Alopecia is the medical term for hair loss. Chemotherapy induced alopecia is one of the most dreaded and feared side effects associated with chemotherapy. Patients have often told us that it is the one side effect that makes them feel like have cancer. It can be an unpleasant reminder of your illness and it can be an unwanted cue to strangers that you are sick.
Why does alopecia occur?
Chemotherapy attacks rapidly growing cells. Cancer cells are rapidly growing and this is why chemotherapy is used to treat cancer. Unfortunately, chemotherapy can also attack other rapidly growing cells in the body, including hair cells.
Depending on the drug, hair loss can be thinning to complete baldness. In addition, hair loss can occur all over the body. Sometimes body hair, eyelashes, eyebrows and pubic hair can fall out.
How and when will hair loss happen?
In general, hair will fall out 1-4 weeks after the start of chemotherapy. Whether you will lose all your hair or you have hair thinning will depend on your treatment. Often, the hair will fall out in clumps. It can also be more gradual and you will notice extra hair in the shower, in your hairbrush, or on your pillow. Your scalp can feel very tender when it hair falls out.
The hair loss will continue throughout your treatment and can continue for a few weeks afterward.
Will my hair grow back?
Almost always, hair loss from chemotherapy is temporary. Once chemotherapy is complete your hair will likely start to grow back. Regrowing your hair will take time. This can be a slow process and may take weeks to start regrowing but usually within 3-6 months there is visible regrowth of hair. Your hair may not look normal right away. Sometimes the shade and texture are different but this difference usually resolves with time.
Can I prevent the hair loss?
There isn’t a treatment that is 100% effective in preventing chemotherapy induced alopecia. Scalp hypothermia (or cooling caps) has been shown to be effective in preventing or reducing hair loss with some types of chemotherapy. The cost of cooling caps can be high and is often not covered by insurance. The average cost is $1500-3000. Scalp hypothermia is not recommended for patients with high number of circulating tumor cells, like leukemia or some types of lymphoma.
Scalp hypothermia works by the patient wearing a fitted cap on their head that is filled with chilled liquid or ice packs. This cap is worn during the chemotherapy infusion. The cold reduces blood flow to your scalp and this prevents the chemotherapy to reach the hair follicles (no chemo in the hair cells prevents hair cell death). The side effects include: headaches and feeling uncomfortably cold. There is also a small risk of cancer recurring in the scalp since it is not receiving chemotherapy.
There are a number of studies looking at the safety and efficacy of scalp hypothermia but the research is ongoing. Discuss these pros and cons with your cancer doctor or team, if you are considering cooling caps to prevent hair loss.
So, what else can I do?
Hair loss is a frustrating and anxiety provoking side effect of chemo. Prior to the start of chemo, we often suggest taking a few steps to try to minimize the emotional distress from hair loss.
Talk with your Cancer Care Team to discuss if the chemo you are taking has a high risk of alopecia.
Get a short haircut. Short hair looks fuller and as the hair falls out it will be less noticeable.
Be gentle with your hair. Don’t blow dry, curl, color, straighten, bleach, or perm your hair. Those treatments can cause stress on your hair and cause it to fall out faster. Use a gentle shampoo.
Plan for a wig or hair covering. Find out where you can get these products and if they are covered by your insurance. Wearing a wig or scarf is a personal decision. You may not want to use them once the hair loss occurs but we always suggest be prepared in case you do.
Photo by Element5 Digital on Unsplash