Sudden loss of hair, or alopecia, is a side effect of chemotherapy and radiation therapy that is usually temporary, except with very high doses of radiation. It occurs at different rates and to different degrees in individuals.
Chemotherapy and radiation therapy result in atrophy of the hair follicle; the hair produced is weak and brittle and either breaks off at the surface of the scalp or is spontaneously released from the follicle. Loss of scalp hair associated with chemotherapy varies in degree from slight thinning to complete baldness, depending on the dose and length of therapy.
Some patients find that their hair is only slightly thinner after weeks of chemotherapy; others lose all hair immediately. Changes in hair color or texture may occur during regrowth. Often the new hair is softer and thicker than before; gray hair sometimes grows back in its original color.
Loss of other body hair is less frequent and less severe, because the hair has a shorter period of active growth and thus receives less exposure. Nevertheless, hair loss can occur on the eyebrows and other parts of the face, the chest, underarms and groin, and arms and legs.
Alopecia can also be the result of chronic stress, protein malnutrition (since hair, like protein, is composed of amino acids), medications, or other medical conditions unrelated to cancer.
Compared to the life-threatening nature of cancer, temporary loss of hair may seem minor or insignificant, but many patients, both men and women, have said that it was the most stressful event they experienced during their illness. Because hair is often an important part of body image, patients experiencing even a temporary loss may feel anger, sadness, embarrassment, and fear of rejection.
Fortunately, new techniques can minimize the extent of hair loss. Recent research indicates that use of a cold compress or “ice turban” on the head during the chemotherapy restricts circulation to the head, preventing the drugs from reaching the scalp hair follicles. Scalp tourniquets have also been used for the same effect. Although studies are not yet conclusive and these techniques are not applicable in all types of cancer or with all types of chemotherapeutic drugs, they may prevent or minimize hair loss.
Patients with cancer can do much to minimize the amount of hair loss and to protect the hair when regrowth begins by minimizing unnecessary manipulation of the hair.
- Have it cut in an easy-to-manage style before treatment begins.
- Use a mild, protein-base shampoo, cream rinse, and hair conditioner every four to seven days. Avoid excessive shampooing, rinse the hair thoroughly, and gently pat it dry.
- Avoid using an electric hair dryer, or use it only at the lowest setting. Ideally, the hair should be air-dried.
- Avoid electric curlers and curling irons, hair clips, elastic bands, barrettes, and bobby pins. Hair spray, hair dye, and permanent solutions may increase the fragility of the hair and should also be avoided.
- Avoid excessive brushing and combing of the hair. Combing with a wide-tooth comb is best.
- Use a satin pillowcase to decrease hair tangles.
- Persons receiving chemotherapy should ask their doctors whether to expect hair loss and if so, how much. Persons expecting total hair loss should:
- Select a wig in advance. A wig as close as possible to the color and style of the hair can be more easily selected before the hair loss occurs. If the hair loss has already occurred, the patient should take an earlier photograph to the wig shop to assist in selection.
- Do comparative shopping for a wig. Wigs should be stylish, lightweight, and reasonably priced. Synthetic wigs are usually more comfortable, easier to care for, and less expensive than human-hair wigs. The approach of the sales person is important: one who offers privacy and empathy can do a great deal to minimize a potentially traumatic event. Investigate resources for obtaining a wig. Many American Cancer Society units and some hospitals maintain wig banks to supply wigs at no “• charge. Wigs and hairpieces are tax-deductible for persons with cancer and some health insurance policies will reimburse the patient whose doctor has written a prescription for a wig.
- Begin to wear the wig before treatment begins. Adjusting to wearing a wig is easier if it becomes part of the lifestyle before hair loss begins.
- Wear a hat, nightcap, scarf, or turban to conceal hair loss. Such accessories are attractive as well as stylish.
- At home, use a hairnet to minimize shedding of hair in bed or on clothes.
- Use eyebrow pencil or false eyelashes if necessary.
- Keep the head covered in summer to prevent a severe sunburn and in winter to prevent heat loss.