Hair & Health Issues

You might not think of your hair's importance in your everyday life until you face losing it. And if you have cancer and are about to undergo chemotherapy, the chance of losing your hair is very real. Both men and women report hair loss as one of the side effects they fear most after being diagnosed with cancer.

Whether or not your hair falls out from your chemotherapy depends mostly on the type and dose of medication you receive. But whether you can maintain a healthy body image after you hair falls out depends a lot on your attitude and the support of your friends and family.

Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body — including those in your hair roots.

Chemotherapy may cause hair loss all over your body — not just on your scalp. Sometimes your eyelash, eyebrow, armpit, pubic and other body hair also fall out. Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness. Talk to your doctor or nurse about the medication you'll be taking. Your doctor or nurse can tell you what to expect.

Fortunately, most of the time hair loss from chemotherapy is temporary. You can expect to regrow a full head of hair six months to a year after you stop treatment, though your hair may temporarily be a different shade or texture.

Hair usually begins falling out 10 to 14 days after you start treatment. It could fall out very quickly in clumps or gradually. You'll likely notice accumulations of loose hair on your pillow, in your hairbrush or in your shower drain.

Your hair loss will continue throughout your treatment and up to a month afterward. Whether your hair thins or you become completely bald will depend on your treatment. You generally need to lose about 50 percent of your hair before it's noticeable to other people.

It takes about four to six weeks for your hair to recover from chemotherapy. In general, you can expect about a quarter inch of growth each month.

When your hair starts to grow back, it will probably be slightly different from the hair you lost. But the difference is usually temporary. Your new hair might have a different texture or color. It might be curlier than it was before, or it could be gray until the cells that control the pigment in your hair begin functioning again.

No treatment exists that can guarantee your hair won't fall out during or after chemotherapy. The best way for you to deal with impending hair loss is to plan ahead and focus on making yourself comfortable with your appearance before, during and after your cancer treatment.

Several treatments have been investigated as possible ways to prevent hair loss, but none has been absolutely effective, including:

• Scalp hypothermia (cryotherapy). During your chemotherapy, ice packs or similar devices are placed on your head to slow blood flow to your scalp. This way, chemotherapy drugs are less likely to have an effect on your scalp. In general, scalp hypothermia works somewhat in 50 percent to 80 percent of people going through chemotherapy who try it. However, the procedure also causes a small risk of cancer recurring in your scalp, as this area doesn't receive the same dose of chemotherapy as the rest of your body. Most people who try this procedure find it to be uncomfortable and very cold.
• Minoxidil (Rogaine). Applying minoxidil — a drug approved for pattern hair loss in men and women — to your scalp before and during chemotherapy isn't likely to prevent your hair loss, although some research shows it may speed up your hair regrowth. In one small study, women undergoing chemotherapy for breast cancer applied minoxidil twice daily throughout their treatment and for four months afterward. Though their hair eventually all fell out, it took longer for the women who applied minoxidil to lose all their hair than it did for the women who didn't use it, and their hair started to grow back earlier.

Your hair loss generally can't be prevented or controlled, but it can be managed. Take the following steps throughout your treatment to minimize the frustration and anxiety associated with hair loss.

Before treatment

• Be gentle to your hair. Get in the habit of being kind to your hair. Don't bleach, color or perm your hair — this can weaken it. Air dry your hair as much as possible and avoid heating devices such as curling irons and hot rollers. Making your hair strong now might make it more likely to stay in your head a little longer during treatment.
• Consider cutting your hair. Short hair tends to look fuller than long hair. So as your hair falls out, it won't be as noticeable if you have short hair. Also, if you have long hair, going short might help you make a better transition to total hair loss.
• Plan ahead for a head covering. Now is the time to start thinking about wigs, scarves or other head coverings. Whether you choose to wear a head covering to conceal your hair loss is up to you. But it's easier to plan for it now rather than later. Your health insurance might help cover the cost of a wig. Talk to your insurance provider.

During treatment

• Baby your remaining hair. Continue your gentle hair strategies throughout your treatment. Try using a satin pillowcase, which is less likely to attract and catch fragile hair. Use a soft brush. Wash your hair only as often as necessary. Consider using a gentle shampoo when washing your hair. Stay away from shampoos with strong detergents and chemicals that can dry out your scalp, including salicylic acid, alcohol and strong fragrances.
• Consider shaving your head. Some people report that their scalp feels itchy, sensitive and irritated during their treatment and while their hair is falling out. Shaving your head can reduce the irritation and save the embarrassment of shedding. Some men shave their heads because they feel it looks better than the patchy hair loss they might be experiencing. Also, a shaved head might be easier for securing your wig or hairpiece.
• Protect your scalp. If your head is going to be exposed to the sun or to cold air, protect it with sunscreen or a head covering. Your scalp can be sensitive as you go through treatment, so extreme cold or sunshine can easily irritate it even more.

After treatment

• Continue gentle hair care. Your new hair growth will be especially fragile and vulnerable to the damage caused by styling products and heating devices. Hold off on coloring or bleaching your new hair for at least six months. Besides damaging new hair, processing could irritate your sensitive scalp.
• Be patient. It's likely that your hair will come back slowly and that it might not look normal right away. But growth takes time, and it also takes time to repair the damage caused by your cancer treatment.

Covering your head as you hair falls out is a purely personal decision. For many women hair is associated with femininity and health, so they choose to maintain that look by wearing a wig. Others choose hats and scarves. Still others choose not to cover their heads at all.

Ask your doctor or a hospital social worker about resources in your area to help you find the best head covering for you. Look Good ... Feel Better is a free program that provides hair and beauty makeovers and tips to women with cancer. These classes are offered throughout the United States and in several other countries. Many classes are offered through local chapters of the American Cancer Society. Look Good ... Feel Better also offers classes for teens with cancer, as well as a Web site especially for men.

Radiation therapy also attacks quickly growing cells in your body, but unlike chemotherapy, it affects only the specific area where treatment is concentrated. If you have radiation to your head, you'll likely lose the hair on your head.

Your hair usually begins growing back after your treatments end. But whether it grows back to its original thickness and fullness depends on your treatment. Different types of radiation and different doses will have different effects on your hair. Higher doses of radiation can cause permanent hair loss. Talk to your doctor about what dose you'll be receiving so you'll know what to expect.

Radiation therapy also affects your skin. The treatment area is likely to be red and may look sunburned or tanned. If your radiation treatment is to your head, it's a good idea to cover your head with a protective hat or scarf because your skin will be sensitive to cold and sunlight. Wigs and other hairpieces might irritate your scalp.

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