Dr Jay Anam

Surgical Oncologist

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.

“How do we manage hair loss?”

As it is appropriately said, ” if you don’t like something, change it. If you cannot change it, change your attitude”. Management begins with a change of attitude, an attitude that accepts a few stumbling blocks, like hair loss to reach the final goal of an absolute cure. Before the start of treatment, consider cutting your hair short. Shorter hair looks fuller as compared to longer hair, even when they fall off, they are less noticeable than long hair. Shorter hair will also help in a better transition to the “no-hair look”. You need to baby your hair, be as gentle as you can. Avoid using any dyes, colors, or heating agents to perm or straighten your hair. Air-drying the hair, using a soft brush, washing the hair when inevitable with a mild shampoo are some tricks that can work to your advantage. These strategies can only prolong the inevitable a little longer. Some patients also report itchy, irritation, or altered sensorium on the scalp during the chemotherapy, all attributed to hair loss. So in such situations, it is better to shave the head, which also will avoid the embarrassment of shedding. For many of us, hair is a part of our identity, our self-confidence. A wig, a scarf, or a hat often, comes to the rescue. For some patients, a wig or a cap may become a way of life; for others, they may aid to tide over the initial phase of embarrassment and self-denial. For many, hair loss is an indication to the world, of your struggle, your agony, your suffering through cancer. It is aptly said when you are going bald, you are only gaining more head. Hair loss is just a footnote in your chapter on your journey, defeating the big C. It should not attain the importance of a real adversary. So, let us prepare, and take the bull by its horn. After all, we know this hair loss is just temporary.

“When will my hair grow back?”

It usually takes 3 to 6 months after completion of treatment for hair to grow back, but maybe with a different shade until the cells that control the pigment in the hair are functioning at their best again.