Hair loss and other changes to your hair

Lymphoma treatment and changes to your hair

Cells that divide rapidly are more sensitive to the effects of lymphoma treatment. This includes hair cells as well as lymphoma cells. For this reason, hair loss and other changes to your hair can be a side effect of lymphoma treatment. You might hear the word ‘alopecia’ used to refer to hair loss.

You might experience this as a side effect of chemotherapy or radiotherapy. Less commonly, it can be a side effect of antibody therapy. 

Not everyone who has treatment for lymphoma experiences changes to their hair. Whether you’re affected or not depends on lots of factors, including: your treatment (type, dose, and how often you have it), age, and overall health, including any other conditions you might have.

Effects on your hair are usually short-term. They can include:

• slight thinning
• part or complete loss
• changes in colour, which could include a streak or band of white hair
• changes in texture, such as thinner, more coarse or curlier than before treatment.

Mostly, in time, hair goes back to how it was before treatment for lymphoma.

Hair in other parts of your body can also be affected. You might also be affected by changes to your nails during treatment.

My hair grew back curly, thicker in texture, and with a white streak. It is back to normal now, possibly a little thicker than before. But the white streak remains. My hairdresser refuses to change it saying people pay a fortune for this look. I like it.

Gill, affected by hair loss

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Chemotherapy and possible effects on hair and nails

Chemotherapy kills lymphoma cells. However, it can also destroy healthy cells, particularly those that normally divide quickly – such as those that produce hair.

Your fingernails and toenails might also be affected by chemotherapy. This is because nails contain keratin (the same protein your hair is made from). Nails grow quickly, making them sensitive to chemotherapy. While you’re having treatment, your nails might become dry, grow more slowly and break easily. They might look a bit different too. For example, you might develop ridges on them, or they might become dry or discoloured.

Chemo did have an impact on my nails too. They have not recovered as well, particularly my toenails, so I visit a chiropodist regularly now.

Gill, affected by hair loss

Will I be affected by hair loss as a side effect of chemotherapy?

Your medical team will speak to you about the likelihood of hair loss and what you might expect before you begin treatment. If you experience hair loss, your hair usually begins to fall out within a couple of weeks of starting treatment.

As a general guide:

• Hair loss is quite common in people who are treated with chemotherapy.
• Chemotherapy regimens (combinations) using more than one drug are more likely to cause hair loss than treatment with just one drug. Those that are given every 2 to 3 weeks are generally regimens that are more likely to cause hair loss than regimens given every week. 
• Intravenous chemotherapy is more likely to cause hair loss than low-dose chemotherapy taken as tablets or capsules (orally). 
• Conditioning treatment before a stem cell transplant usually involves high-dose chemotherapy. It can cause quick and complete hair loss, on areas of the body other than just your head.

Macmillan Cancer Support have an online search tool where you can find out more about specific chemotherapy drugs or regimens and their possible side effects.

Does hair fall out gradually or all at once with chemotherapy?

Hair loss usually starts at the top and sides of your head, above your ears. It might fall out gradually, in clumps, or quite quickly. You might notice hair on your pillow or clothes, in your hairbrush, or in the plug hole of your bath or shower.

Hair in other parts of your body might be affected, for example eyebrows, eyelashes, facial hair, armpit hair and pubic hair. You could also lose hair from inside your nose, which can cause you to have a runny nose.

I started seven straight days of chemo. It was very intense and I lost all of my body hair.

Matt, diagnosed with non-Hodgkin lymphoma

You can read more of Matt’s personal experience of non-Hodgkin lymphoma on our website.

Will my hair grow back after chemotherapy?

Hair usually grows back within a few months to a year. There are headwear and other options available if you choose to cover the effects.

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Radiotherapy and possible effects on hair and nails

Radiotherapy damages lymphoma cells to stop them from dividing. However, it also damages healthy cells. Unlike lymphoma cells, healthy cells are generally able to recover well. Cells that grow at a fast rate (including hair cells) are more sensitive to these effects. Radiotherapy can therefore stop you from making new hair.

Radiotherapy doesn’t usually affect nails, unless they are in the radiotherapy treatment field – however, this is unlikely with lymphoma treatment. 

Will I be affected by hair loss as a side effect of radiotherapy?

Radiotherapy affects hair in the area of the body that receives treatment. This is a common side effect of radiotherapy treatment. 

Does hair fall out gradually or all at once with radiotherapy?

If you experience hair loss with radiotherapy, it usually begins to fall out within a couple of weeks of starting treatment.  It might fall out gradually, in clumps, or quite quickly. You might notice hair on your pillow or clothes, in your hairbrush, or in the plug hole of your bath or shower. Speak to your medical team for information about what to expect.

Will my hair grow back after radiotherapy?

At lower doses of radiotherapy, hair loss is usually temporary. With higher doses, it might be permanent. The speed of hair re-growth depends on the type of radiotherapy, the number of treatments you’ve had and the area of the body treated.

Hair usually starts to grow back around 3 to 6 months after treatment. 

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Targeted drugs and hair loss

Most people who are treated with targeted drugs don’t experience hair loss. In general, it affects fewer than 15 in 100 people.

Some targeted drugs are a type of immunotherapy treatment, for example antibody therapy. They use your immune system to treat your lymphoma. Fewer than 2 in 100 people treated with immunotherapy are affected by hair loss.

Some targeted drugs work on a protein called epidermal growth factor receptor (EGFR), which fuels the growth of cancer cells. EGFR is also needed for the normal growth of hair and nails, which is why these drugs can cause changes to your hair and nails.

Targeted drugs might cause:

• the hair on your head to become more thin, dry or curly
• your hair to turn a yellow colour
• hair on your face, including eyelashes and eyebrows, to grow more quickly and thickly
• facial hair growth to slow and eyebrows to thin
• changes to your nails, for example, they might become discoloured, brittle and dry.

Will my hair grow back after targeted therapy?

When your hair starts to grow back depends on the type of targeted treatment you are treated with. With some targeted therapies, it can start to grow back during treatment. Your medical team should be able to give you an idea of what to expect. 

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How can I prepare for changes to my hair?

For a lot of people, the possibility of changes to their hair – and particularly hair loss – is one of their biggest worries about having lymphoma treatment. 

I lost my hair which I’d never cut. I asked about the cold cap (sometimes used to prevent hair loss by reducing the blood flow to the scalp) but was told it wasn’t suitable for people with lymphoma. I also lost my eyebrows and eyelashes. I just didn’t feel like the same person at all.

Mollie, diagnosed with diffuse large B-cell lymphoma

Hair loss can be an important part of self-identity, so unwanted changes to it can significantly affect self-esteem and confidence. It’s a visible side effect of treatment, and it can make it obvious to other people that you’re having treatment, including people you might not have chosen to tell. This loss of control and privacy can be very challenging to cope with.

You might want to consider in advance how to approach hair loss. Some people choose to disguise it, while others try to embrace it.

I decided to shave my hair off in the early stages of my treatment to get it over and done with. I thought it easier to just go without my hair for a while.

Matt, diagnosed with non-Hodgkin lymphoma

Speak to your medical team for advice specific to your situation – if your hair is likely to be affected, you might want to ask where from and how quickly you could expect it to grow back. Getting an idea of what to expect can help you to prepare for changes to your hair and give you time to consider what approach you might like to take.

Tips to help prepare for hair loss

The members of our Facebook group also share some top tips for looking and feeling good, including about coping with hair loss. 

If possible, think about your approach before changes happen – this could include what you might say to people, as well as if and how you choose to cover changes to your appearance. 

These are some ideas you might want to consider; however, it’s important to take an approach that you feel is best for you:

• Cut or shave the hair on your head as this can make hair loss less obvious. Some people also find it more comfortable. It can also make it easier to fit headwear such as a wig. 
• Shave facial hair as this can help you get used to having less hair and heighten your sense of control over the situation.
• Try using an app that shows how you would look without hair. Search online for one that’s suitable for your device.

You might also think about what you might say to the people around you. For example:

• Think about preparing the people around you for the possibility of your hair loss. This might help to lessen your anxiety about others’ reactions to any changes in your appearance.
• You could also signpost family and friends to our information, to help explain hair loss as a side effect of treatment.

I found losing my hair really difficult. I let nature take its cause and tried to hold on to every last strand. In hindsight, I think this prolonged the agony for me. Although everyone is different, I think I would have been better to shave it off or cut it short when it started to drop out.

Andrea, affected by hair loss

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What options are there if I choose to cover my hair loss?

There are lots of headwear and cosmetic options you might be interested in if you choose to cover your hair loss. We outline some popular choices below. 

You could try some out before you start treatment. Give yourself as much time as you can so that you can choose an option you’re comfortable with and start to get used to it.

Wigs

Wigs can be made from:

• synthetic materials
• real (human) hair
• a mix of synthetic and real hair. 

You might also use a wig stocking cap (often made from cotton or nylon). You wear this over your scalp so that the wig grips more securely. It can also make it more comfortable to wear. 

Some people find stocking caps hot to wear, however. If this is the case, you might want to limit wearing them to times when it’s less likely to be hot (for example, on a cooler day as opposed to in a warm, crowded room).

If you are considering a wig, you could ask your clinical nurse specialist or another member of your medical team if they can suggest a wig supplier in your area. 

Some hospitals have an advisory service where you can talk to a specialist about headwear options. You might want to book an appointment with a wig specialist before you begin to lose hair – you could take a friend or family member with you too, for emotional support and to help you choose. Having a consultation before you experience hair loss allows time to choose a style and to get used to wearing the wig. Some people choose a wig that’s as close as possible to their natural hair, while others take the opportunity to try a completely different look. 

Synthetic wigs

Synthetic wigs are usually made of a type of plastic. Sometimes, they are available for free on the NHS. Synthetic wigs last for around 6 to 9 months. 

• An advantage of synthetic wigs is that they are easy to handwash – you can use regular shampoo on them and leave them to dry overnight. 
• Something to keep in mind with synthetic wigs is that you can’t style them with heat (such as a hairdryer or other heat-styling tools) – doing so makes the fibres become frizzy.

Can I get a free synthetic wig or help towards the costs?

You might be eligible to receive a synthetic wig free of charge.

If you live in Scotland, Wales or Northern Ireland, synthetic wigs are available free of charge.

If you live in England, synthetic wigs are available for free on the NHS if you meet certain eligibility criteria. These include:

• your age (under 16, or under 19 in full-time education)
• earning under a certain amount of money
• claiming certain financial support. 

Real hair wigs

Real hair wigs are made from human hair. They can last for a few years. Real wigs cost more than synthetic wigs and are not usually available on the NHS. 

• An advantage of real wigs is that they often look very natural. 
• Something to keep in mind with real wigs is that they sometimes need practice to style – you can ask a wig specialist how often you are likely to need to wash the wig and whether this should be done by a hair stylist.

You might be interested in Macmillan Cancer Support’s video tutorial on choosing a wig.

Can I get a free real (human) hair wig or help towards the costs?

The NHS does not cover the cost of a human hair wig. However, many wig suppliers can give you a form to complete so that you do not need to pay VAT on them. Note that you need to do this before you buy it as you cannot claim it back later.

You can find out more about wigs, including getting one through your health service or the NHS, on Cancer Research UK’s website. 

Macmillan Cancer Support has more information about paying for a wig. You might also be able to apply for grants and benefits from other organisations or charities to help pay for a wig. For example, you could use a Macmillan Grant towards the cost of a wig.

For children and young people up to the age of 24, Little Princess Trust provides real hair wigs to those who have lost their hair due to cancer treatment or other conditions.

What other options for help towards the cost of wigs are there?

You could consider buying a wig from a wig bank. These are made up of wigs that people have donated. This is a cheaper option than buying a wig that is new. The wigs are cleaned and conditioned before they are on sale. You can find a wig bank online, for example, on the Wig bank’s website, or ask your wig specialist.

My New Hair is a charity that offers advice and support to people affected by medical hair loss. You can search their database of salons that can help you choose, style and fit a suitable wig.

You can find out more about wigs, including getting one through your health service or the NHS, on Cancer Research UK’s website. 

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Cosmetics and camouflage options

Cosmetics can help hide hair loss. There are various make-up, sprays, lotions and powders available. Ask a member of your medical team whether they are safe for you.

• Concealing powders or sprays use tiny fibres that you spray onto or sprinkle over your scalp to make your hair look thicker. You might need to use a hairspray to set the fibres in place. Concealing powders can be useful to cover partial hair loss, although they don’t always stay in place if your hair gets wet, for example, in the rain or in a swimming pool. You wash them out and re-apply them.
• Masking lotions are waterproof, non-greasy creams that colour your scalp (but not your hair) to disguise hair loss. They come as a cream that you apply to the scalp with a cosmetic sponge. Using a colour that is a shade darker than your natural hair colour can help to cover partial hair loss.
• Micro-tattoos use tiny needles to put a coloured material (pigment) into the top layer of your skin. This gives the appearance of closely shaven hair. As the needles pierce the skin, micro-tattooing could increase your risk of infection. Doctors therefore usually advise waiting at least 6 months after finishing treatment before micro-tattooing, and it’s possible that your hair might have already grown back by this time. Micro-tattoos are semi-permanent and fade over time.
• Micro-blading is a semi-permanent tattooing technique for eyebrows. Like micro-tattoos, micro-blading uses tiny needles to add coloured material (pigment) to your skin and this fades over time. Avoid this technique during treatment or if you are immunosuppressed. 
• False eyelashes and false eyebrows come in lots of colours and styles. You, or a beauty therapist, stick them on with a special glue. There are also magnetic options that you attach using a magnetic eye liner.

Cancer Research UK has skin care and make up tips during cancer treatment, including video tutorials, on their website.

The charity Look Good, Feel Better also offers free workshops across the country to help men, women and young adults with visible effects of cancer treatment. 

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Accessories

There are lots of options for accessories available, including hats, headscarves, wraps, turbans, bandanas and zandanas (pre-tied bandana). They come in a wide range of styles, colours and fabrics and can be worn in different ways. 

You might be interested in information from Macmillan Cancer Support about scarves and bandanas, including their video about headwear options for hair loss.

Whether you choose to distract from your hair loss is entirely your decision. Some people take attention away from their head by wearing bright clothes, jewellery or other accessories.

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Looking after areas affected by hair loss

Areas of the body affected by lymphoma treatment and hair loss can be more sensitive than they were before. We give some general tips to help care for them below, but it’s important to follow specific advice given to you by your medical team.

How can I look after the skin on my scalp?

Chemotherapy and radiotherapy can affect the skin on your scalp and make it feel sore. Hair loss can make your scalp feel sore or itchy, and your hair fragile. Some people say that they feel a tingling sensation on their scalp. Occasionally, the hair cells can become infected (folliculitis).

Follow the advice of your medical team about how to look after your scalp. You might need to treat it gently while it’s recovering from treatment. A pillowcase made from a natural fabric, such as cotton, can also help to lower scalp irritation.

Keep the skin on your scalp moisturised

• Moisturise the skin on your scalp using gentle, unscented and mild products.
• Softly massage a mild moisturiser into your skin each day. If you are having radiotherapy, your medical team might give you a cream or dressing to protect affected skin.
• If your scalp is flaky, put a few drops of unscented, natural oil (such as almond oil or olive oil) or aloe vera onto some cotton wool and gently massage it in. Avoid anti-dandruff shampoos, as these can have chemicals in that might irritate your skin. 

Protect your scalp

• Protect your scalp from the sun, wind and cold by wearing a hat or other head covering. You could also use SPF50 sun lotion or sunblock if your head is uncovered – even in cold weather, your scalp is still sensitive to sunlight.

Let your medical team know straightaway if you notice spots on your scalp or if your scalp feels moist as this could be a sign of infection that needs treatment. Tell them if the skin elsewhere on your body feels sore or irritated too.

How can I look after the hair on my head?

• Limit how often you wash your hair. Use a gentle shampoo and lukewarm water. Let your hair dry naturally or pat it with a towel.
• From time to time, instead of washing it, you could use dry shampoo or sprinkle talcum powder into your hair. Leave it a while, then brush it out. This absorbs grease and helps to ease tenderness. Use a soft hairbrush.
• Comb or brush your hair gently but avoid plaiting it or tying it tightly. Soft hair ties or ribbons are gentler than elastic bands.
• Avoid chemical treatments like perms, bleaches or dyes, and heat damage from straighteners, curling tongs or heated rollers.
• Use a wide-toothed comb or a baby brush. These are often gentler than other types such as paddle brushes, round brushes and rat tail combs.

If you lose hair at night, you could wear a soft wrap, turban or hair net in bed to help collect loose hair as it falls out. Sticky tape can help to pick up hairs from your bed sheets and pillowcase.

How can I look after my eyes if I have lost my eyelashes?

• Wear sunglasses if you lose your eyelashes and your eyes feel sensitive to sunlight.
• If your eyes feel dry and sting from having lost your eyelashes, you could lubricate your eyes with drop or ‘artificial tears’, such as hypromellose eye drops. Ask a member of your medical team whether this is suitable for you.

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