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Hair loss, hair thinning and cancer drugs

Cancer drugs can cause hair loss or hair thinning. But there are things that you can do to help you cope.

About hair loss or hair thinning

Hair loss is one of the most well known side effects of cancer treatment. For many people losing their hair can be distressing and devastating.

It can be a constant reminder of your cancer and what you’re going through. But for most people, their hair will grow back once treatment has finished.

Cancer drugs can cause:

  • mild thinning of your hair
  • partial hair loss, or loss of patches of hair
  • complete hair loss (alopecia)

Chemotherapy is the type of cancer drug treatment most likely to cause hair loss.

Complete hair loss is very unlikely with any other type of treatment. But some other cancer drugs can cause hair thinning. It is not possible to tell beforehand who will be affected or how badly.

Hair loss also depends on factors such as:

  • the type of drug or combination of drugs you are taking
  • the dose
  • the route (by mouth or as an injection or a drip through a vein)
  • how sensitive you are to the drug
  • your drug treatment in the past

Drugs that cause hair loss or thinning

Chemotherapy

Most people think that chemotherapy drugs always cause hair loss. But some don't cause any hair loss at all or only slight thinning.

Other types of chemotherapy may cause complete hair loss. It might include your eyelashes, eyebrows, underarm, leg and sometimes pubic hair.

Hair loss is usually gradual rather than sudden. If your hair is going to fall out, it usually begins within 2 to 4 weeks after treatment starts.

Your hair will grow back once your chemotherapy treatment has finished. In very rare cases the hair does not grow back. This only happens with very high doses of particular drugs. You can ask your doctor or specialist nurse whether your drugs are likely to cause hair loss.

Other cancer therapies

Some hormone therapies and targeted cancer drugs can cause hair thinning. Usually, this is mild and may not even be noticeable.

With hormone therapies, hair loss usually happens within the first year of starting treatment.

When your hair grows back

Chemotherapy

Unless you have had very high doses of particular chemotherapy drugs, your hair will grow back once the course of treatment is over.

There is evidence that in some people after treatment with a type of chemotherapy called docetaxel, hair might take much longer to grow back. And that in a few people hair loss might be permanent. But this is rare and usually depends on the dose you’ve had and for how long you’ve had it. Speak to your doctor if you are worried about this.

After chemotherapy, it may take several months for your hair to grow back. And your hair is likely to be softer. It might come back a different colour and may be more curly than before. It will probably grow back at the same rate as it grew before chemotherapy.

Within 3 to 6 months after your treatment ends, your hair should return. For most people, their hair will fully recover within 6 to 12 months.

Other cancer therapies

Thinning hair caused by hormone therapy or targeted cancer drugs will also recover. Your hair will usually thicken within a few weeks of finishing the treatment.

A type of targeted cancer drug called epidermal growth factor receptor (EGFR) inhibitors can cause permanent hair loss. But this is usually when you have it long-term.

Coping with hair loss

These tips can help if you are worried about hair loss or thinning from cancer treatment.

Tips for possible complete hair loss

  • Ask about a wig before you start treatment, so you can match the colour and texture of your real hair.
  • If you are feeling adventurous, choose a wig for a whole new look – why not try the colour and style you've always wanted!
  • Think about having your hair gradually cut short before your treatment starts - this might help you get used to seeing yourself with less hair.
  • Some people shave their hair off completely to avoid the distress of seeing their hair fall out.
  • Wear a hair net at night so you won't wake up with hair all over your pillow, which can be upsetting.
  • Keep your head warm in cooler weather - some people wear a soft hat in bed.
  • Rub in oil or moisturiser if your scalp feels dry and itchy, try unperfumed products such as Epaderm, Hydromol or Doublebase.
  • Try a moisturising liquid (emollient) instead of soap if your scalp is dry, for example aqueous cream, Oilatum or Diprobase.
  • Protect your scalp by covering your head in the sun - your scalp is particularly sensitive to the sun.

Tips for hair loss or thinning

  • Use gentle hair products such as baby shampoos.
  • Don't use perms or hair colours on thinning hair – colours may not take well and perms can damage the hair.
  • Use a soft baby brush and comb thinning hair gently.
  • Avoid using hair dryers, curling tongs, hair straighteners and curlers on thinning hair and pat your hair dry after washing.
  • If your scalp flakes or itches this means it is dry – use oil or moisturiser, not dandruff shampoo.
  • Protect your scalp by covering your head in the sun.

Covering your head

There are a lot of ways to cover your head if your hair falls out.

A wig is the most obvious choice. But not everyone wants to wear one. They can be a bit hot and itchy, especially in the summer. You can wear a soft inner cap (a wig stocking) under the wig to make it more comfortable. Some people worry that the wig will slip or fall off. You can buy sticky pads designed specifically to keep the wig still. 

Some people prefer hats, scarves or baseball caps. Or you can just leave your head uncovered if you feel confident with your bald head.

Ask your nurse if you think you would like a wig. Some people can get a wig on the NHS.

There are different types of hats and scarves you can wear when you have hair loss or thinning. You can buy these in high street shops or on the internet.

Reducing hair loss from chemotherapy

Your doctor will want to give you the treatment that's most likely to work best in treating your cancer. But sometimes there is a choice of drugs you can have.

Speak to your doctor if you find the thought of losing your hair very upsetting. Your doctor might be able to suggest a treatment less likely to cause hair loss. It's worth discussing.

Cold caps (scalp cooling)

Your doctor might also suggest you try something called a cold cap (also called scalp cooling). This can sometimes reduce the amount of hair loss.

You wear a cold cap to lower the temperature of your scalp. This reduces the blood flow in the scalp. And this lowers the amount of drug reaching the hair follicles on your head. With less of the cancer drugs getting to the hair follicles, the hair is less likely to die off and fall out.

Problems with cold caps

Scalp cooling only blocks certain chemotherapy drugs and doesn't work for everyone. So you might still have hair thinning, or lose your hair completely. You can't tell whether it will work for you until you try it.

Doctors can’t use scalp cooling for all types of cancer. You can't have scalp cooling if there is a risk that there might be high levels of circulating cancer cells in your scalp blood vessels. This is because the cells in these blood vessels might survive the treatment.

So, scalp cooling isn't usually suitable for people:

  • with cancers such as leukaemia and lymphoma
  • who are due to have radiotherapy to their scalp

Scalp cooling is also not suitable for people with the following conditions:

  • cryoglobulinemia
  • posttraumatic cold dystrophy
  • cold agglutinin disease

When having continuous chemotherapy through a pump or chemotherapy tablets, you can’t have scalp cooling either. This is because you would need to wear a cold cap for 24 hours a day.

Some people worry that their cancer might spread to the scalp (metastasise) if they’ve used a cold cap during chemotherapy. Researchers did a systematic review of studies in 2018. A systematic review means that a group of experts gather all the evidence about a particular subject. They then go through it to work out whether there is any evidence to support it.

The review showed that the risk of cancer spreading to the scalp after using a cold cap was very small.

How you have it

You have to spend longer at the hospital having your treatment if you have scalp cooling. You need to wear the cold cap for 30 to 45 minutes before you have your drugs.

It might make you feel cold all over. Wear a jumper or ask for a blanket. Hot drinks will help you feel warmer. Some people find that the cold cap gives them a headache.

You have to continue wearing the cold cap for some time afterwards. This can be between 20 to 90 minutes. The time you need to wear it will depend on what type of chemotherapy drug you’ve had.

Ask your specialist nurse if wearing a cold cap during chemotherapy is suitable for you. You can talk about the possible risks with your specialist if you're worried.

Patient stories on hair loss and thinning

People react differently to cancer drugs. Here are some stories from cancer patients:

"My hair started to fall out 2 weeks after my first chemotherapy session. As soon as I noticed a few strands coming out, I had my hair cut very short. A few days later it all started to come out and I shaved the rest off.

As a man it doesn't really bother me and my wife quite likes my bald head. Still I'm looking forward to it growing back."

"My doctor said my hair would gradually thin, so I was expecting it. However, I was a bit frightened when it started to come out in handfuls when I washed my hair. So I had my hair cut in a short style to suit thin hair.

When I was in hospital the nurses organised for the wig lady to visit. She was very friendly and helped me choose a wig similar to my own colour and style. I was nervous when my daughter came to see me but she said she could hardly tell the difference. I thought it was a lot greyer than my real colour but my daughter thought it was a perfect match!

I don't wear it all the time. I usually wear a scarf round my head but I like wearing my wig when I go out and I feel very comfortable in it."

"My hair took about 6 to 7 months to grow back. At first, it was quite curly, but as it grew, it became heavier and the curls dropped out."

Last reviewed: 
10 Jan 2020
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  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in.

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