Caring for Your Hair and Scalp During Chemotherapy

If having cancer and going through grueling rounds of treatment weren't enough, now you have to lose your hair, too? If you are feeling anxious and angry, you are by no means alone. Hair loss is one of the most dreaded side effects of chemotherapy, which works by targeting the fastest-growing cells in your body. Among the most rapid-growing cells are hair follicles, which divide every 23 to 72 hours. Because of this, hair loss is one of the most common—and distressing—side effects of cancer treatment.

The most important thing to know is, except in extremely rare cases, the hair grows back. So, the prognosis is very favorable.

Chemotherapy-induced hair loss is called anagen effluvium, which is diffuse hair loss due to exposure to a drug that is toxic to the hair matrix. While some people with experience a visible thinning of hair, including the eyebrows and eyelashes, others will have total hair loss. The severity of loss is often directly associated with the type of chemotherapy drugs used, the dosage used, and how often they are administered; higher dosages are associated with more severe loss.

Whether you're simply noticing more hair in your brush or clumps are falling out in the shower, hair loss can be emotionally devastating—especially for women—and support from loved ones is crucial at this time. Beyond the impact of your treatment on your hair, chemotherapy and radiation can also wreak havoc on your skin, making it more difficult to care for your scalp. Thankfully, there are many steps you can take to feel more comfortable while undergoing therapy and confident about yourself and your appearance. Remember, you are part of a huge community of women who are going through and have gone through these challenges and who have likely felt exactly how you feel now.

Hair loss from chemotherapy comes in two forms: Hair breakage and actual hair loss. While there is no right or wrong way to care for the scalp, there are many helpful suggestions.

Ask your healthcare providers about cold-cap treatment. Some patients are using this therapy, which is widely used in Europe, to preserve their hair. It freezes the scalp, reducing the effects of chemotherapy on scalp hair and slowing hair loss. While many women report great results, this method can be expensive. 

Do as little as possible with your hair. This is both to reduce psychological distress as well as minimize breakage and loss that comes from too much brushing, pulling, or styling of the hair. You can shampoo and condition frequently if you prefer that, but generally washing the hair once or twice per week is sufficient.

Be gentle when handling the hair. Use a wide-toothed comb when brushing. You may want to wear a hair net at night, which can prevent your hair from falling out in clumps on your pillowcase and having to clean it up in the morning.

Choose mild haircare products. Many shampoos have fragrances and harsh chemicals that only serve to dry out already-irritated skin. Conditioners, by contrast, can sometimes be overly oily or contain emollients, humectants you simply don't need. When it comes to hair cleansing, the first rule of thumb is to simplify. If your hair is thinning, use a milder shampoo that is gentler on the scalp. Doctors often recommend a baby shampoo which has the right pH balance for dry, inflamed skin. If your scalp is itchy or sensitive, rubbing baby oil or mineral oil on the skin can usually help.

Consider a new hairstyle. If your hair has not entirely fallen out, you may want to consider a new hairstyle that doesn't require so much blow-drying, curling, or hair products. A pixie cut, for example, requires little hair product and allows you to style in whatever direction needed to conceal thinning patches. Some women choose to shave their heads to reassert their power over their bodies during cancer treatment, and also to avoid having to see the hair fall out—and this is also something to consider.

Skip coloring or perming. As for hair treatments, doctors will almost universally advise against coloring or perming during chemotherapy. Even if you don't experience a lot (or any) hair loss, chemotherapy can still damage the hair shaft and cause a dry, itchy, flaky scalp. This can lead to unpredictable results when coloring or perming and can sometimes even accelerate the thinning of your hair. Moreover, the harsh chemicals are almost guaranteed to cause you irritation you don't need.

If coloring your hair is really important to you, opt for temporary/semi-permanent hair coloring that doesn't contain peroxide or paraphenylenediamine (PPD). On the hand, if you want to lighten your hair, it is probably best to wait until you've finished chemo as these hair products almost universally contain peroxide and bleach.

Try a wig. While it may feel like the end of the world, wearing a wig can actually help you feel more confident in public—and these days, there are countless styles and colors to choose from. You can even cut and color your wig to match your natural color and style. Insurance plans will often cover the expense of wigs for people undergoing cancer treatment if they are prescribed as a "cranial prosthesis." There are even organizations that provide them for free.

If you choose to wear one, get a cap liner to help eliminate some of the itchiness. You can order from the American Cancer Society's not-for-profit website and catalog, “tlc” Tender Loving Care®catalog by visiting www.tlcdirect.org or by calling 1-800-850-9445. You can also ask your cancer team and fellow patients for recommendations, or look online for local wig shops.

Wear a headscarf to protect your scalp. If you're uncomfortable with wearing a wig, wear a headscarf to provide sun protection, keep your scalp warm, and feel more comfortable. When you're outdoors with nothing protecting your scalp, use a UV sunscreen with an SPF of at least 30.

Though hair is important for self-esteem and symbolizes femininity in our culture, while you are battling cancer, the most important thing is to stay emotionally and mentally strong for the fight. Your hair will very likely grow back, and above all, it does not define you. Your strength through adversity does.