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Hair Loss

Hair loss (alopecia) is a common side effect of some cancer treatments including chemotherapy and radiation therapy. The cells that control hair growth are fast-growing cells and can be damaged by treatments that attack cancer cells. This is because many cancer treatments attack cells that divide and grow rapidly, like cancer cells and cells of the hair follicle.

The risk of hair loss and how and when it occurs can be different for each treatment and for each patient. Hair loss with chemotherapy and other cancer medicines is usually temporary, and hair will grow back after treatment ends. However, some patients may see lasting changes in hair growth, texture, or appearance, especially after radiation therapy.

Hair loss can cause a great deal of worry and distress for children and teens facing cancer. The care team can help families know if a specific treatment might cause hair loss and what to expect.

Hair Loss After Chemotherapy

Not all chemotherapy drugs cause hair loss. Certain medicines have a very high risk of hair loss. Other medicines cause hair loss less often, or hair loss may be less noticeable. The timing and degree of hair loss depends on the type, dose, and schedule of chemotherapy.

Hair loss is often most visible on the scalp toward the front of the head where hair is not as thick. Some patients develop complete baldness. Other patients may have thinning hair or patchy hair loss. Because chemotherapy travels throughout the body, hair loss can also include eyebrows, eye lashes, and body hair.

For many patients, hair loss begins 2-4 weeks after the start of chemotherapy. Hair may fall out in clumps or thin gradually. After chemotherapy ends, hair will start to grow back. It may take 2-3 months before new hair growth is seen. Hair may be a different texture, especially at first. Some patients may have “chemo curls” where hair grows back curlier than before.

Why Does Chemotherapy Cause Hair Loss?

Hair growth occurs under the surface of skin. Each strand of hair goes through steps of a cycle, from active growth to shedding. Chemotherapy can harm the cells that control hair growth and support the hair follicle where hair develops. This can cause hair to fall out and prevent new hair growth.

What Cancer Medicines Cause Hair Loss?

Hair loss is a common side effect of some cancer medicines including certain chemotherapy and targeted therapy drugs. The likelihood and severity of hair loss is different for each medicine. Families should talk with their doctor or pharmacist to understand the risk of hair loss for the specific drug regimen prescribed.

Medicines with High Risk of Hair Loss Medicines with Moderate Risk of Hair Loss
Bleomycin (Blenoxane®)
Cyclophosphamide (Cytoxan®)
Daunorubicin (Cerubidine®)
Docetaxel (Docefrez®, Taxotere®) 
Doxorubicin (Adriamycin®)
Epirubicin (Ellence®)
Etoposide (Toposar®)
Idarubicin (Idamycin PFS)
Ifosfamide (Ifex®)
Irinotecan (Camptosar®)
Paclitaxel (Abraxane®, Taxol®)
Temozolomide (Temodar®)
Vismodegib (Erivedge®)
Vemurafenib (Zelboraf®)|
Vorinostat (Zolinza®)
Carboplatin (Paraplatin®)
Cisplatin (Platinol®)
Cytarabine (Cytosar-U®, Depocyt®)
Dabrafenib (Tefinalar®)
Dactinomycin (Cosmegen®)
Fluorouracil (Adrucil®)
Gemcitabine (Gemzar®)
Hydroxyurea
Lomustine (Gleostine®)
Melphalan (Alkeran®, Evomela®)
Methotrexate (Rasuvo®, Trexall®)
Mitoxantrone (Novantrone®)
Sorafenib (Nexavar®)
Thiotepa (Tepadina®)
Topotecan (Hycamtin®)
Vinblastine (Velban®)
Vincristine (Vincasar PFS®)

Visit the List of Medicines to view possible side effects for different drugs.

The risk of hair loss during chemotherapy depends on factors such as:

  • Dose of chemotherapy – Higher doses of chemotherapy increase risk of hair loss.
  • Method or route of administration – IV chemotherapy can have greater risk compared to medicines taken by mouth.
  • Frequency of chemotherapy – Patients who get chemo every 2-3 weeks may have more hair loss than with a weekly chemotherapy regimen.
  • Whether chemotherapy is given as a single drug or in combination – Combination chemotherapy often increases risk of hair loss.
  • Other factors that may increase the risk of hair loss during chemotherapy include

Hair Loss After Radiation Therapy

Patients receiving radiation therapy usually have hair loss in the area of treatment. The amount of hair loss after radiation depends on the size of the area treated and the dose of radiation. Some patients will have complete hair loss in the area, while other patients may have thinning of the hair. Hair loss due to radiation can sometimes be permanent, especially if high doses of radiation were used. Hair that grows back may not be as thick or may be a different texture. Hair usually grows back 3-6 months after radiation treatment ends.

Coping with Hair Loss: Tips for Families

Hair loss can be one of the most upsetting side effects of cancer treatment. Hair loss is a visible reminder of being sick. For children and teens trying to be “normal” and fit in with their peers, this can have a big impact on well-being and quality of life. The care team, including child life specialists, social workers, and psychologists, can help prepare families and provide resources. It can also help to hear from other families about their experiences.

Before Treatment Begins / Before Hair Loss

  • Discuss side effects with the care team. Plan for side effects, including hair loss, by talking with the care team. Hair loss is not always predictable, but the care team can help families understand whether hair loss is likely with a particular treatment.
  • Prepare ahead of time. Hair loss can be sudden or gradual. It can be surprising and scary when it happens, even if you expect it. Hair may fall out in the shower or you may notice hair on the pillow or in your brush. A child life specialist can help families prepare children using age-friendly information.
  • Make a plan for when hair falls out. Some patients cut their hair short or shave their head before hair falls out. Other patients may wait and see what happens. This might be a time to try a crazy haircut or hair color. Be sure to check with the care team before using any dye or chemical product. Also, keep in mind that hair dye can damage hair and contribute to hair loss.
  • Consider head cover options. It can help to think about hats, head scarves, and wigs before hair falls out. Shopping for head coverings can give patients some sense of control and personal choice. Encourage patients to think about their personal style and comfort. A variety of options are available, and they can be a way to express personality, communicate gender, and promote social interaction. Hats and wigs are available in sizes and styles specially designed for children.

Choosing a Wig or Hat

Some patients may choose to wear hats, head scarves, bandanas, or wigs. Other patients find wearing head coverings uncomfortable. It is a personal choice for patients and families. Factors to consider include:

  • Comfort
  • Personal expression
  • Warmth/sun protection
  • Cost
  • Ease of wear
  • Ease of upkeep

Many children’s hospitals partner with organizations that help provide hats, scarfs, and wigs to patients in need. A social worker can also help families explore options and understand what is or isn’t covered by insurance.

 

During Treatment / Hair Loss

  • Treat hair gently. Use a mild shampoo such as baby shampoo to clean hair and scalp. Wash gently, and avoid rubbing too hard. Pat dry with a towel. Do not wash hair every day. Brush hair gently with a soft brush or wide toothed comb. Be careful with hair accessories that can get tangled or pull on hair.
  • Protect skin. Newly exposed skin is extra sensitive. The scalp may become red, flaky, and tender. Follow care team instructions for skin care and protection, especially after radiation therapy. Protect skin from the sun by limiting time outdoors, wearing a hat, and using sunscreen.
  • Talk to children about how to handle hard questions and situations. Hair loss can be especially difficult as children go back to school and social activities. Help children think about how they might respond to questions, looks, and even bullying. In most cases, people are just curious. Prepare and practice responses ahead of time so that interactions are less awkward. Encourage children and teens to be themselves and not to let appearance keep them from doing the things they enjoy.

Many children and teens struggle with body image concerns during and after cancer. Some patients may develop symptoms of anxiety or depression or avoid friends and social activities. If body image concerns get worse or affect daily activities, talk to a mental health professional.

 

After Treatment / New Hair Growth

  • Continue to treat hair and scalp gently. Protect scalp from the sun while hair grows in.
  • Wait until hair has grown in before coloring hair or using chemical products.
  • Do not use vitamins, supplements, or topical hair growth products without talking to a doctor.
  • Find a professional hair stylist who has worked with cancer patients and can give advice during the growing out process.

Each patient copes with hair loss differently. What is helpful for one person may not be helpful for another. For example, friends and family often wish to shave their heads in support of the patient. For some patients, this can help them feel like they are not alone. But for other patients, this can make them feel worse. Some patients say that seeing their family or friends without hair is just another reminder and further reduces the normalcy in their lives. Family and friends can ask the patient directly about what they find supportive.

Patients often have ups and downs in coping with hair loss. Life events, embarrassing moments, dealing with head coverings, or just the long process of hair loss and hair regrowth can present new challenges and emotions. Frustration, anxiety, self-consciousness, sadness, and anger are all common emotions that can come up any time. Talking to a trusted friend, especially a fellow patient or survivor, can help provide support. Coping is a process. If negative emotions get worse or interfere with daily activities, talk to your care team. A variety of resources and mental health services are available to help.

Common Questions about Hair Loss and Cancer

Will chemo make me lose my hair? It depends. Hair loss is very common with certain chemo medicines. However, chemo does not always cause hair loss. Some patients may not lose their hair. Others may have thinning hair. With some chemotherapy, hair loss is complete and includes eyebrows, eyelashes, and body hair. The specific type of chemo and the dose you receive will determine the risk of hair loss and how it occurs.

When will my hair fall out after chemo? Usually, hair begins to fall out 2-3 weeks after starting chemo. Hair loss may be seen sooner or later, depending on the chemo schedule.

Will my hair grow back after chemo? Hair loss after chemo is usually temporary. But it might take a while to regrow hair after treatment ends. Most patients see hair growth 2-3 months after chemo is complete. New hair may appear more like “peach fuzz” and then will fill in as the hair growth cycle returns to normal. It can take 6-12 months before hair reaches full thickness. Parents may need to explain to children who had long hair that growing out the length can take a very long time. On average, hair grows about 6 inches per year.

Will I lose my hair after radiation? Hair loss after radiation therapy is generally limited to the parts of the body that receive treatment. Patients who have radiation to parts of the body other than the head will not lose the hair on their head unless they also receive chemo or other medicines that cause hair loss.

Can I prevent hair loss during chemo? Currently, there is no safe and effective way to prevent hair loss in children receiving chemotherapy. Scalp cooling using cooling caps has shown some potential benefits in preventing hair loss in adults with cancer. However, the research is limited, and there is not enough information about the safety or effectiveness in children. Read more about cooling caps in cancer below.

Resources for More Information about Hair Loss