Coping with Hair Loss
Hair is constantly growing, with old hairs falling out and being replaced by new ones. Some cancer treatments make people lose some or all of their hair, most often in clumps during shampooing or brushing.
It’s normal for people to feel upset about losing their hair. It helps to know that hair grows back, and you can take steps to make its loss less of problem for you.
Hair is lost when chemotherapy drugs damage hair follicles, making hair fall out. It can be hard to predict which patients will lose their hair and which ones won’t, even when they take the same drugs. Some drugs can cause hair thinning or hair loss only on the scalp. Others can also cause the thinning or loss of pubic hair, arm and leg hair, eyebrows, and eyelashes.
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 is going to happen, it most often starts within 1-3 weeks of treatment and becomes more noticeable 1 to 2 months after starting therapy. Your scalp may feel very sensitive to washing, combing, or brushing. But hair often starts to grow back even before treatment ends.
How to prepare for hair loss
- Each person is different. Ask your health care team if hair loss is likely to happen. If it is, ask if it will happen quickly or gradually.
- If you are going to get chemotherapy that might cause hair loss, talk to your health care team about whether a cooling cap might help reduce your risk. More research is being done to understand how effective and safe cooling caps may be. There are some side effects of cooling caps to consider, such as headaches, scalp pain, and neck and shoulder discomfort. Talk to your health care team about the benefits, limitations, and side effects of cooling caps.
- If the thought of losing your hair bothers you, you might choose to cut your hair very short or even shave your head before it starts falling out.
- 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 – you might need a smaller wig as you lose hair. To match hair color, you can cut a swatch of hair from the top front of your head, where hair is lightest.
- Wigs and other scalp coverings may be partially or fully covered by your health insurance. If so, ask for a prescription for a “cranial prosthesis.” Do not use the word “wig” on the prescription.
- Get a list of wig shops in your area from your cancer team, other patients, or from the phone book. You can also order the American Cancer Society’s “tlc” Tender Loving Care® catalog (for women with hair loss due to cancer treatment) by visiting tlc or by calling 1-800-850-9445.
When you have hair loss
- If you’re going to buy a wig, try on different styles until you find one you really like. Consider buying 2 wigs, one for everyday use and one for special occasions. (See Choosing and Wearing a Wig.)
- Synthetic wigs need less care and styling than human hair wigs. They also cost less and may be easier to manage if your energy is low during cancer treatment.
- Some people find wigs are hot or itchy, and use turbans or scarves instead. Cotton fabrics tend to stay on a smooth scalp better than nylon or polyester.
- If your hair becomes very thin or is completely gone during treatment, be sure to protect the skin on your scalp from heat, cold, and the sun. Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 and a hat. In cold weather, wear a hat or scarf to cover and stay warm.
- Your scalp may feel itchy or sensitive. Be gentle when brushing and washing your hair. Using a wide-toothed comb may help.
- Hair loss might be somewhat reduced by avoiding too much brushing or pulling (which can happen while making braids or ponytails, using rollers, blow drying, or using curling or flat irons).
- Wear a hair net at night, or sleep on a satin pillowcase to keep hair from coming out in clumps. Be gentle with eyelashes and eyebrows, which might also be affected.
- When new hair starts to grow, it may break easily at first. Avoid perms and dyes for the first few months. Keep hair short and easy to style.
- Your new hair may be curlier or straighter, thicker or finer—or even a new color. Usually this change is short term; with time your hair will very likely go back to the way it was before treatment.
- Written by
- References
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Dest VM. Neurologic, ocular, and dermatologic toxicities. In Holmes Gobel B, Triest-Robinson S, Vogel WH, eds. Advanced Oncology Nursing Certification and Review Resource Manual. 2nd ed. Pittsburgh, PA. Oncology Nursing Society; 2016:611-614.
Katz A. Scalp cooling. Clin J Oncology Nurs. 2017; 21(4):413-415.
Komen MMC, van den Hurk CJG, Nortier JWR, van der Ploeg T, Smorenburg CH, van der Hoeven JJM. Patient-oriented outcome assessment and
objective evaluation of chemotherapy-induced alopecia. Eur J Oncol Nurs. 2018; 33:49-55.
Lacouture ME. Management of Dermatologic Toxicities. J National Comprehensive Cancer Network. 2015;13(5.5):686-689.
Maeng HM, Berger AM. Hair loss and other hair changes. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer:
Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019: 2129-2133.
Nail LM, Lee-Lin F. Alopecia. In Brown CG, ed. A Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA. Oncology Nursing Society;
2015:21-33.
Pappas-Taffer L, Kachiu Lee H, Higgins W, Robinson-Bostom L, McDonald DJ. Dermatologic toxicities of anticancer therapies. In Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia: Elsevier, 2014:648-675.
Roe H. Chemotherapy-induced alopecia: Advice and support for hair loss. Br J Nurs. 2011; 20(10):S4-11.
Suchonwanit P, McMichael AJ. Alopecia in association with malignancy: A review. Am J Clin Dermatol. 2018; 19(6):853-865.
Williams LA, Ginex PK, Ebanks Jr. GL, et al. ONS Guidelines for Cancer Treatment-Related Skin Toxicity. Oncology Nursing Forum. 2020; 47(5)
Last Revised: December 10, 2020
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