Hair might be an important part of your identify, so it’s natural that thinning or loss could affect your self-esteem and confidence. Practical advice can ease your discomfort related to hair loss, while emotional support may help you to cope with how you feel in response to this change.
Hair loss is a side effect of some chemotherapy and some radiotherapy treatments. Occasionally people on brentuximab antibody therapy experience hair loss, too. Effects on your hair are usually temporary and range from slight thinning through partial loss to complete loss. Your medical team will speak to you about your risk of hair loss before you begin treatment.
Chemotherapy and hair loss
Chemotherapy damages dividing cells. This means it kills lymphoma cells as well as healthy cells, particularly those that are dividing rapidly. Hair follicles, which produce hair, are some of the quickest dividing cells in your body and they are often affected by chemotherapy. Any loss usually begins within a couple of weeks of starting treatment. Hair may fall out gradually or in clumps. Speak to your medical team for advice on what to expect.
Not everyone who has chemotherapy experiences hair loss. Whether you lose your hair, and where you lose it from, depends on factors including the chemotherapy regimen (combination of drugs) you are having and your individual sensitivity to it. You could lose hair from your head and some of your body hair, including pubic and underarm hair. Facial hair, including eyebrows, eyelashes as well as beard and moustache, could also be affected. You might lose nasal hair, which can cause your nose to run.
You can find out more about your particular chemotherapy drug or regimen and its possible side effects using the search tool on the Macmillan Cancer Support website.
Hair usually starts growing back after your chemotherapy treatment ends. This usually happens within 3–6 months of finishing chemotherapy, although it can take more or less time. Hair might grow back finer, straighter, curlier or a different colour from what it used to be. It tends to eventually return to what it was before treatment. The change is permanent for a small number of people.
Note: Your fingernails might also be affected. Nails contain keratin (the same protein your hair is made from) and they grow quickly, making them sensitive to chemotherapy. They might become dry, marked or discoloured and can break easily while you are having treatment. As with hair loss, these effects are usually temporary. You may wish to improve the appearance of your nails using nail varnish. Avoid quick-drying types as these can make your nails even more dry and brittle. If you are considering using newer nail technologies, such as gel manicures, check with your medical team whether they are suitable for you.
Radiotherapy and hair loss
Radiotherapy causes changes to cells and stops them from dividing. This means that while it damages lymphoma cells, it also stops hair follicles from dividing and making new hair.
As radiotherapy is delivered to a precise area of your body, you will lose hair only from this area, if at all. Although it varies from person to person, in general, hair loss happens gradually towards the end of radiotherapy treatment. You may start to notice hair on your pillow, clothes and in the shower. It usually takes around 6–12 months for hair to grow back after treatment has finished. When it does, it might be curlier or a different texture from what it was before treatment.
Hair loss in the area treated with radiotherapy is permanent for a small number of people. The likelihood of this depends on the dose of radiotherapy prescribed. Your medical team should talk to you about your risk of this happening before you start treatment.
It takes time for hair to grow back
On average, hair grows at a rate of around 1cm a month. Part of your hair is made of a protein called keratin. After lymphoma treatment, you may have a temporary lack of keratin, which can weaken your hair and slow its growth. Once keratin level returns to normal, stronger hair can begin to grow. How quickly your hair grows back depends on several factors, including the treatment type you've had, your individual response to it and your general health.
Hair loss is often distressing and can impact your self-esteem. It can be a visual reminder of undergoing treatment, which can make it harder to cope with it.
Prepare yourself for the change in appearance before you begin treatment. Speak to your medical team about any hair loss you should expect. You may wish to consider the following suggestions:
- If you are very likely to lose your hair, you may want to cut it short before your treatment starts. You might also consider shaving your beard and moustache if you have them. This can help you get used to having less hair and give you a sense of control over your situation.
- Try out wigs and other headwear options. If time allows, order these before you begin losing hair so that they are ready as soon as you need them.
- Let friends and family know that you expect to lose your hair. This can prepare them for the potential change in your appearance. If you feel uneasy about how they might respond, talking to them in advance of your treatment may help to reduce your feelings of anxiety.
You might have heard of something called ‘cold capping’ or ‘scalp cooling’, which can reduce hair loss. Cold capping works by reducing the flow of blood carrying chemotherapy to your hair and is not recommended for people with lymphoma. This is because you could have lymphoma cells in the blood vessels of your scalp. If you wear a cold cap, the cells are more likely to survive chemotherapy, making the treatment less effective.
Certain types of chemotherapy can affect your eyebrows and eyelashes. As with hair loss elsewhere on your body, losing your eyebrows and eyelashes can be upsetting. Your eyes might be more sensitive to light if you lose your eyelashes, in which case sunglasses can help.
Make-up can help to disguise the loss of eyebrows and eyelashes. Cancer Research UK has information on how to do this, including video tutorials. The charity Look Good, Feel Better offers free workshops across the country to help women with visible effects of cancer treatment.
Information in this section focuses on caring for your scalp (the skin covering the top of your head). Let your medical team know if the skin elsewhere on your body feels sore or irritated.
Look after your skin by using gentle, unperfumed products such as baby soaps and moisturisers. Softly massage a mild moisturiser into your skin each day to help restore its normal condition. If you are having radiotherapy, you may be given a cream or a dressing to protect affected skin.
Your scalp might feel tender during and after chemotherapy, or after radiotherapy to your scalp. Follow the advice of your medical team, which might include some of the general guidance below for people with treatment-related hair loss.
It is important to let your medical team know if you notice spots on your scalp or if your scalp feels moist. It could mean you have an infection that needs treatment.
Washing, drying and styling your hair
- Sprinkle talcum powder into your hair. Leave it for a while and then brush it out. This can help to absorb grease and ease tenderness. You could do this from time to time instead of washing your hair.
- Wash your hair gently. If you have had radiotherapy to your scalp, avoid rubbing the treated area. Use lukewarm water. Hot water can irritate your scalp.
- Use gentle products, like baby shampoo. These are less likely to dry and irritate your scalp. Ask your medical team to recommend soaps, shampoos and conditioners.
- Let your hair dry naturally or pat it with a towel. Heat dries your hair and can cause it to break.
- Use a wide-toothed comb or a baby brush. They are often gentler than other types such as paddle brushes, round brushes and rat tail combs.
- Avoid heated styling tools. This includes heated rollers, curling wands, hair dryers and straighteners. Heat can damage your hair and cause it to break.
- Use soft hair ties when tying back your hair. This prevents strain on your hair. Elastic bands and plaiting can pull on your hair and cause it to break.
- Avoid hair dyes, perms and chemical straightening. The chemicals used in these processes will dry your hair. They can also put stress on your hair and cause further loss.
- Massage a mild, unperfumed moisturiser into your scalp. If your scalp is flaky, put a few drops of a natural oil (such as almond oil or olive oil) or aloe vera onto some cotton wool. Gently massage it into your scalp.
Staying comfortable in bed
- Use pillowcases made of 100% cotton. Man-made fibres, such as polyester, can make your skin hot and irritate it.
- Consider using a chilled pillow. This type of pillow is filled with a material (a gel or foam) that stays cool. Using one can reduce irritation of your scalp.
- Wear a hairnet or a towelling turban. Doing so will help to catch hairs as they fall out rather than allowing them to scatter across your pillow.
- Use sticky tape to pick up hairs from your bed sheets. You might find this easier than picking them up with your fingers.
Protecting your scalp from the sun, wind and cold
- Cover your head. Wear a hat or, if you have little hair covering your scalp, apply a sun-blocking cream. You should do this even in cold weather because your scalp is still sensitive to sunlight.
There are various ways you can cover your hair loss if you choose to. Some suggestions are below. It’s a good idea to speak to your nurse specialist or another member of your medical team about options too. Your hospital might have a hair loss support worker or links with headwear companies that could be useful to you.
If you are considering a wig, ask your nurse specialist or another member of your medical team if they can put you in touch with a local wig maker.
You might want to match your wig to your natural hair. In this case, book a consultation with a wig specialist before you begin losing your hair. This will allow them to see the type and colour you’d like your wig to be and give them time to make it for when you need it. You may even want to discuss the possibility of using your own hair in the wig. Alternatively, you could choose something completely different – perhaps a new style or cut you’ve never had before. A wig specialist can talk through those options with you.
Wigs can be made from synthetic (man-made) or real hair, or a combination of the two.
- cost between £50–£200
- are easy to wash
- cannot be heat-styled or the fibres will become frizzy
- last for around 6–12 months.
Real hair wigs
- cost between £200–£2,000
- can look very natural
- might need to be washed and styled by a hairdresser
- last for around 3–4 years.
You may be entitled to a synthetic wig on the NHS. These are free of charge in Scotland, Wales and Northern Ireland and for people on low income in England. Please see the leaflet from the Department of Health, HC11, Help with health costs, for more information. In England, you may be able to get a grant towards the costs from Macmillan Cancer Support.
If you do not meet the criteria for a free wig, you might still be eligible for a subsidised wig from your hospital. Ask your nurse specialist for details.
If you buy a wig privately, you shouldn’t have to pay value added tax (VAT). This applies to anyone who has lost their hair because of cancer. Ask the company for a VAT exemption form when you buy the wig. You won’t be able to claim it back at a later date.
You might have heard of ‘spray-on hair’, which uses tiny fibres to cover hair loss. If you are thinking of trying such a product, it is important to check with your hospital consultant that it is safe for you. As spray-on hair uses chemicals, a patch test is always advisable before use.
- Hats, headscarves, turbans and bandanas, to name a few headwear options, come in a wide range of colours and fabrics and can be worn in many different ways.
- Clothing and fashion (eg jewellery, ties and brightly coloured shirts) can take people’s attention away from your head.
Your scalp might itch as your hair begins to grow back. If your scalp is dry, frequent shampooing and moisturising can help.
It is advisable to wait 6–12 months after finishing chemotherapy treatment before you colour, chemically straighten or perm your hair. Chemotherapy can still be present in your hair strands and could react with the chemicals used in the styling processes. Ask your hairdresser about natural products like vegetable-based and wash-in-wash-out dyes. These are often suitable alternatives to permanent dyes.
You should also wait several months after your hair has started to grow back before you have woven-in or glued-in hair extensions. Your new hair may be weak and extensions can pull on it and cause it to break.