Wigs and hairpieces. The following tips may be useful if you choose to wear a wig or hairpiece when your hair begins to fall:
Try to find a store that sells wigs and hairpieces designed specifically for people with cancer. You could also schedule an appointment at your home or order through a catalog.
There are many types of wigs and hairpieces. If you want a wig or hairpiece that looks like your own hair, it is useful to choose a wig or hairpiece before your hair falls out. In this way, the match with your style and hair color will be greater. You may also want a wig or a hairpiece with a new cut that you have always wanted to try. A hairdresser can help you comb the wig or hairpiece.
Your health insurance company may cover wigs or hairpieces. Wigs and hairpieces can also be classified as tax-deductible medical expenses. It is possible that the doctor should prescribe the use of a wig or a hairpiece so that you can present the prescription at your insurance company. There may also be wigs or hairpieces on loan or free at the center where cancer is treated or at other community organizations. Consult the resources with an oncology social worker (in English) or with the nursing staff.
Make sure the wig or hairpiece fits in the store. This will help prevent irritation of the scalp.
Hair care that grows back. When the hair begins to grow back, it will be much thinner and will be damaged more easily than your original hair. It is also possible to grow back with a different texture or a different color from your original hair. The following tips could be useful to take care of the hair that grows back:
- Wash your hair only twice a week.
- Massage the scalp to remove scales and dry skin.
Use a comb with wide teeth, instead of a brush, for hair. When combing, avoid picking up and holding the hair, curling it or using the hair dryer with very hot air.
Avoid curling or straightening hair with chemicals, such as solutions for permanent waving, until the hair grows back. Some people may need to wait up to a year to be able to curl or straighten their hair with chemicals. Before trying again with chemicals, try a small strand of hair to see how it reacts. You can also ask your hairdresser for suggestions.
Avoid using permanent or semi-permanent dyes for at least 3 months after treatment.