Cancer treatments and hair loss

You may not mind being bald, but if you do want to cover up there are many types of wigs or hairpieces|, hats, turbans, or scarves that you can use.

Chemotherapy Back to top

Chemotherapy| is a treatment which uses anti-cancer drugs to destroy cancer cells. The drugs work by attacking the cancer cells and disrupting their growth. Unfortunately, they can also affect the normal cells in the body, including the cells of the hair follicles. This causes hair loss, also known as alopecia. Unlike cancer cells, however, the normal cells quickly recover, so if you lose your hair due to chemotherapy it will almost always grow back when your treatment is over. Before you start chemotherapy, your doctor or chemotherapy nurse will discuss the possibility of hair loss and other side effects with you.

Not all chemotherapy drugs make your hair fall out, and sometimes the loss is so small it's hardly noticeable. However, some people will have temporary, partial or complete baldness. Some chemotherapy drugs make other body hair fall out, such as eyebrows, eyelashes, nasal hair, beard, moustache, chest, underarm, leg and pubic hair. The amount of hair that falls out depends on the drug or combination of drugs used, the doses given and the way that your body reacts to the drug.

If your hair is going to fall out, it usually starts within two to three weeks of starting chemotherapy, although very occasionally it can start within a few days. The first thing you may notice is that your hair starts to come out more when you brush, comb or wash it. You may also find hair on your pillow in the morning. We offer advice about looking after your hair| during this time.

Hair may just thin and become dry, fragile and break easily. For other people their hair may carry on falling out over a few weeks so that they become completely bald. Sometimes the hair comes out very quickly over 1-2 days, which can be very upsetting. Some people find that their scalp feels tender.

Preventing hair loss during chemotherapy

By cooling the scalp| it's sometimes possible to reduce the amount of chemotherapy drugs that reach the hair follicles on your scalp. This reduces, and in some cases prevents, the hair from falling out. It's done by using a 'cold cap' or a machine that cools the scalp. There are many different ways of cooling the scalp so the methods used vary from one hospital to another. Some hospitals don't have facilities for scalp cooling.

Types of scalp cooling

There are two widely available methods for scalp cooling: one uses a hat known as a cold cap which is filled with gel that can be chilled and the other uses a refrigerated cooling system to pump liquid coolant through a cap that is attached to the system.

Cold caps that are filled with gel can be applied easily and kept in place by Velcro. The cap can be very uncomfortable and heavy, as well as being very cold, and may give you a headache. It also needs to be changed every 20-40 minutes to keep your scalp cool.

Caps attached to the refrigerated cooling system generally feel lighter than the gel caps. You need to sit by the machine while the cap is in place, so you can’t walk about freely. However, the cap can be disconnected for short periods if necessary, for example if you need to use the toilet.

Both methods of scalp cooling need to be worn for some time before and after the chemotherapy drugs are given. You may have the cap on for a few hours in total. You may feel chilly during the treatment, but the chemotherapy staff will do all they can to make you as comfortable as possible.

Scalp cooling is only effective when used with certain chemotherapy drugs and it’s not always possible to know how effective the treatment will be until you try it. Scalp cooling is not advisable when treating some types of cancer. Your doctor or chemotherapy nurse can tell you if it’s available and whether it’s appropriate for you.

How will my hair grow back after chemotherapy?

Hair almost always grows back after chemotherapy. It may begin to grow back before you finish your treatment. At first the hair is very fine but you will probably have a full head of hair after 3-6 months. You may find that your new hair is curlier, straighter or finer than it was before. It may also be a slightly different colour, or sometimes a mixture of dark and grey hair. Very rarely, after high doses of chemotherapy the hair does not grow back.

Radiotherapy Back to top

Radiotherapy| treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells.

Unlike chemotherapy, radiotherapy causes hair loss only in the area being treated. For example, if you have radiotherapy to your head, you'll probably lose some hair from your scalp in the area where the radiotherapy beam goes into and out of your scalp. If you are having treatment for breast cancer|, and the radiotherapy includes your armpit, the hair under your arm is likely to fall out.

Will my hair grow back after radiotherapy?

Hair does not always grow back after radiotherapy treatment. Some people have permanent hair loss, or find that the hair that grows back is patchy. Your doctor or radiographer will discuss the possibility of permanent hair loss, and other side effects, with you before you start your treatment.

If you have patchy hair loss on your head you may want to continue wearing a hairpiece or wig| or some other type of headwear. If your hair loss is permanent, it may be possible to have a hair transplant. However this is a very specialised treatment which is not available on the NHS and is expensive.

If your hair does grow back it may not be as thick as it was before. The time it takes to grow back depends on the amount of radiotherapy you’ve had and the length of your treatment. On average your hair will start to grow back 3-6 months after finishing your treatment, but it may take longer if the treatment dose to your scalp has been high.

Other treatments Back to top

Other types of cancer treatment, including hormonal therapies| or biological therapies|, can sometimes make your hair thinner or dry and brittle. Your doctor, specialist nurse, or our cancer support specialists can let you know whether your treatment likely to affect your hair.