Chemotherapy and Coping With Hair Loss

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Helpful Strategies to Cope With Hair Loss

Hair loss is a very common side effect of chemotherapy. While not harmful or permanent, hair loss is ranked by cancer patients as one of the most feared side effects of chemotherapy. It is normal to have strong negative emotions towards losing your hair.

Four common reactions are: feeling unprepared, shocked, embarrassed, and losing a sense of yourself. Hair is an important part of identity and it can be associated with strong cultural beliefs and values. As such, hair loss can cause lowered self-esteem, anxiety and depression.

For many women, it is more traumatic than losing a breast from breast cancer. While there are no sure therapies to prevent hair loss from chemotherapy, there are strategies that can help make the hair loss less traumatic.

Why Does Chemotherapy Cause Hair Loss?

Not all chemotherapy drugs cause hair loss. The drugs more commonly associated with hair loss are: doxorubicin, cyclophosphamide, fluorouracil, paclitaxel, and methotrexate.

Traditional chemotherapy drugs work by destroying cells actively in the process of replicating. Cancer cells replicate rapidly and uncontrollably, ignoring signals from the body to stop growing.

The problem is that chemotherapy drugs also destroy the normal cells in the body that replicate rapidly. This includes the cells lining the gut, blood cells, reproductive cells, and skin and hair cells. The cells in the hair follicles are destroyed, causing the hair to fall out.

When Will the Hair Fall out and Will I Lose All My Hair?

Hair loss does not occur straight after the first chemotherapy session. More commonly, the hair falls out two to three weeks after the first treatment or after several treatments.

The pattern of hair loss following chemotherapy is different for every person. There may be no hair loss, only mild thinning, patches of hair loss, or most commonly, complete loss. It may fall out very quickly, in clumps or gradually.

It is not possible to tell beforehand who will be affected or how badly. It will depend on the drugs used, the dose given, and the person’s individual sensitivity to the drug.

Lesser-Known Hair Loss

Most people associate hair loss from chemotherapy with a bald head. However, it can be shocking to learn that hair loss can occur from other areas of the body too.

Hair can also be lost from the eyebrows, eyelashes, face (moustache and beard), arms, legs, chest and pubic region. Hair loss from these areas can be quite traumatic, especially if you are not prepared for it.

Are There Other Symptoms Associated With Hair Loss?

Any hair that does not fall out may become dull and dry. It is also often more fragile and prone to breaking.

While the hair is falling out, the skin may be more sensitive and feel hot, itchy, and/or tingly. The skin may become dry and peel and some people develop pimples. The skin will also be more sensitive to sunburn and the cold.

Will the Hair Grow Back and What Can I Expect?

The hair that falls out during chemotherapy almost always grows back. Only in very rare circumstances will the hair loss be permanent. This usually only happens with very high doses of particular drugs.

Hair will usually continue to fall out for two to three weeks after the last chemotherapy session. After that, it will stop falling out, and after a month or so should start to grow back.

It can take four to 12 months for the hair to grow back fully. When it does grow back, it is often initially different than the old hair; it may be softer, a different color, or even a different texture — sometimes curly, even if your hair was previously straight. With time, the hair will return to its normal color and texture.

Can Anything Prevent Hair Loss?

Unfortunately, there is no FDA-approved treatment to prevent hair loss from chemotherapy.

Cold caps are one therapy that have been tested. It involves applying cold to the scalp for a period before, during and after chemotherapy treatment. The theory is that applying cold to the scalp slows down the activity of the cells in the hair follicles and reduces the flow of blood to the area.

If applied during treatment, this may reduce the amount of chemotherapy drug targeting the area. Research studies have shown mixed results, but there have been some positive results in the Netherlands. The cold caps reduced the amount of hair lost, but did not reduce hair loss completely.

The main concern that prevents cold caps from gaining regulatory approval is they may also protect cancer cells hiding in the scalp. This is of particular concern for blood cancers, such as leukaemia and lymphoma, as well as other cancers that may have spread.

There have been some reports of breast cancers appearing on the scalp following use of cold caps. For this reason, your doctor may not agree to you using this treatment. There is also a chance it might not work due to the specific chemo drug you are being treated with, among other factors.

While there is no approved treatment to prevent hair loss, many dermatologists approve the use of minoxidil (Rogaine) to speed up hair growth following chemotherapy. It is applied directly to the scalp.

How Can I Cope Psychologically?

Hair loss can affect your self-esteem and confidence. It can make you feel embarrassed, unattractive, and socially out of place. It can also make you feel vulnerable and exposed, marking you out as a cancer patient.

It may prompt questions and comments about cancer you aren’t prepared to talk about. Some friends and family may not be able to hide their shock.

Although nothing can truly prevent the difficulty of hair loss, it can help to be prepared. Accept that hair loss will happen and allow yourself time to adapt. It is normal to feel a whole range of negative emotions.

Set up a routine and strategies to focus on yourself as a whole person, with a body, mind and personality. Some people choose to wear bright clothes, makeup or jewellery, or even create a new look for themselves.

Most people do find their friends and family are supportive, but it can help to join a cancer support network to talk with people who are going through the same thing. Seek help from a psychologist if you need to.

Physical Strategies to Help With Hair Loss

Before your hair falls out:

  • Treat your hair gently to make it stronger prior to chemotherapy. Avoid hair dryers, curling tongs, perms and harsh chemicals.
  • If you want to wear a wig, consider choosing one before your hair falls out so you can match your natural color, texture and style. You can borrow wigs from many hospitals or from wig libraries if you don’t want to purchase one.
  • Some people find it is less upsetting to cut their hair before it falls out. Shaving can help with itchiness and can avoid the embarrassment of hair falling out in public.

As your hair falls out:

  • Wear a hairnet at night to collect hair that falls out. This can be less upsetting than finding it all over the pillow in the morning.
  • Brush the hair gently, using a large-toothed comb or a hairbrush with soft bristles. Using a harder brush will pull more of your sensitive hair out.
  • Limit the use of hair dryers, styling equipment, and harsh styling products. Your hair will be very sensitive, so avoid any unnecessary styling.
  • Ask the hairdresser to cut your hair to a style that suits the new you. You may find you like the way short hair looks on you!
  • It is preferable not to dye your hair. However if you want to, use only vegetable-based dyes and do a test patch first to check for a skin reaction.

Once there is some hair loss and/or skin irritation:

  • Use sun protection to avoid sunburn
  • Wear a beanie, hat, scarf, toupee, wig or turban to protect the head from sunburn and the cold
  • If your eyelashes fall out, wear sunglasses to protect your eyes from the dust and sun
  • Keep the hair and scalp clean with mild shampoo, such as baby shampoo
  • If the scalp is dry and itchy, check with your doctor if you can use sorbolene cream or other moisturising products
  • Use a satin pillowcase as nylon can irritate the scalp
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