Why hair loss in chemotherapy? Do cold caps for chemo really work?

Will I lose my hair?

Many people find hair loss the most upsetting side effect of chemotherapy. The rapidly growing cells that make up the hair roots (follicles) are sensitive to chemotherapeutic drugs. Not all drugs cause hair loss, however. There are several important things to remember. The hair loss is temporary. Body hair generally returns once the chemotherapy drug is stopped. Occasionally, the hair will begin to regrow while you are still being treated with the chemotherapy drug. Complete baldness occurs generally within two to three cycles of the drug. When your hair begins to regrow it will be thick and soft and sometimes even better than before.

If I am bald to begin with, will I grow hair when chemotherapy stops? 

No. If you are already bald before starting your chemotherapy treatments, there will be no new hair growth.

Will I lose my hair in places other than on my head? 

The hair follicles of the beard, eyebrows, mustache, eyelashes, armpits, legs, and pubic area are all rapidly growing cells and are sensitive to some of the drugs used in chemotherapy. Sometimes the loss is partial, but many times there is a complete loss of scalp and body hair.

What should I do to prepare for the hair loss? 

You should buy a hairpiece, a wig, or a toupee before you start the treatment. Eyebrow pencil and false eyelashes may be needed. Some people find that horn-rimmed glasses or other glasses that are fitted with rims coming just in front of the eyebrows can conceal this hair loss. Turbans, hats, or scarves can be used instead of a wig, but most patients feel more comfortable if they have made the effort to buy a wig before their hair starts to fall out. Wigs are tax-deductible medical expenses and may be covered by some medical insurance policies. Some hospitals and some American Cancer Society units have wig banks where you can get them free.

If you have long hair, cut it short before it begins to thin. If you buy a hairpiece, use it as the hair begins to thin out. Some black patients find they can delay hair loss by braiding their hair instead of vigorously combing it.

Cold caps for chemotherapy

What is a cold cap and how does it help to prevent hair loss? 

Researchers are investigating ways to prevent hair loss through the use of scalp hypothermia the cooling of the scalp with a cold cap. The cap is usually put on the head about 10 minutes before the drug is given and is left on during the treatment and for 30 to 50 minutes afterward. The cold cap causes a narrowing of the blood vessels of the scalp, lessening the amount of drug that reaches the hair follicles. The cap does not prevent hair loss in all patients. The best protection seems to be obtained in those receiving low drug doses.

Can the cold cap be used for all cancer patients? 

The National Cancer Institute researchers caution that cold caps should not be used in patients with cancers that might spread to the scalp, such as leukemia, lymphoma, and mycosis fungoides. The use of a cold cap in treating these cancers could prevent the skull and scalp area from receiving necessary treatment. Additional studies of scalp hypothermia are being done. You should discuss the pros and cons of cold caps with your doctor.

Are there any side effects to using the cold cap? 

Some patients have complained of headaches, a sensation of cold, and a feeling that the cap was heavy.

When hair falls out from radiation or chemotherapy treatments, does it fall out gradually or all at once? 

Though hair loss differs from patient to patient, and from drug to drug, don't be surprised if your hair falls out in huge hunks, and your head becomes sensitive. Your scalp may also become flaky and irritated. A mild dandruff shampoo or some olive oil rubbed into the scalp may help.

Do you have any general hints about buying wigs and hairpieces? 

Yes, we have a few hints.

• Buy the wig before you start losing your hair. This is very important. It is really best to get the wig before you start having the chemotherapy treatments if at all possible.

• Buy the wig yourself. Bring a friend with you if you like, but don't send someone else to do it for you. It is essential that the wig or hairpiece fits you well, looks nice on you, and pleases you.

• The less expensive wigs tend to look synthetic. If this is the kind you are buying, dust it with a little baby powder to take away the shiny look.

• Get your first wig the same color as your hair. You can start wearing it while you lose your hair.

• Many people find it useful to buy more than one wig. Having a second wig is especially helpful if you tend to perspire.

• Buy a good synthetic, rather than a real hair wig, because it washes better, is less expensive to maintain, is cooler, and is cheaper than the real hair wigs.

Is there any kind of wig that is better if I am only going to have partial hair loss? 

If your doctor expects you to have only partial hair loss, it is better to get a capless wig.

Will it be hard to hold the wig on my head if I have complete hair loss? 

It may be. It is generally recommended that you use beautician's tape folded upon itself to hold the wig in place. Tape it to the crown and the temple areas of the wig. There is a company that makes wig retainer pads, which can be attached to any wig by a simple basting stitch. The pads cushion the scalp by conforming to the natural contour of the head. You should also have the wig styled to fit your face. Styling is usually included in the cost of the wig, but if it isn't, you can have it done at a beauty parlor. If you are expecting complete hair loss, make sure that the inside of the wig is smooth.

Can I wear a headband underneath my wig? 

Yes, if you prefer. People who wear headbands under their wigs usually like cotton scarfs instead of silk or synthetic scarfs. Cotton is cooler and helps keep the wig from sliding.

Are there any special scarfs or turbans made for women with hair loss? 

There are several manufacturers of special scarfs and turbans. One style, called Hide & Chic, is a combination scarf and hat of light cotton and polyester that has body and shape to disguise the lack of hair beneath. There is also a child's version. The Sweetie Cap is a comfortable, inexpensive cover up complete with bangs, which can be used as a cool, featherweight alternative to a wig. A lightly padded headband, called Scarf Shapers, gives height and shape to scarfs. It is made of soft poly cotton and padded with batting; it fastens at the back with velcro and is washable.

How often should I wash a wig if I am wearing it every day? 

People who wear wigs all the time usually wash them every week. Wigs tend to trap dust, and then they become hotter to wear. You should use shampoo to wash your wigs. Deodorant soaps will leave a coating on them.

Scalp Cooling for Reducing Chemotherapy Hair Loss

Are there specific things I can do while losing my hair? 

You can wear a soft fabric nightcap to catch the hair. If you use a nightcap, make sure it is a soft one, not a stiff netting type. Check the elastic on it so it will be comfortable for your head size.

What about when my hair starts growing in again? 

As your hair starts growing in, shampoo it often. You might also want to go back to a hairpiece rather than wearing your full wig while your hair is growing back.

Will coloring my hair or having a permanent while I am having chemotherapy make my hair fall out?

 It does not seem so. There has been some limited research done on this subject, and the women who colored their hair or had permanents during chemotherapy did not seem to have any more or any less hair loss than those who did not.


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