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Hair Loss

Although hair loss may seem insignificant compared to a diagnosis of breast cancer, it can have a significant impact on self-esteem, desires to be social and your self-confidence during and after breast cancer treatment. Understanding why hair loss occurs and how the impact of hair loss can be managed both practically and emotionally is necessary when preparing for treatment.

Hair-loss, or chemotherapy-induced alopecia is not uncommon in cancer patients. It is estimated that up to 65% of chemotherapy patients will experience some degree of hair loss. In addition, 47% of female cancer patients report that the fear of losing their hair is the most negative aspect of the treatment.1 The same study reports that 8% of women refuse chemotherapy because of the significant psychological and emotional impact that they will experience because of hair loss.

Chemotherapy for breast cancer will almost always cause a degree of hair loss or thinning hair. The good news for breast cancer patients is that almost all patients will grow their hair back within months after completing treatment. There are a very small number of breast cancer patients that will have permanent thinning of their hair.

Chemotherapy Drugs and Hair Loss

Hair loss is one of the most common side effects of chemotherapy drugs. The dosing and frequency of administration of drugs will have an impact on how quickly hair falls out. The reason that chemotherapy causes hair loss is its ability to kill cells that are rapidly growing. Hair follicles are constantly active, which is why you have to get a haircut every few weeks or months. Chemotherapy drugs affect all rapidly dividing cells and do not discriminate between cancer cells and other cells of the body.

Hair loss is also not limited to hair on the head, but hair all over the body. This includes hair under the arms, on the arms and legs, the pubic area as well as eyelashes and eyebrows. Similar to hair on the head, these other areas will re-grow hair, typically between three and ten months after chemotherapy is complete. When hair grows back, it is often different than before, including a difference in texture, color, quality, thickness and whether or not it is curly or straight.

Preventing Complete Hair Loss during Chemotherapy

Restricting blood flow to the scalp may prevent the potency of the chemotherapy drug to hair follicles on the head. This treatment includes ice packs or cold packs to the scalp during treatment. This process is known as scalp cryotherapy or scalp hypothermia. It may also lead to headaches or pain in the location that the ice packs were positioned.2 This is uncomfortable for some people and may not be an option for everybody.

Another option to help with thinning hair and alopecia during chemotherapy is to use the product Rogaine™, or a generic version of the drug called minoxidil. This is a topical cream that may be available as an over the counter medicine, and can be used during and after the chemotherapy treatment. It is important to note that using minoxidil will not prevent complete hair loss but it may speed up the re-growth process in some patients.

In a study of 22 women that were preparing to start chemotherapy, a randomized control trial that used a placebo and a 2% minoxidil solution showed that the minoxidil group did have improves hair growth after chemotherapy when compared to the control group. The study showed that the alopecia that was directly related to chemotherapy and hair grew back and average of 50.2 days faster for women in the minoxidil cohort versus the placebo cohort. 3

Non-Medical Options

Many women will choose non-medical means to compensate for their hair loss until significant regrowth occurs. This may include wearing a wig, cutting their hair very short, wearing hats or scarves, or simply being seen without hair while it has fallen out. Whichever a patient decides to do is entirely personal. Talk to your medical team, other cancer patients and even survivors for advice and resources.

References

1 McGarvey, E. L., Pinkerton, R. C., Baum, L. D., & etal. (2001). Psychological sequelae and alopecia among women with cancer. Cancer Practice , 283-289.

2 Mols, F., van den Hurk, C. J., Vingerhoets, A. J., & etal. (2009). Scalp cooling to prevent chemotherapy-induced hair loss: practical and clinical considerations . Supportive Care in Cancer , 181-189.

3 Duvic, M., Lemark, N. A., Valero, V., & etal. (2004). A randomized trial of minoxidil in chemotherapy-induced alopecia. Journal of the American Academy of Dermatology , 74-78.

4 Trueb, R. M. (2009). Chemotherapy-Induced Alopecia. Seminars in Cutaneous Medicine and Surgery , 11-14.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.