(Alopecia)

Unfortunately, hair loss is a common side of effect of many chemotherapy agents and radiation treatment to the head.  How much hair you lose and for how long has to do with the radiation target area or drug dose, how long the drug remains in your body, the use of prolonged infusions, and the use of combination therapy.

In addition, some malignancies can spread in such a way as to destroy the hair follicles causing permanent hair loss.  If hair loss is indirectly due to a malignancy’s growth by robbing the body of protein and nutrients, the loss is likely to be temporary.

With chemotherapy, hair loss may take several forms: overall thinning, loss in patches, or total loss. The loss is usually temporary. 

With radiation therapy to the head however, hair loss may be permanent because of damage to the hair-growing follicles.

Hair loss begins 1 to 3 weeks after treatment begins and can occur suddenly with large clumps of hair falling out at once.  While you can’t stop the hair loss, you can plan ahead for how you will deal with it:  There are many options:

You may want to cut your hair very short before the loss begins.  Some patients even prefer a baldhead. 

If you are going to purchase a wig (which may be covered by your insurance policy), buy it before your treatment begins. That way it will be easier to match the color of your existing hair.

Headscarves, turbans, and hats are another option.

It can take several months for your hair to grow back but the good news is, for most people, it does grow back.

Chemotherapy drugs most likey to cause hair loss are:
Cisplatinum
Cytarabine (ARA-C)
Cyclophosphamide (Cytoxan)
Doxorubicin (Adriamycin)
Epirubicin
Etoposide (Taxol)
Ifosfamide
Vincristine (Oncovin)

Chemotherapy drugs less likely to cause hair loss are:
Actinomycin
Bleomycins
Daunorubicin
Methotrexate
Carboplatin
Mitomycine
Vinblastine

There are steps you should take to care for your hair and scalp during cancer treatments:

When you wash your hair use a mild shampoo like a baby shampoo.  Pat your hair dry carefully.

Avoid the use of anything that stresses, pulls or tugs at your hair: hair dryers, hot rolling irons, curlers of any type, and hair barrettes.

Your hair might grow back differently than it was when you lost it.  Patients report a new head of curly hair when it used to be straight or gray when it use to be black or thick when it use to be thin.

Research to Prevent Hair Loss

Research is underway on products that someday may be able to reduce the hair loss associated with chemotherapy and radiation treatments.  In January 2001 an article in Science detailed research into the enzyme CDK2.  When a CDK inhibitor was applied to the scalps of rats that were undergoing common types of chemotherapy, hair loss was reduced in 33% to 50% of the animals.

Insurance Coverage

Your insurance plan MAY cover a portion or all of the cost of a "full cranial prosthesis" or wig. Some advocacy groups complain that coverage is spotty at best and often the patient has to appeal an initial rejection. You should have a doctor's prescription for the prosthesis; the reason usually given is to "maintain emotional well-being." A letter from your doctor may be required. 

This page was last edited on 06/26/2008
Written by Rachael Myers Lowe, cancerpage.com
Reviewed by Katie Mullaly, RN, MSN and Jane Quigley, RN, BSN