Cancer Blog | 2 Nov 2021, Monday
Hair Loss During Cancer Treatment
Chemotherapy is the numero uno cause of hair loss.
As described by Bernard and Cannon, our bodies try and maintain a steady-state of equilibrium, homeostasis. There is a constant and controlled cell division that sustain the optimum functionality of each organ. A rapid but a controlled multiplication at sites like the hair follicles, epithelium of the small intestine, bone marrow etc. are seen. In contrast, cancer is a saga of the uncontrolled rapid proliferation of cells.
What causes hair loss during cancer treatment?
Chemotherapy consists of agents that destroy, all rapidly dividing cells. It cannot distinguish between the hair follicle, which is undergoing rapid, a controlled division from the cancer cells undergoing uncontrolled proliferation.
As a result, there is hair loss, from the scalp, eyelashes, eyebrows, armpit, pubic and other body parts. Different chemotherapeutics can cause anything from mere thinning of hair to complete baldness. This hair loss is only temporary. Hair follicles begin their healthy growth once again when the effect of chemotherapy wears off.
It’s a ghastly sight to watch clumps of your own groomed hair fall on the pillow, or a come out in the comb and even clogging the shower sink. Depending on the drug and dosage, there may be complete alopecia by week four, of starting chemotherapy. Mirror suddenly becomes a foe, a reflection of changed appearance and a reminder of the illness.
“Which chemotherapy drugs cause hair loss?”
Adriamycin and Paclitaxel the two most important drugs used in the treatment of breast cancer, lead to hair loss. Adriamycin causes mainly scalp hair loss, while Paclitaxel, within a few weeks of initiation of therapy, can cause complete hair loss, which includes the scalp, eyebrows, eyelashes, legs, arms, and pubic area. Other agents like Cyclophosphamide and 5-FU can also cause some hair loss. Methotrexate is another drug known to cause thinning of hair in patients; however, it does not cause complete hair loss.
Other modalities of cancer treatment can also add to this hair loss. Hormonal therapy agent, Tamoxifen can cause thinning of scalp hair, while radiation therapy is known to cause complete hair loss of the particular part of the body treated.
“Can we prevent this hair loss?”
Hair loss is a part of collateral damage. We cannot avoid it entirely, but we can mitigate it.
Scalp Hypothermia – recently a trial was conducted at the Tata Memorial Hospital, using scalp cooling technology. A scalp cooling cap is used which aims to reduce the blood supply to the hair follicles, thus decreasing the reach of the chemotherapy to the hair follicle. The trial included 51 women, 34 availing the cooling technology while 17 were a part of the control group. Before the start of chemotherapy, these patients wear a cooling cap which reduces the scalp temperature to -4 degrees. The cooling cap is worn during the infusion of drugs and continued for 90 mins after completion of therapy. The study observed 56% hair retention and 85% hair regrowth compared to 100% loss and 12% regrowth in the control group. Even though the sample size of 51 patients is too small to draw meaningful conclusions, the ladies with cooling technology are clearly at an advantage. These ladies undergoing scalp hypothermia do report feeling uncomfortably cold and having headaches. With the availability of this technology in India, this option is worth exploring.