Hair Loss

What is hair loss?

Hair loss means the loss of some or all hair from the scalp and/or other parts of the body. The medical term for hair loss is alopecia. In patients with cancer, hair loss can be a side effect of treatment rather than the cancer itself. 

Hair loss from cancer treatment is not usually physically harmful, but it can be emotionally very hard. It can affect self-image, privacy, and confidence because it is such a visible side effect. 

What does hair loss look like?

Some patients experience hair loss as gradual thinning, while others lose hair more quickly in clumps. Hair may come out while brushing, washing, or when waking up on a pillow. Depending on the treatment, a person may lose hair from the scalp, eyebrows, eyelashes, facial hair, arms, legs, or pubic area. Radiation-related hair loss usually happens only on the part of the body getting radiation, while chemotherapy-related hair loss can affect hair throughout the body.

Who gets hair loss?

Not all chemotherapy drugs cause the same extent of hair loss. Some chemotherapy drugs have a high likelihood of causing hair loss, while others may cause only mild thinning or no noticeable hair loss at all. Some commonly used chemotherapy medications associated with a high likelihood of hair loss include:

• Topoisomerase inhibitors
  
  • Etoposide
  • Irinotecan
• Anthracyclines
  
  • Doxorubicin
  • Idarubicin
  • Daunorubicin
  • Mitoxantrone
• Taxanes
  
  • Paclitaxel
  • Docetaxel
• Vinca alkaloids
  
  • Vincristine
  • Vinblastine
• Alkylating agents
  • Cyclophosphamide
  • Ifosfamide
• Eribulin

Radiation therapy can also cause hair loss, but usually only in the area being treated. Hair loss from radiation may grow back, but sometimes it can be permanent if high doses are used.

How is hair loss prevented?

Hair loss cannot always be fully prevented, but one of the main options during chemotherapy to lower the chance or reduce its severity is scalp cooling. This uses a cooling cap or cooling system before, during, and after chemotherapy to reduce the amount of drug that reaches the hair follicles. Studies show that scalp cooling can help reduce chemotherapy-related hair loss for some patients, although it does not work equally well for every regimen. Current FDA-approved cooling caps include:

• DigniCap
• Paxman
• Amma

If you are interested in any cooling cap therapies, it is important to talk to your medical team as early as possible to allow enough time for all necessary steps to be taken before treatment begins.

How is hair loss treated?

There is no treatment available that stops hair loss once it starts, so the focus is often on supporting hair regrow over time. In most patients, hair begins to grow back after chemotherapy ends, though it may come back with a different texture, color, or thickness at first. 

If head coverings are desired, there are several options, including wigs, hats, and scarves. Some centers may be able to supply these products, and your doctor may be able to prescribe a wig for you as it may be covered by your insurance. It’s also important to use gentle hair products and protect the scalp from sun and cold while on therapy. If eyebrows or eyelashes are lost, some patients also use cosmetics or other supportive measures to feel more comfortable.