Cancer treatments and hair loss
Cancer treatments such as chemotherapy and radiotherapy can make your hair fall out. There are many ways of dealing with this.
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. These can also keep your head warm.
Chemotherapy 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 hair loss. Permanent hair loss following chemotherapy is rare.
Some chemotherapy drugs make other body hair fall out, such as eyebrows, eyelashes, nasal hair, beard, moustache, chest, underarm, leg and pubic hair. Again, this is almost always temporary.
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 2-3 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 have a section about looking after your hair.
Hair may just thin and become dry, fragile and break easily. For other people, their hair may carry on falling out over several weeks until 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.
If you lose the hair from inside your nose you may be more likely to have a runny nose. Although this can be irritating, it’s only temporary and will stop when the hairs grow back. Having plenty of tissues when you’re out and about can help.
Preventing hair loss during chemotherapy (scalp cooling)
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.
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.
Cold caps can be fitted easily and kept in place with Velcro. The cap can be uncomfortable and heavy, as well as being very cold, and it may give you a headache. It also needs to be changed every 20-40 minutes to keep your scalp cool.
The other type of scalp cooling uses a refrigerated cooling system to pump liquid coolant through a cap that is attached to the system.
This type of cap generally feels lighter than a gel-filled cap. 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 up to 30–40 minutes before your chemotherapy drugs are given and for some time afterwards. 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 and some hospitals don’t have facilities for scalp cooling. Your doctor or chemotherapy nurse can tell you if it’s available and whether it’s appropriate for you.
Will my hair grow back after chemotherapy?
Hair almost always grows back after chemotherapy treatment finishes. It may even begin to grow back before you finish your treatment.
At first, the hair will be 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 treats cancer by using high-energy rays that 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're having treatment for breast cancer and the radiotherapy includes your armpit, the hair under your arm is likely to fall out. You can ask the radiotherapy staff to show you exactly where your hair will fall out.
Will my hair grow back after radiotherapy?
Hair doesn't 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, 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 specialised treatment that isn't available on the NHS. It can also be expensive and take a long time to complete. Your GP can refer you to a dermatologist (a specialist in skin conditions) or a plastic surgeon with expertise in this area if you’d like to know more about hair transplants. You can also contact a trichologist (a hair health specialist) for a referral. The Institue of Trichologists can give you more information.
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 how long you had treatment for. 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 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.