The normal scalp contains about 100,000 hairs. They are constantly growing, with old hairs falling out and being replaced by new ones. Some cancer treatments will cause people to lose some or all of their hair, most often in clumps during shampooing or brushing. Sometimes clumps of hair are found on the pillow in the morning.

It is normal for men and women to feel upset about hair loss. It helps to understand why it happens, to know that hair will grow back, and to take steps to make it less of problem for you.

Hair loss can happen when chemotherapy drugs travel throughout the body to kill cancer cells. Some of these drugs damage hair follicles, causing the hair to fall out. Hair loss can be hard to predict. Some patients have it, and others do not, even when they take the same drugs. Some drugs can cause hair loss on the scalp and other places on the body, including pubic hair, arm and leg hair, eyebrows, and eyelashes. Some drugs can cause only the loss of head hair. Radiation therapy to the head often causes scalp hair loss. Sometimes, depending on the dose of radiation to the head, the hair does not grow back the same as it was before.

If hair loss does occur, it most often begins within 2 weeks of the start of treatment and gets worse 1 to 2 months after starting therapy. Your scalp may feel very sensitive to washing, combing, or brushing during the short time when your hair is actually falling out. Hair often starts to grow back even before therapy is completed.

What the patient can do

• If you think you might want a wig, buy it before treatment begins or at the very start of treatment. Ask if the wig can be adjusted--your wig size can shrink as you lose hair.
• If you buy a wig before hair loss begins, the wig shop can better match your hair color and texture. Or you can cut a swatch of hair from the top front of your head, where hair is lightest, to use for matching.
• Be sure to get a prescription from your doctor for the wig because it is often covered by insurance.
• Get a list of wig shops in your area from your doctor or nurse, other patients, or from the phone book. You can also order a "tlc"™ catalog (for women with hair loss due to cancer treatment) by calling 1-800-850-9445, or visit their Web site at www.tlcdirect.org.
• If you are going to buy a wig, try on different ones until you find one that you really like. Consider buying 2 wigs, one for everyday and one for special occasions.
• Synthetic wigs need less styling than human hair wigs. They may be easier to care for if you have low energy during cancer treatment.
• Some people find wigs to be hot or itchy. In that case, turbans or scarves can be used instead of wigs. Cotton items tend to stay on your smooth scalp better than nylon or polyester.
• Be gentle when brushing and washing your hair.
• Wear a hat or scarf outdoors in cold weather to reduce the loss of body heat.
• Use sunscreen, sunblock, or a hat to protect your scalp from the sun.
• Hair loss can be somewhat reduced by avoiding too much brushing or pulling of hair, and by avoiding heat (such as electric rollers, hair dryers, and curling irons).
• Wear a hair net at night, or sleep on a satin pillowcase to keep hair from coming out in clumps.
• Avoid styles that pull on the hair, such as braids or ponytails.
• Use a wide-toothed comb.
• Be gentle with eyelashes and eyebrows, which are sometimes affected too.
• If you are bothered by hair falling out, you may choose to cut your hair very short or even shave your head.
• When new hair starts to grow, it may break easily at first. Avoid perms for the first few months. Keep hair short and easy to style.

Go to a list of symptoms to find other problems in Caring for the Patient with Cancer at Home: A Guide for Patients and Families.

Revised: 04/07/08