Hair Loss (Alopecia)

Can hair loss be prevented?

Some scalp cooling devices and cold caps are FDA approved to prevent chemotherapy-induced alopecia (CIA). But they can have some side effects, and they aren't recommended for everyone. Unfortunately, they don't prevent hair loss caused by other types of cancer treatment such as immunotherapy and targeted drug therapy.

Ask your cancer care team if you are likely to lose your hair. If so, ask whether you will lose it quickly or over time. They may also be able to tell you if a scalp cooling device or cold cap could make you less likely to lose your hair.

Not all scalp cooling devices are FDA approved, and they might not be covered by insurance. You can talk to your cancer care team about the benefits, risks, and side effects. 

What are my options if I do lose my hair?

Wigs and other scalp coverings may be partially or fully covered by your health insurance. You will likely need to pay for your wig and then file a reimbursement claim with your insurance provider. Ask your cancer care team for a wig prescription.

Many people choose to cut their hair very short or even shave their head before it starts falling out. When your hair is very short or shaved, you might have less discomfort if it starts to fall out. Some people also feel more in control when they do this.

Many people choose to go bald, too. Some people like not having to worry about wigs or head coverings. Others see it as empowering or meaningful.  

There isn’t one right way to manage hair loss from cancer treatment. What matters most is finding an option that makes you feel comfortable, whatever that option is.

Is hair loss from cancer treatment permanent?

Hair loss related to cancer treatment is usually not permanent.

A few studies have found an increased risk of permanent or long-term hair loss with high doses of docetaxel (Doxil). Chemo regimens that combine taxanes and anthracyclines are also more likely to cause long-term or permanent hair loss.

About 1 in 3 breast cancer survivors experience long-term or permanent hair loss.

Just over 1 in 3 childhood cancer survivors experience long-term or permanent hair loss.

Hair growth after cancer treatment

When the hair on your scalp first starts to grow back, it might be a different color or texture. This is completely normal. A little over half of people who lose their hair because of cancer treatment report changes like this. These changes are almost always temporary.

Your hair will most likely return to its natural color and texture in a few months as your hair follicles recover and your hair continues to grow.

Everyone’s hair grows at different rates. One person’s hair might grow back quickly after cancer treatment, while another person’s hair growth could take more time.

Certain people may also be more likely to lose their hair during cancer treatment because of other factors. Genetics, nutrition, and other health conditions can all play a part. This is why each person’s experience with hair loss is unique, even if they get the same treatment.

Treatments for hair loss and thinning

There are many different treatments for hair loss and thinning. However, only a few have been shown to be effective in treating hair loss and thinning related to cancer treatment. Here are the most common ones.

Minoxidil

Minoxidil is a medicine approved for male and female-pattern alopecia. It’s often used off-label for other types of hair loss, including chemo-induced alopecia. Many studies show that topical (applied to the scalp) minoxidil speeds hair growth after cancer treatment.

There aren’t as many studies on oral (pill) minoxidil for hair loss, but the studies that have been done show positive results. There are also current clinical trials evaluating low dose minoxidil for permanent chemo-induced alopecia.

Bimatoprost

Bimatoprost is a medicine for eye conditions like glaucoma. Topical bimatoprost has been shown to improve treatment-induced eyelash and eyebrow hair loss.

Spironolactone

Spironolactone is a medicine that is approved for female-pattern hair loss. More studies are needed to evaluate its use in people with chemo-induced hair loss. But it is sometimes used off-label for this purpose.

Light therapy (Photobiomodulation)

Low-level laser therapy (LLLT) is a type of treatment usually used for wounds, pain, or inflammation. It has been shown to treat male and female-pattern hair loss effectively. There have not been as many studies evaluating how well LLLT works for chemo-induced alopecia.

LLLT is relatively low cost (compared to some other treatments for hair loss). It can be used at home, and it carries few risks. LLLT is sometimes also called photobiomodulation (PBM).

There have been a small number of studies in breast cancer patients that show significant improvement in hair regrowth following chemo compared to breast cancer patients who did not have LLLT.

As with any treatment or medicine, always talk to your doctor or cancer care team before starting or stopping anything. Tell them what medicines you currently take and if you’ve tried anything for hair loss in the past.

Tips for coping with hair loss and thinning

Whether your hair is just starting to fall out, or is beginning to grow back, here are some ways you can take care of yourself.

Be gentle.

• Your scalp might feel itchy, sore, or sensitive. Be gentle when brushing and washing your hair.
• Styles that pull on your hair (like ponytails and braids) can also worsen or speed up hair loss.
• Use a mild shampoo (such as baby shampoo) to wash your hair.
• Try to limit washing your hair to no more than 2 times per week.

Protect your scalp.

• If your scalp is exposed, use a broad-spectrum sunscreen with an SPF of at least 30.
• In cold weather, wear a hat or scarf to cover your head and stay warm.

Choose gentle fabrics and materials.

• A sleep cap minimizes friction (rubbing) between your scalp and pillowcase. This can reduce irritation.
• Bamboo, silk, and cotton are among the softest materials for people with hair loss. They tend to be the gentlest and coolest on the scalp.
• Hats with soft cotton or bamboo linings are often suggested.
• For unlined hats and wigs, think about adding a liner that absorbs and wicks away sweat to keep you comfortable.
• Organic fabrics might be a good choice for people with sensitive scalps. These fabrics are free from many chemicals that may cause itchiness and irritation.

Avoid harsh treatments.

• Avoid products with harsh chemicals or fragrances.
• Don’t bleach, color, relax, or perm your hair. These types of treatments can weaken the hair and worsen breakage.

Avoid styling with heat.

• Whenever possible, let your hair air-dry.
• Avoid heating devices like flat irons, curling irons, or hot rollers.

Improve blood flow to your scalp.

• Regular scalp massages can improve circulation (blood flow). This may promote hair growth.

Take care of your body.

• Good sleep, nutrition, and physical activity are all important for your body to heal and recover.

Find emotional support.

• Losing your hair is one of the most traumatizing side effects of cancer treatment because it’s so visible.
• It isn’t selfish or vain to be sad, angry, or however you feel.
• Connecting with friends, family, or support groups can help you cope.
• Be patient and kind to yourself during this process. Remember, you aren’t alone.

Most hair loss related to cancer treatment is temporary. Hair often starts growing back after treatment ends. A small number of cancer treatments are more likely to cause long-term or permanent hair loss. Ask your cancer care team about your specific cancer treatments and what to expect.

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