Why Chemotherapy Causes Hair Loss

Those Most And Least Likely Drugs To Have This Side Effect Of Cancer Treatment

Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.

• Other Causes

To many, hair loss is one of the more dreaded side effects of chemotherapy for cancer. An estimated 65% of patients undergoing classic chemotherapy experience what doctors call alopecia. But while some chemotherapy medications almost always result in such hair loss, others typically cause minimal hair loss.

Other factors related to chemo can affect hair loss as well, such as the dose of the drug given. Of course, effectively treating your cancer is the top priority. But knowing about this potential in advance can help you prepare for it. Fortunately, there are options available to help people cope with this symptom.

/ How Do I Care For My Hair During My Chemotherapy

During chemo we recommend gentle care for your hair. Dont wash it too often and always use a gentle, mild shampoo. If you need to use a hair dryer, make sure you always use the lowest temperature setting. Try not to let your hair dry out due to sun exposure, colour treatments or perms. Hard brushes and curlers are definitely to be avoided as well.

How To Tackle Hair Loss Caused By Chemotherapy

Although most of the drugs used in the treatment of cancer can cause hair loss, some of them do not. The pattern of hair loss differs from drug to drug. While some will cause a rapid loss of hair, others might start off with the thinning of hair.

It is also important to talk to your doctor so they can the side effects can be explained before going into the therapy. It is a good idea to let your family know what to expect, especially the young ones.

You can choose a scarf or a wig to wear after the loss of hair occurs. The loss of hair by chemotherapy is temporary. The hair that grows after the therapy might also be of a different shade from the original. This is also temporary.

However, you could reduce the impact of chemotherapy drugs on your hair follicles using a cooling cap.

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Effect Of Other Cancer Therapies

The newer targeted therapies for cancer don’t usually cause total hair loss like chemotherapy drugs but can result in changes such as thinning of the hair and dryness, as well as changes in texture similar to chemo curls. Some targeted therapies may also affect the pigmentation of hair, often causing the hair to become darker.

Some of the targeted therapies that have been linked with hair changes or hair loss include:

• Cyclin-dependent kinase 4/6 inhibitors such as Ibrance , Kisqali , and Verzenio
• VEGF inhibitors such as Nexavar
• BRAF inhibitors such as Zelboraf and Tafinlar
• Bcr/Abl inhibitors such as Tasigna and Gleevec

Some of the hormonal therapies commonly used for breast cancer have been associated with thinning of the hair for some people. Unlike chemotherapy, people may be using the drug for many months or even years before they notice the changes in their hair. Hormonal therapies more often linked to hair loss include:

• Tamoxifen
• Aromatase inhibitors: Hair loss appears to be more common with Arimidex and Femara than with Aromasin .
• Faslodex

Immunotherapy drugs for cancer, at least checkpoint inhibitors, do not usually cause hair loss, though oftentimes these drugs are used along with chemotherapy. Researchers are looking at ways of harnessing the gene involved in autoimmune alopecia to improve the effectiveness of chemotherapy.

When Will My Hair Grow Back

Once you finish your treatments, your hair should begin to grow back. Hair regrowth can take 3 to 5 months. When your hair grows back, it may have a different texture or color. In rare cases, your hair wont grow back as fully as it did before.

There is a very small risk that your hair wont grow back after radiation therapy to your head.

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Do All Chemo Patients Experience Hair Loss

The degree at which you may experience hair loss depends on a number of factors :

• The dosage of the medication.
• Frequency at which chemotherapy is given.
• Intravenous drugs are more likely to result in hair loss.
• Certain medicines used in combination can result in alopecia.
• Genes or your individual genetic makeup some patients are not as prone to losing hair while others may experience major hair loss.

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A Variety Of Head Coverings Are Available

If you feel self-conscious about hair loss, wearing a head covering might help. From wigs to scarves to hats, there are many options. Such coverings can also protect your head from sunlight exposure and cold air.

If you think you might want a wig that matches your natural hair color, considering buying it before you begin chemotherapy. This may help the wig shop to better match the color and texture of your hair. Try on different styles until you find one you like.

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How To Prepare For Hair Loss

• Each person is different. Ask your health care team if hair loss is likely to happen. If it is, ask if it will happen quickly or gradually.
• If you are going to get chemotherapy that might cause hair loss, talk to your health care team about whether a cooling cap might help reduce your risk. More research is being done to understand how effective and safe cooling caps may be. There are some side effects of cooling caps to consider, such as headaches, scalp pain, and neck and shoulder discomfort. Talk to your health care team about the benefits, limitations, and side effects of cooling caps.
• If the thought of losing your hair bothers you, you might choose to cut your hair very short or even shave your head before it starts falling out.
• If you think you might want a wig, buy it before treatment begins or at the very start of treatment. Ask if the wig can be adjusted you might need a smaller wig as you lose hair. To match hair color, you can cut a swatch of hair from the top front of your head, where hair is lightest..
• Wigs and other scalp coverings may be partially or fully covered by your health insurance. If so, ask for a prescription for a cranial prosthesis. Do not use the word wig on the prescription.
• Get a list of wig shops in your area from your cancer team, other patients, or from the phone book. You can also order the American Cancer Societys tlc Tender Loving Care® catalog by visiting tlc or by calling 1-800-850-9445.

/ Why Does Chemotherapy Make My Hair Fall Out

Hair loss or alopecia is the best known and most visible side effect of chemotherapy. Actually chemotherapy is an umbrella term for any cancer treatment using what are known as cytostatics. Cancer cells tend to divide rapidly. Cytostatic drugs are drugs that aim to quickly destroy these rapidly dividing cells or to delay their growth. Unfortunately, they also kill other, healthy cells that also divide rapidly, such as the cells in our hair follicles that make our hair grow. This is why chemotherapy also causes hair loss.

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Can I Prevent Hair Loss From Chemo

While hair loss may depend on the chemotherapy drug used and how the treatment is given, these choices are appropriately made to be the most effective against the type of cancer being treated.

One preventive measure is the use of scalp cooling. This can be done with ice packs, cooling caps, or scalp cooling systems used before, during, or after treatment. This causes the capillaries supplying the hair follicles to constrict, so they are exposed to less of the chemotherapy medication.

The effectiveness of scalp cooling is still being studied, but devices have been approved by the Food and Drug Administration. It seems to work best for taxane-based chemotherapy.

Using Rogaine has not been shown to prevent hair loss, but it may reduce the severity or shorten the time it takes to regrow the hair .

Being gentle with your hair and scalp can help reduce hair loss and breakage, as well as prevent scalp irritation. Follow these tips:

• Do not shampoo frequently.
• Use warm water to clean your scalp, and pat dry rather than rubbing.
• Use mild shampoos and conditioners that do not have perfumes. Avoid any hair products such as hair spray, gels, or oils.
• Be gentle and keep combing or brushing to a minimum.
• If you must use a hairdryer, use a low heat setting. Don’t use a curling iron.
• Avoid using brush rollers to curl or set hair, as well as any style where you pull the hair back with ponytail holders or hairbands.
• Dont dye your hair or get a perm.
• Try sleeping on a satin pillowcase.

When Will My Hair Grow Back After Chemotherapy

Typically, you wonât see hair regrowth right after chemotherapy. It takes some time for the medicines you have consumed during chemotherapy to completely leave your body. 2 to 3 weeks after the procedure, you may notice new hair strands .

You may even notice that the hair growth rate on your head is faster than the rest of your body. New hair may be slightly different in texture and type as compared to your original hair type. However, this is usually temporary. You may even notice a change in your hair color.

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Questions To Ask The Health Care Team

You may want to ask your cancer care team the following questions.

• Is my specific cancer treatment plan likely to cause hair loss?

• If so, when will my hair loss happen? Will I lose hair over time or all at once?

• How should I care for my hair and scalp during hair loss?

• When will my hair grow back? What can I expect when my hair does return?

• Is there a counselor, oncology social worker, or other team member who can help me cope with hair loss?

• Are there any programs that provide free or low-cost wigs or other head coverings?

Why Will I Lose My Hair During Cancer Treatment

Cancer treatments, such as radiation and chemotherapy, attack fast-growing cancer cells. These treatments can also affect normal cells that grow fast, such as hair cells.

Chemotherapy can cause hair loss on your scalp, pubic area, arms, legs, eyebrows, and eyelashes. Radiation therapy to your head often causes hair loss on your scalp. Sometimes, depending on the dose of radiation to your head, your hair may grow back differently from how it looked before, or it may not grow back at all.

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What You Should Know About Chemotherapy

• Not all chemotherapy drugs cause hair loss.
• Hair loss can be fast or slow you may lose all, or just some, of your hair hair may fall out in clumps hair may thin out.
• If you have total hair loss, you will lose eyelashes, eyebrows, armpit and pubic hair.
• Hair loss may begin 2-3 weeks after your first chemotherapy treatment, or it may not begin until after your second cycle.
• Hair may start growing back while you are still in treatment or three to six months after you have completed chemo.
• The extent of hair loss may depend on a number of factors: the chemo drug being used, the dose, how it is given and how frequently it is given. For example:
• People getting high-dose, intravenous chemo are more likely than those on low-dose or oral chemotherapy to have total hair loss.
• Combination chemotherapy regimens, particularly ones that include doxorubicin, docetaxel, paclitaxel, or etoposide are more likely to cause hair loss than chemotherapy with a single drug.

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Be Gentle To Your Head Skin Too

Treating the scalp skin is just as important as being gentle to your hair. There are methods you can use additionally to make sure there is no itch or bruises caused by scratching.

Also, ask your doctors about scalp hypothermia it involves placing ice packs or similar cooling items on your head before, during, and after chemotherapy. The consequences are a feeling of coldness which influences blood vessels to narrow down and take in less medicine. According to some experiences, this reduces hair loss.

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Why Do Not All Chemotherapy Patients Lose Their Hair Answering An Intriguing Question

• Extras : 6

Alopecia is one of the side effects of chemotherapy that patients fear most to the point that, just for that reason, up to 14% of women refuse chemotherapy. In fact, chemotherapy drugs destroy cancer rapidly growing cells, but do not spare other rapidly growing cells, including hair keratinocytes. In temporary alopecia, full regrowth is, however, possible. Within 96 h, DNA is repaired and hair bulb structures are restored , and within 36 months, new hairs are visible . In 65% of patients, they acquire temporary different features, including curliness in 35% of cases . Permanent or persistent alopecia is another possible outcome. High-dose busulfan and cyclophosphamide regimens, but breast cancer protocols as well, often including taxanes, are reported to cause it . Almost constantly, all hairy areas are involved. The severest forms occur in up to 10% of cases and seem to be associated with regulatory variants in the ABCB1 gene .

The current understanding of the problem takes into main consideration the high mitotic rate of hair keratinocytes, which, in fact, approach the maximum proliferative rate of keratinogenic epithelial cells . Hair keratinocytes are, just for that reason, particularly susceptible to any cytostatic insult. Stem cells are ordinarily spared, but in PA, they become the likely target of an undue antimitotic activity .

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Radiation Treatment And Hair Loss

Radiation therapy uses a high-energy beam to damage quickly growing cells in your body. The goal is to target cancer cells, but some normal cells get damaged as well.

Radiation only causes hair loss on the particular part of the body treated. If radiation is used to treat the breast, there is no hair loss on your head. But there might be loss of hair around the nipple, if you have hair there.

Radiation to the brain, used to treat breast cancer that has spread to the brain, can cause hair loss on your head. Depending on the dose of radiation, your hair may be patchier when it grows back or it may not grow back.

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