Hair Loss

One of the most commonly known side effects of chemotherapy is hair loss.  Hair loss is also known as alopecia.  Many people do not think about how important your hair is until you face losing it.  Both men and women report hair loss as one of the side effects they fear the most after being diagnosed with cancer.

Losing their hair concerns many people, as it makes them ‘feel’ and ‘look’ like a cancer patient.  It is generally the symbol to everyone that you have cancer.  It will also remind many they have cancer when they look in the mirror each day.  For those who do not wish to let others know that you have cancer, you may fear this side effect the most and more than other chemotherapy complications. Some people learn to embrace it.  Everyone is different.

Your medical team will let you know if you will lose your hair.  They can also provide advice about how to cope with losing your hair and help you prepare.

On this page we will discuss some of the most common questions people have.  We will also provide you with ways that can help you.

Why does hair loss occur?

Chemotherapy attacks rapidly  growing cancer cells. Unfortunately, these treatments also attack other rapidly growing cells in your body.  Chemotherapy can also kill cells in your hair roots. This can result in hair loss.

Chemotherapy may cause hair loss all over your body, not just your scalp.  This can sometimes include your eyelash, armpit, pubic and other body hair.  Especially with high dose chemotherapy.  Some chemotherapy drugs are more likely to cause hair loss than others.  Most of the time, hair loss from chemotherapy is temporary.

Radiotherapy can cause hair loss at the site of the radiotherapy only.  Not all over the body as chemotherapy does.

When does hair loss occur?

Chemotherapy

Many people who are about to start chemotherapy worry about hair loss. Not all chemotherapy makes you lose your hair. Around sixty five percent of people who receive chemotherapy will have hair loss.

Some people lose their hair very quickly and others lose it after several treatments. It most commonly causes head hair to fall out firstly.  Often hair in other parts of the body may also be affected.  Hair loss usually occurs around  2-3 weeks after the first treatment.

Common chemotherapy drugs used in lymphoma

Hair loss is common with chemotherapy such as:

• Doxorubicin
• Adriamycin
• Epirubicin
• Daunorubicin
• Cyclophosphamide
• Ifosfamide
• Etoposide
• Gemcitabine
• Vincristine

Hair loss is more common in high dose chemotherapy regimens rather than in low-dose chemotherapy given orally.  Immunotherapies do not cause hair loss.

Radiotherapy

Radiotherapy also attacks rapidly growing cells in your body.  Unlike chemotherapy, it affects only the area where treatment is targeting.  If you have radiation to your head, you will likely lose the hair on your head.  One hundred percent of people who have radiotherapy will lose their hair at the affected site.   Hair may start to fall out 2 or 3 weeks into treatment.

What to expect?

Most people’s hair usually begins falling out after 2-3 weeks after chemotherapy starts.  It can start falling out gradually when they wake up on their pillow, when you wash or brush your hair.  Or it can fall out quickly in clumps.  Many people report that their scalp feels itchy or tender.

Hair loss will continue throughout your treatment and up to around 3 weeks after the last dose of chemotherapy. Depending on the chemotherapy that you are receiving, some people’s hair may only thin, while others will make them become completely bald.

It can sometimes depend on the type of hair you have.  For some people who have thick hair may be less noticeable than people who have thin hair.

Many people who have hair loss often report that it can be a distressing side effect of treatment. When you look in the mirror it can be a constant reminder of your lymphoma.  For some people they embrace it and make the most of it.

When will your hair grow back?

Chemotherapy

Most people’s hair usually starts to grow back 3-6 weeks after the last dose of chemotherapy.  Many people initially have fine hair (often referred to baby hair) growth first, that often falls out again before hair grows back properly.

Hair can sometimes take a little longer after radiotherapy.  Sometimes it may not grow back at all at that patch.

Your hair may have a new colour or texture. Some people who are known to always have had straight hair, and their hair grows back very curly.  Or it could be grey until the cells that control the pigment in your hair begin functioning again.

Radiotherapy

Your hair usually begins growing back after your treatments end.  Depending on the treatment, your hair may or may not grow back to the original thickness.  Higher doses of radiotherapy can sometimes cause permanent hair loss.

Can I prevent my hair from falling out?

Unfortunately there is nothing that can be done to prevent hair loss in lymphoma.  You may have heard or will see other patients in the cancer centre where you are having treatment having scalp cooling caps.  These are not recommended for haematology (blood cancer) patients such as lymphoma.  They have been studied for those with breast or ovarian cancer that have found to have some effect for people (not all).

Scalp cooling caps are fitted while someone is having chemotherapy.  The caps are closely fitted and cooled by a chilled liquid.  They slow the blood flow to the scalp.  The chemotherapy drugs are less likely to have an effect on your hair.

They are not recommended as lymphoma is a systemic cancer.  This means lymphoma cells can move all around the body, including the scalp.  This treatment may result in a small risk that the lymphoma can reoccur in the scalp or in the near area.  This is because less chemotherapy makes it to this area.

Managing hair loss

Your hair loss can not be prevented or controlled, but it can be managed.  If you have hair loss, you may experience a range of different emotions including anger, anxiety and acceptance.  Some people may feel self-conscious about their appearance and other people find that is not as bad as expected.  Experiencing a variety of feelings and reactions is very common.

Many feel uncomfortable talking about it or asked about why you have hair loss.  Sometimes being ready with a response can help.

The following things have been reported by patients that can help.

Before treatment

• Be gentle to your hair. Don’t bleach, colour or perm your hair before treatment as this can weaken it.  Dry your hair naturally as much as you can by avoiding hair dryers, curling irons or hair straighteners.  Keeping your hair as healthy and strong now can help it stay in your head longer during treatment.
• If you have long hair, consider cutting your hair shorter. This may allow you to start to mentally prepare before your hair falls out.  Short hair often looks fuller than long hair too.  It also won’t be as noticeable if you have short hair.
• Start to plan for a head covering soon after you learn you need chemotherapy. Think about whether you wish to have a wig or other head coverings.  Whether you choose to wear a head covering to cover your hair loss is up to you.

Taking care of hair and scalp during and after treatment

If your scalp is sensitive and your hair is thin:

• Use a gentle shampoo and conditioner
• Reduce temperatures of your showers to lukewarm. Hot water can be harsh on your scalp
• Reduce the number of times you wash your hair each week
• Brush your hair gently with a soft bristle brush
• Dry your hair naturally or use a cool setting on the hair dryer
• Avoid heated rollers, curling wands, or straightening irons
• Avoid harsh chemicals such as hair colouring, gel, mousse and perming agents until your hair has grown stronger. These chemicals could destroy new hair growth and irritate your scalp.
• Some people report that their scalp feels itchy, sensitive and irritated. Many shave their head once it becomes uncomfortable when their hair is falling out.  This can reduce the irritation and the embarrassment of hair falling out.  Some people find it is some way they can have control of their hair loss.
• Protect your scalp. If your head is going to be exposed to the sun or cold air, you need to protect it with sunscreen or a head covering.  Your scalp may be more sensitive to sun or cold air during treatment.  You can also feel the cold more, as hair acts to keep us warm.
• We have listed options below
• If you have lost hair under your arms avoid perfumed deodorants.

If you have lost your hair:

• Gentle massage and moisturising of the scalp can be invigorating and reduce flaky areas
• Protect your scalp from the sun with sunscreen or a scarf or hat
• Use a pillowcase made from silk, satin, polyester, or cotton
• You may like to wear a soft cap or beanie to keep your head warm as having no hair or less hair can make you feel cold. 

Radiotherapy also affects your skin. The treatment area is likely to be red and may look sunburned or tanned. If your radiation treatment is to your head, it’s a good idea to cover your head with a protective hat or scarf because your skin will be sensitive to cold and sunlight. Wigs and other hairpieces might irritate your scalp.

If you have any concerns, discuss them with your doctor or nurses and follow their specific advice on caring for your scalp during treatment.