Hair Loss

Hair loss is also medically known as alopecia. Anti-cancer treatments can cause hair loss by affecting the cells that help with hair growth. It may occur at any part of the body, including the head, face, underarms and pubic area. The amount and pattern of hair loss differs from person to person depending on the type of treatment received, but this is usually a temporary effect of cancer treatment, and hair grows back most of the time.

Causes of Hair Loss

Chemotherapy. Not all chemotherapy drugs cause hair loss. Examples of drugs that are more likely to cause hair loss are: Cyclophosphamide, Ifosfamide, Docetaxel, Paclitaxel, Doxorubicin, Epirubicin, Etoposide, and Irinotecan. Hair loss from chemotherapy usually occurs within a few cycles of treatment, and hair starts to regrow about 1-3 months after chemotherapy ends. There may be a change in texture or colour of your regrown hair, but this will return to normal after several years.
Radiation therapy. Hair loss only occurs at the area where radiation is done. While hair regrowth usually starts after 3-6 months of completing your radiation therapy, at times hair may not grow back at all if a very high dose of radiation is used.
Targeted therapy. Targeted therapy usually does not lead to complete hair loss, but some drugs can cause your hair to become thinner or curlier. Examples of these drugs are: Afatinib, Cetuximab, Dabrafenib, Dasatinib, Erlotinib, Ibrutinib, Imatinib, Nilotinib, Panitumumab, Sorafenib, Trametinib, and Vemurafenib.
Hormonal therapy. While it usually does not cause complete hair loss, some people experience a certain extent of hair thinning after several months to years of starting some types of hormonal therapy, including: Tamoxifen, Anastrozole, Letrozole, Exemestane and Fulvestrant.

How it can be treated

Hair loss from some chemotherapy drugs can be potentially prevented using a scalp cooling device, but this is at present not available at NCCS due to costs to patients and reservations on the general effectiveness in most patients undergoing chemotherapy.

Your doctor may advise you on the use of topical medications (e.g. minoxidil) if you experience hair thinning from hormonal or targeted therapy, or if your hair does not fully grow back after other anti-cancer treatments. Your doctor may also refer you to a Dermatologist, who can advise you further on the management of hair loss.

What you can do

Although there is currently no way to completely prevent alopecia from anti-cancer treatment, learning how to manage hair loss before, during and after your anti-cancer treatment allows you to cope better:

Before treatment

You may choose to cut your hair short, so that it is easier to manage when it starts to fall out. A shorter hairstyle also makes your hair look fuller
It is best to get a wig while you still have hair, so that you can match it to your hair colour and style. You may wish to obtain your wig from commercial hair wigs shops. Alternatively, you can contact NCCS' Wig Bank managed by Cancer Helpline at +65 6225 5655 to fix an appointment for wig loan, fitting and styling
Plan early. If you find wigs uncomfortable, you may choose to use other head coverings like a scarf or hat

Brush and handle your hair gently. Stronger hair stay on longer during treatment

Avoid tying your hair too tightly

During treatment

You may choose to shave your head; some people have sensitive scalp during treatment, and shaving reduces this irritation. It may also help you emotionally if you do not see your hair shedding
Be gentle to your remaining hair. Brush hair gently using a hairbrush with soft bristles or a wide-tooth comb. Wash hair only as needed with a mild / baby shampoo, and pat dry with a soft towel
Protect your scalp. Use sunscreen or wear a scarf or hat when you are outdoors. If your scalp is itchy or tender, you may use lotions and conditioners to soothe it. Choose a soft, comfortable covering for your pillow
Wear a hair net at night when you sleep, to prevent getting hair over your bed and pillow
For women, applying a little make-up will brighten up your face. The most important thing is to do whatever feels comfortable and gives you the most confidence
Share your feelings with your loved ones, or join a support group. Many people feel angry, depressed or embarrassed about hair loss. Talking about it openly and honestly can help
Participating in support programs may be helpful (e.g. Look Good, Feel Better). You may call Psychosocial Oncology at +65 6306 1777 to enquire about available programs

Avoid treatments or products that may hurt your scalp (e.g. hair gels, hair dyes, perms, clips)
Avoid using hair dryers
Avoid using wigs if they irritate your scalp. You may opt for scarves or hats instead

After treatment

Be patient as it will take a few months or longer for your hair to regrow. Your regrown hair may feel softer or curlier as compared to before. Continue to be gentle with your hair; it is still more fragile now as you are recovering from your cancer treatment

Avoid over-brushing and blow-drying of regrown hair, till at least 3 months after treatment
You may not want to wash your hair as often as you used to, as this may damage developing hair
Avoid perming and using hair dyes till at least 6 months after treatment. These products usually contain chemicals that will cause damage and irritation to your hair and scalp. If you need to, ask your hairdresser if they can suggest henna or vegetable based dyes, as these are considered gentler products. Test the dye on a small part of your hair to see how it works, before using it for the rest of your hair

When to call your cancer care team

You can contact your healthcare team, or call +65 6306 1777 or +65 6436 8088 to book an appointment to speak to a medical social worker if you feel that your worry about hair loss is affecting your daily life.

If you have any questions regarding the above information, please call the Cancer Helpline at +65 6225 5655 for further details.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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Hair Loss (Alopecia)