Hair Loss

HAIR LOSS DURING BREAST CANCER TREATMENT - FACT SHEET

This fact sheet was produced by Breast Cancer Network

Because it’s visible to others, hair loss (alopecia) can be one of the more distressing aspects of your treatment for breast cancer.

Your hair may be very much part of your self-image and femininity, so losing your hair can affect your confidence and the way you see yourself. Some women who are about to undergo treatment, and believe that they are prepared to lose their hair, still find it very upsetting when it actually occurs.

“You know, I didn’t mind losing my breast as much as I minded losing my hair. I know that might sound odd but it’s how I felt – I cried and cried. Losing my hair made my breast cancer so public.” – Sarah

This resource has been developed with input from women who have experienced hair loss as a result of undergoing breast cancer treatment.

What can I do to prepare myself for hair loss?

Hair loss from chemotherapy treatment occurs because the chemotherapy kills not only the cancer cells, but also healthy cells, including the cells in your hair follicles. After chemotherapy treatment is finished, the healthy cells repair themselves and hair grows back.

Whether or not you lose your hair depends on the types of chemotherapy drugs prescribed for you.

Some types of chemotherapy cause complete hair loss, some cause the hair to thin out, while others may have no effect on your hair at all. You may also find that your eyebrows and eyelashes fall out, and that you lose the hair on your legs, arms, underarms and pubic area. This may occur at different stages of your treatment. You can ask your medical oncologist or oncology nurse how your chemotherapy may affect your hair.

On the last page of this fact sheet, you will find a list of common combinations of chemotherapy drugs used to treat breast cancer, along with their likely effect on your hair.

Some women who take the breast cancer hormone treatments tamoxifen, anastrozole, letrozole and exemestane may also experience hair thinning because of the oestrogen-lowering effect of these treatments. However, these treatments are unlikely to cause complete hair loss. Hair thinning usually improves after the first year of taking these medications, though some women will experience hair thinning for as long as they take these medications. If you are still experiencing hair thinning, you may like to discuss with your doctor whether switching to another one of these medications would be possible, as they may not all equally affect your hair.

Being prepared and talking with others about how you feel can help you adjust to the temporary change in appearance. If you have children, it’s important to prepare them also for this change, and to let them know that your hair will grow back.

What can I do to prevent or reduce hair loss?

As a way of minimising hair loss while undergoing chemotherapy, some medical oncology clinics offer women access to a scalp cooling machine. These have been shown to reduce hair loss from chemotherapy. You will be required to wear a silicone cap that is attached to a cooling machine. The cap is placed on your head and is gradually cooled as it is filled with a gel coolant. The system offers a comfortable fit. You will need to sit by the machine while the cap is in place so you won’t be able to walk around freely, however the cap can be disconnected for short periods, for example, if you need to use the toilet. The correct fitting of the cap essential; if it falls around your face, you will need to ask your oncology nurse to refit it.

Scalp cooling systems work by chilling the scalp and reducing blood flow to the scalp to prevent chemotherapy from getting to the hair follicles. This means the hair is less likely to be damaged and fall out. If you decide to use a scalp cooling machine, you will need to wear the cap every time you have chemotherapy treatment. You will need to wear it for about 30 minutes before each chemotherapy session starts, and then during and for a time after each chemotherapy treatment session. Scalp cooling can reduce hair loss but your hair may thin or may still fall out completely. Scalp cooling only protects the hair on your scalp; body hair including eyelashes and eyebrows may still be lost.

Scalp cooling machines are only available in some oncology centres and are not suitable for everyone. If you would like to learn more about scalp cooling, it is best to talk to your breast care nurse or medical oncologist.

Good hair management and scalp care between scalp cooling sessions is also important.

If your hair is likely to thin from chemotherapy

  • Use a gentle shampoo and conditioner. Organic products with reduced sulphates are recommended.
  • Try to use a lukewarm water in the shower as hot showers are harsh on the scalp.
  • Brush your hair from the ends upwards towards the scalp, to protect the scalp (one of the reasons for hair loss is the hair breaking off at the scalp).
  • Brush your hair before you wash it, always brushing from the ends upwards. A wet brush is recommended as it is more gentle on the hair.
  • Avoid cutting your hair too short so that if there are small patches of hair loss, you have hair to cover it.
  • When fastening hair, avoid using hair fasteners or hair ties. Pins or crocodile clips are best.
  • Protect your scalp from the sun.
  • Heated rollers or curling wands should only be used occasionally.
  • Avoid perming or straightening your hair.
  • If you colour your hair, ask your hairdresser to use/recommend an organic (vegetable-based) hair colour which will be gentle on your hair and scalp. These may have to be ordered in for you.
  • Dry your hair naturally or use a cool setting on the hair dryer.

If you’re likely to lose all of your hair

“My scalp was tender for a few days when my hair was falling out. I found that a silk pillowcase was more comfortable to sleep on.” – Stephanie.

“I chose to have my hair shaved off. That way I felt I had some control.” – Elena.

Hair usually starts to fall out about 17 to 21 days after the first cycle of chemotherapy treatment, and it generally happens quickly. First, your scalp may become tender or itchy. The tenderness may cause discomfort when you’re resting your head on a pillow or against a hard surface. If necessary, you might want to take some mild pain relief tablets such as paracetamol.

For some women, the first sign that they’re about to lose their hair is finding large amounts of hair clogging the drain after a shower. Others notice hair on the pillow when they wake up or find that they can pull hair out in clumps with gentle pressure.

At this stage, some women choose to shave the rest of their hair. This way, you’ll have less mess to deal with, and it gets the hair loss process over and done with in one go. You might find you look better with no hair than with wispy bits of straggly hair on a bald scalp. If you shave your hair, your scalp might feel a bit ‘prickly’ for a few days, which could make a wig uncomfortable. Wig suppliers and some oncology units sell ‘chemotherapy caps’ to be worn under a wig to ease this discomfort.

Rather than shave your hair, you could wear a turban to contain the hair and wait until most of it has fallen out on its own. Once there is just a little hair left, you may want to shave this off.

If you decide to shave your hair, your hairdresser may be able to do it for you. You might want to see if this can be done in a private place – some hairdressers will come to your home. They will need to use electric clippers to prevent cuts or nicks to the skin. For most women, this is a very emotional time. Be sure you have the support you need. Some health services which provide wigs may also offer a shaving service where you can have your hair shaved in a private, supportive space.

Dealing with hair loss is a very individual thing. Some women don’t want to wear a wig or cover their heads at all. Others couldn’t imagine being seen by others without a wig, hat, turban or scarf. There are no rules – just decide what’s right for you.

As hair loss usually happens over just a few days, it helps to have arranged appropriate head covering before your hair begins to fall out. Apart from how you look, keep in mind that hair helps the body retain heat in the cold and protects the scalp from the sun.

You’ll probably need some head covering during winter at night or when you’re in the sun. Options for covering your head include wigs, hats, scarves, beanies and turbans. If you prefer not to cover up, remember to use sunscreen.

“I thought I was emotionally prepared to lose my hair although I never truly understood how much it was a part of my identity until it was gone.” – Helen

Wigs

Wigs can be made from synthetic fibres, real hair or a combination of both. They vary in price from around $80 to many hundreds of dollars. The most expensive are not necessarily the best. Remember that hair loss is temporary – you may only need the wig to last for six to 12 months. HairTriss offers a large variety of human, synthetic and mixed wigs at https://hairtriss.com/collections/wigs. We also assist women in fitting wigs.

P.S : Even if you think you won’t want to wear a wig, it’s a good idea to have chosen one in case you change your mind. If you don’t feel like trying wigs on, keep some of your hair so that you can match the colour if you do change your mind.

Wig accessories

  • You will probably require a wig brush.
  • Wig shampoo is available, but generally baby shampoo works just as well.
  • Many women find that putting their wig over a bottle at night has the same effect as a wig stand.
  • A thin ‘chemotherapy cap’ worn under a wig should help reduce any itching. Hats, scarves and turbans

“At 26 and single, losing my hair was overwhelming. How would I cope? Wigs, beanies and scarves became my accessories. And they were fun. I could be someone different every day! I didn’t look too bad bald either!” – Mia

Eyelash (madarosis) or eyebrow loss (superciliary madarosis)

It can be very distressing to lose your eyelashes and eyebrows as a result of breast cancer treatment.

“I was devastated by the loss of my eyebrows and eyelashes. I looked featureless. I attended the Look Good ... Feel Better program and quickly learned to love eyeliner. I was really excited when they started to grow back. I swear I’ll never take my eyelashes for granted again.” – Pam.

The loss of eyelashes is not as easy to conceal as the loss of hair from your head and, importantly, eyelashes normally protect your eyes from grit and dust – without them it’s a good idea to wear glasses or sunglasses when you’re outdoors. Artificial tears (available from pharmacies) may help to keep your eyes lubricated.

Once chemotherapy is completed, eyelashes and eyebrows should grow back, however they may not grow back as thickly as before and the new hair is typically fine, short and brittle and may lack colour.

If your eyes are not feeling sore, you may like to try using makeup or false eyelashes to replace your own eyelashes. You can buy false eyelashes from pharmacies and makeup counters at HairTriss studio Salon. Synthetic eyebrows can also be purchased and fitted in our salon. Check with Morgan if you are thinking about this option.

Some women choose to ‘create’ eyebrows with an eyebrow pencil or eyebrow powder. You may want to check out this product if you are interested : ...

You also may like to try wearing fake eyebrows, which are available for purchase from Hair Triss Salon at www.Hairtriss.com

Looking good, feeling good

For many of us, our hair is an important part of our identity and influences our self-image. For many women hair is their ‘crowning glory’. It can be a real challenge to feel good when you don’t have any.

We encourage you to do whatever you need to do to feel good.

Some women find that by wearing lipstick and/or earrings the attention of others is drawn away from the scalp.

Look Good ... Feel Better programs help you to learn about skin care during treatment, makeup and wigs, hair extensions, hats, scarves and turbans in a safe, supportive and fun environment. Suzanne can be reach at hairtriss@gmail.com for details of the program HairTriss offers to you.

What to expect when your hair grows back

The length of time that it takes for hair to grow back varies from person to person, but it’s important to remember that hair loss from chemotherapy is temporary. Your hair will grow back once treatment is finished.

While it’s different for everyone, you may feel a fine ‘fuzz’ on the scalp five to six weeks after your final treatment. Some women find that they have a short but thick covering of hair over their entire scalp around 12 weeks after their final treatment, but again everyone is different and it may take a little longer, or a little less time to reach this point. At this stage it helps to leave the wig off as much as possible to encourage hair growth. Occasionally hair will start to grow back before treatment has finished. This does not mean that the treatment is less effective.

Your hair will continue to grow at its normal rate – which for most people is about 1 cm a month. Some women have also found that using a shampoo that promotes hair growth can be beneficial. These shampoos can be purchased at pharmacies and department stores. Some women find that gently massaging their scalp can also help stimulate hair growth.

Sometimes hair grows back a different colour – and sometimes it’s curly when it used to be straight. These curls may be temporary or permanent.

“I know I should be grateful to have hair after six long, mostly cold months without it, but I’d give anything to have my old hair back. It’s now curly. People who I haven’t seen for a while don’t recognise me until I speak and then they can recognise me by my voice. No one ever prepared me for that.” – Paige.

Some people recommend avoiding chemical dyes or perms in the first few months. There’s no real evidence that these will damage the hair or cause it to fall out, but you may prefer to forego the perm and use more gentle vegetable dyes for a while. You could also ask your hairdresser to test a small area of hair before colouring your whole head.

“My hair was growing back but I wanted instant length. I decided to have hair extensions and was rapt with the result. I figured I’d saved so much over the months not needing colours or cuts; this was my treat to myself.” – Ana

“When my hair grew back, it was very grey. Being only 40 and having had no grey hairs before chemotherapy, it was a bit distressing. My hairdresser just smiled and said ‘We can fix that’, so I had my first hair colour at 40! This gave me the confidence to head out in public with no hats and a short trendy hairstyle.” – Shannan.

Many women experience hair loss as a result of treatment for breast cancer. You can make contact with other breast cancer survivors or a breast cancer support group through the American Cancer Society 1 (800) 227-2345.

Chemotherapy treatments and hair loss

Add chart here.


Suzanne,
HairTriss team.