Coping with Hair Loss During Cancer Treatment

Hair loss, known medically as alopecia, is one of the most common side effects of chemotherapy, the drugs used to attack the cancer cells in your body. It’s normal for both men and women to worry about losing their hair during cancer treatment. Hair loss can be difficult emotionally because of the way it alters your appearance.

It’s hard to predict exactly how much hair loss you will have. Some people lose all the hair on their body, even their eyebrows and the hair on their arms and legs. Others lose only a little bit of hair or none at all, even though they are taking the same medications.

The good news is that, for almost everyone, hair usually starts to come back about two months after treatment ends.

Why hair loss occurs

Your scalp has about 100,000 hairs. They age, fall out, and are replaced by new hairs in a continuous process, often without your noticing. Hairs grow in follicles and rely on nutrient-rich blood reaching those follicles to help strands become healthy and strong. When you have chemotherapy, your blood carries that powerful medication to your hair follicles as well, causing your hair to fall out.

Hair usually starts to fall out within one to two weeks of your first treatment. Hair loss may be at its worst about one month after the start of treatment. As hair falls out, you may find clumps of it on your pillow and in your brush or comb. You may also notice that your scalp is quite sensitive when you brush or comb your hair.

Coping with hair loss

You can take steps to prepare yourself for the possibility of hair loss before you start chemo:

• Consider your comfort level. Think about how you might feel as you experience gradual hair loss. Some people choose to cut their hair short or even shave it all off before treatment begins to take some control.

• Learn to care for your hair. To help protect your hair during chemotherapy:

  • Be gentle. Avoid tugging (such as brushing it into a ponytail or making a tight braid), heat (hot rollers and straightening irons), and chemical treatments (perms and coloring).

  • Also be gentle with eyebrows and eyelashes, which may fall out.

  • Use a wide-tooth comb to style.

  • Wash hair gently.

• Consider a wig. Ask your doctor for a prescription for a wig (or hair prosthesis). With a prescription, you may be able to get your health insurance plan to cover part or all of its cost. You might even want to buy more than one wig for variety. If you want a wig that’s similar to your natural hair color and style, go wig shopping before treatment begins to get the best match; ask if your wig can be adjusted for comfort during treatment if necessary. Also, learn how to care for and style a wig; some types need to be maintained by a professional stylist.

• Get creative with turbans. Consider cotton turbans or big scarves as alternatives to a wig if your scalp becomes uncomfortable or if you simply want to change your look while waiting for your hair to grow back. The American Cancer Society offers turbans, scarves, and other hair coverings at the not-for-profit site Tender Loving Care. 

• Protect your scalp from the sun. Apply sunblock and wear a hat or scarf to cover your scalp.

When your hair starts to grow back, it may be fragile and break when styled. Be gentle when brushing and styling the new growth. It's also recommended that patients avoid perms for the first few months after the new growth starts.