Chemotherapy & hair loss . . . what you should expect & how to make the best of the situation

You might not think about how important your hair is until you face losing it. And if you have cancer and are about to undergo chemotherapy, the chance of hair loss is very real. Both men and women report hair loss as one of the side effects they fear most after being diagnosed with cancer.

Whether or not you have hair loss from your chemotherapy depends mostly on the type and dose of medication you receive. But whether you can maintain a healthy body image after hair loss depends a lot on your attitude and the support of your friends and family.

Chemotherapy and hair loss: Why does it occur?

Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body — including those in your hair roots.

Chemotherapy may cause hair loss all over your body — not just on your scalp. Sometimes your eyelash, eyebrow, armpit, pubic and other body hair also falls out. Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness. Talk to your doctor or nurse about the medication you'll be taking. Your doctor or nurse can tell you what to expect.

Fortunately, most of the time hair loss from chemotherapy is temporary. You can expect to re-grow a full head of hair six months to a year after your treatment ends, though your hair may temporarily be a different shade or texture.

Can hair loss be prevented?

No treatment exists that can guarantee your hair won't fall out during or after chemotherapy. The best way for you to deal with impending hair loss is to plan ahead and focus on making yourself comfortable with your appearance before, during and after your cancer treatment.

Several treatments have been investigated as possible ways to prevent hair loss, but none has been absolutely effective, including:

    -  Scalp hypothermia (cryotherapy) During your chemotherapy, ice packs or similar devices are placed on your head to slow blood flow to your scalp. This way, chemotherapy drugs are less likely to have an effect on your scalp. Studies of scalp hypothermia have found it works somewhat in the majority of people who have tried it. However, the procedure also causes a small risk of cancer recurring in your scalp, as this area doesn't receive the same dose of chemotherapy as the rest of your body. Most people who try this procedure find it to be uncomfortable and very cold.

    -  Minoxidil (Rogaine) Applying minoxidil — a drug approved for pattern hair loss in men and women — to your scalp before and during chemotherapy isn't likely to prevent your hair loss, although some research shows it may speed up your hair re-growth. More research is needed to understand whether minoxidil is effective in re-growing hair after cancer treatment.

How to make the best of it

Your hair loss generally can't be prevented or controlled, but it can be managed. Take the following steps throughout your treatment to minimize the frustration and anxiety associated with hair loss.

Before treatment

    -  Be gentle to your hair. Get in the habit of being kind to your hair. Don't bleach, color or perm your hair — this can weaken it. Air-dry your hair as much as possible and avoid heating devices such as curling irons and hot rollers. Strengthening your hair now might make it more likely to stay in your head a little longer during treatment.

    -  Consider cutting your hair. Short hair tends to look fuller than long hair. So as your hair falls out, it won't be as noticeable if you have short hair. Also, if you have long hair, going short might help you make a better transition to total hair loss.

    -  Plan ahead for a head covering. Now is the time to start thinking about wigs, scarves or other head coverings. Whether you choose to wear a head covering to conceal your hair loss is up to you. But it's easier to plan for it now rather than later. Ask your doctor to write a prescription for a wig, the cost of which may be covered by your health insurance.

During treatment

    -  Baby your remaining hair. Continue your gentle hair strategies throughout your chemotherapy treatment. Try using a satin pillowcase, which is less likely to attract and catch fragile hair. Use a soft brush. Wash your hair only as often as necessary. Consider using a gentle shampoo. Stay away from shampoos with strong detergents and chemicals that can dry out your scalp, including salicylic acid, alcohol and strong fragrances.

    -  Consider shaving your head. Some people report that their scalp feels itchy, sensitive and irritated during their treatment and while their hair is falling out. Shaving your head can reduce the irritation and save the embarrassment of shedding. Some men shave their heads because they feel it looks better than the patchy hair loss they might be experiencing. Also, a shaved head might be easier for securing a wig or hairpiece.

    -  Protect your scalp. If your head is going to be exposed to the sun or to cold air, protect it with sunscreen or a head covering. Your scalp may be sensitive as you go through treatment, so extreme cold or sunshine can easily irritate it even more. Having no hair or having less hair can make you feel cold, so a head covering may make you more comfortable.

After treatment

    -  Continue gentle hair care. Your new hair growth will be especially fragile and vulnerable to the damage caused by styling products and heating devices. Hold off on coloring or bleaching your new hair for at least six months. Besides damaging new hair, processing could irritate your sensitive scalp.

    -  Be patient. It's likely that your hair will come back slowly and that it might not look normal right away. But growth takes time, and it also takes time to repair the damage caused by your cancer treatment.

Cover your head

Covering your head as your hair falls out is a purely personal decision. For many women hair is associated with femininity and health, so they choose to maintain that look by wearing a wig. Others choose hats and scarves. Still others choose not to cover their heads at all.

Ask your doctor or a hospital social worker about resources in your area to help you find the best head covering for you. Look Good...Feel Better is a free program that provides hair and beauty makeovers and tips to women with cancer. These classes are offered throughout the United States and in several other countries. Many classes are offered through local chapters of the American Cancer Society. Look Good...Feel Better also offers classes for teens with cancer, as well as a Web site especially for men.