Chemotherapy commonly asked Q&A

Chemotherapy commonly asked Q&A

Our new Hair Loss Help at Home service has been launched to support during the current Coronavirus situation.

We hope that our Chemotherapy guide will help you to navigate information and choices on a broad range of hair loss and hair care related topics. In this section we have put together essential questions and answers.

We would like to take this opportunity to thank the thousands of women who have joined us on-line and shared their experiences so that we, together with the experts, can offer you guidance and ideas.

We understand that you may be anxious about hair loss so let’s start by making sure you have a good understanding of hair loss and some of the myths. Then you can discover what is available so that you can keep your unique sense of style. Why not pop the kettle on, find somewhere cosy and take your time to look through our most commonly asked questions and answers.

Chemotherapy commonly asked Q&A

• Do all chemotherapy drugs cause hair loss?
• Why does hair fall out due to chemotherapy?
• Can hair loss be prevented?
• Is hair loss painful?
• What is Folliculitis?
• How will eyelashes, brows & facial hair be affected?
• Does nasal hair fall out?
• Will body hair fall out?
• What is the difference between hair loss and hair thinning?
• How long does hair take to re-grow after chemotherapy?
• Why is hair sometimes curly after chemo?
• Will cutting or shaving hair off prior to or after hair loss affect hair growth?
• What ways can I cover up or disguise hair loss?
• Are all cancer patients able to access financial help with the costs of a wig?
• Are NHS wigs low quality?
• How can I care for my scalp?
• How can I speak with my medical team about hair loss?

Do all chemotherapy drugs cause hair loss?

No. Firstly it’s important to note that not all chemotherapy drugs cause hair loss. Many people assume that if they have chemotherapy treatment they will loose their hair. This is not always the case.

Whilst many chemotherapy treatments can cause hair loss some chemotherapy treatments won’t cause any hair loss at all. Please check with your nurse specialist or oncologist to find out. If you already know the name of you chemotherapy drug you can also check on reputable websites such as Macmillan, Cancer Research UK, Breast Cancer Care and other organisations.

Why does hair fall out due to chemotherapy?

Cancer is when abnormal cells divide in an uncontrolled way. There are over 200 different types of cancer and many different types of treatment, such as chemotherapy. Many people assume that if they have chemotherapy treatment they will loose their hair. This is not always the case. Whilst many chemotherapy treatments can cause hair loss some chemotherapy treatments won’t cause any hair loss at all.

Chemotherapy treatments that cause hair loss as a side effect do so because the type of chemotherapy uses an anti-cancer (cytotoxic) drug to target and destroy quick growing cancer cells. This type of hair loss is called chemotherapy-induced alopecia (CIA). These chemotherapy drugs work by attacking the quick growing cancer cells and disrupting their growth. Unfortunately, chemotherapy drugs can also affect and disrupt the regular process of normal cells. In particular, the cells of the hair follicles that are also quick growing. This is why hair falls out.

Re-growth – however, unlike the cancer cells, the quick growing cells of the hair follicle normally have the ability to regenerate again meaning that hair will almost always grow back after treatment.

Hair loss can vary. The affect and amount of hair that may fall out depends on:

The main factors

• The specific drug or combination of drugs being used
• The doses given
• The way your body reacts

Other factors:

• Scalp cooling – the effectiveness of the hair loss prevention process known as scalp cooling/cold cap (if applicable to your treatment)
• Any other underlying health condition, medications or stress induced hair loss that may affect your hair or cause hair loss during treatment.

As trials for new chemotherapy treatments for cancer are being developed all the time it is not always possible to tell if hair will be affected. However, the vast majority of chemotherapy drugs have well-researched and documented side effects.

Please check with your nurse specialist or oncologist to find out. If you already know the name of you chemotherapy drug you can also check on reputable websites such as Macmillan, Cancer Research UK, Breast Cancer Care and other organisations.

At Cancer Hair Care we are always here to support you with information and ideas.

For more in-depth information about chemotherapy and hair loss take a look at our guide to understanding the Hair growth cycle.

Can hair loss be prevented?

Scalp cooling or a cold cap is one of those things that, until you are faced with the possibility of losing your hair, you probably may not have heard much about. It’s a method of cooling the scalp which can be used with some forms of chemotherapy (not with other treatments) to try and help reduce hair loss. Once you understand the basics you can explore if scalp cooling might be available and suitable for you. Read more about Scalp cooling.

Is hair loss painful?

Some people say that their scalp feels more sensitive, sore or itchy especially just before and during the initial hair fall. This is normal and usually subsides after a few days. However, if you see small red spots appear that are intensely itchy this may be an inflammation of your hair follicle, called folliculitis, which may need to be treated. If you are concerned we always recommend talking with your nurse or doctor. Read more to discover how to calm an itchy scalp in our Scalp care section.

What is Folliculitis?

Folliculitis is an inflammation of your hair follicle, it does sometime occur when hair falls out due to cancer treatments. If you have folliculitis, you will notice the formation of tiny little red spots called pustules at the affected follicle openings. It can cause intense itching and tenderness and be too sensitive to wear a wig. However, try not to scratch as this may further inflame your skin. Treatment options offered by your doctor may include antiseptic creams, lotions, or antibiotics. It is always advised that you seek medical advice during cancer treatment at a time when your body is more susceptible to infections. Read more to discover how to calm an itchy scalp in our Scalp care section.

How will eyelashes, brows & facial hair be affected?

“If chemotherapy causes your scalp hair to fall often other body hair can also be affected. Your facial hair, including eyebrows and lashes are also likely to fall out. This is also the case if you are having scalp cooling because scalp cooling only helps to reduce hair loss on the scalp.

Read more in our entire section dedicated to Eyebrows & eyelashes.

Does nasal hair fall out?

If chemotherapy causes your scalp hair to fall out often other facial and body hair can also be affected. Many people don’t realise that the hair on the inside of the nose also falls out. This can result in a heightened sensitivity to smell, have a running nose and being more open to infection.

Keeping tissues handy can be helpful if your nose becomes runny. Additionally, it can be helpful to know that you may be more sensitive to smells then you normally would be. This is because the nose hairs help to filter smells and so when nose hair falls out, smell can be heightened.

If you are finding smells are overwhelming or unpleasant you may like to consider using products that are fragrance-free.

Will body hair fall out?

If chemotherapy causes your scalp hair to fall often other facial and body hair can also be affected. If chemotherapy cause hair to fall out on your scalp it is highly likely to also cause body hair to also fall out.
Examples of body hair that may also fall out are:

Facial:

Eyebrows and eyelashes
Nose hair
Beards and moustaches

Body Hair:

Pubic hair
Leg, arm and underarm hair
Chest hair
Leg hair
Other areas of the body where hair grows

What is the difference between hair loss and hair thinning?

Chemotherapy drugs can cause complete hair loss, hair thinning or no effect to hair at all. Hair thinning means that your hair may look thinner than normal and have less volume. This means that some hair may fall out, but it’s not expected that you will experience complete hair loss.

The term hair loss tends to refer to complete loss of hair resulting in no or very little hair remaining. In this case you may like to consider ways to cover up such as wigs, headscarves and hats, or you may be comfortable with having a bare scalp.

In the case of hair thinning you may find that one particular area of your hair feels and looks thinner, or there is just less hair all over. The amount that your hair thins is individual to you and your natural amount of hair. We will look at helpful ways to manage and disguise any hair thinning such as wigs and hairpieces in our Wig guide. Remember the hair usually starts to grow back after treatment is complete.

How long does hair take to re-grow after chemotherapy?

Most people find that once they have completed the course of the chemotherapy drug that causes hair loss the Hair growth cycle starts to re-activate within a few weeks. However, if you are on a combination chemotherapy, for example whereby half way through treatment the chemo drug is changed you may find that hair starts to grow back before treatment has finished.

The growth rate of hair can vary a great deal but the average hair on the scalp grows at approximately half an inch a month, which gives an average growth of six inches a year. However, following chemotherapy treatment it often takes a while for the follicle to recover and in turn produce a visible hair. Most of the time this results in slow growing hair at first.

Read more in-depth information in our New hair growth section

Why is hair sometimes curly after chemotherapy?

The shape of the hair follicle determines whether or not a hair will be curly, wavy, afro or straight. A straight hair occurs when the sides of the follicle form a smooth cylinder shape that creates a straight hair. In the case of curly or wavy hair the follicle is a more twisted shape causing the hair to spiral as it grows creating a more wavy curl. An afro hair is created by a flatter shape causing the hair to bend and corrugate almost like a zig zag.

Some people have naturally curly hair and so this is their regular texture. For people who had straight hair prior to hair loss but now have curly new hair, this can be explained because when the hair falls out the hair follicle can collapse. This alters the shape meaning that the straight follicle becomes twisted. This is normally temporary and you will probably find that, after some time, the hair becomes straighter as the follicle reforms its regular shape and the length and weight of hair changes.

Read more in-depth information in our New hair growth section.

Will cutting or shaving hair off prior to or after hair loss affect hair growth?

The short answer is no, you can not affect the hair growth system by shaving or cutting hair prior to or after hair loss. This question is one that causes a lot of concern and miss understanding. At Cancer Hair Care we often have people contact us who are really worried about causing a problem to future hair growth. This is understandable as everyone wants to be sure they are doing the best they can.

Let’s go into more detail about hair cutting so that you can feel well informed to make choices.

Cutting hair off prior to or during hair loss due to chemotherapy

Deciding to cut hair short prior to or during hair loss is a personal decision and does not affect the hair growth system.

In our section about the Hair growth cycle, we understand that the hair root sits underneath the skin surface. This is where the three phases of the growth cycle occur with each and every individual hair. Therefore cutting hair short prior to or during hair loss cannot affect the hair growth function that takes place underneath the skin. If cutting hair short is something you decide to do we recommend that you avoid shaving with a bare razor. This is simply due to the possibility of infection if you cut yourself and not to do with affecting hair re-growth. Do use clean clippers/scissors and take a look at our section Cutting hair before hair loss.
You can also read more in-depth information in our New hair growth section.

When can I have my first haircut?

There is no rule as to when you can first cut your hair – it all depends on the condition of your hair and what style you are aiming for. It is an entirely personal decision.

Quite often hair grows at different rates so you may want to trim one area and not another. For example, many people find that there are longer sprouts of hairs that they want to snip at, in particular on the area around the ears and hairline that can feel untidy if they stick out. These areas commonly need a trim before the rest and it is fine to do so. For more in-depth information about hair cutting take a look in our New Hair Growth section

When can I colour my new hair?

We have put together an advice section entirely about colouring new hair growth. Generally speaking, as long as your hair and scalp are healthy and you do a skin-sensitivity test prior to colour, there is no specific length required to apply all-over colour to the hair. Read more in New Hair Growth

What ways can I cover up or disguise hair loss?

There is a multitude of wigs, hairpieces, headwear, specialist headscarves, caps, hats and all types of ideas available to create either a hair style or a new look that you feel confident with. Take a look in Scarves, hats & headwear or our Wig guide for ideas and inspiration.

Are all cancer patients able to access financial help with the costs of a wig?

Depending on where you live and which health care provider is treating you will usually determine what type of financial support is available for a wig. For example if you are being treated in a NHS hospital you will be charged a prescription charge (around £60 – 80 for a synthetic hair/modacrylic wig) unless you qualify (e.g HC2 certificate) for help with charges.

If you are being treated privately you may find that your private health insurance company will contribute towards the cost of a wig. Additionally there are some charities and organisations such as Wig Bank who provide low cost wigs.

Remember that you will still need to buy wig care items and accessories such as a wig stand and shampoo and conditioner suitable for your wig.

Read our in-depth section about Visiting your local NHS wig supplier.

Are NHS wigs low quality?

This is not true – the NHS do not make wigs themselves, they outsource this service to wig suppliers around the country. The NHS requires their chosen providers to follow a code of conduct and care for their patients and wigs supplied. The wig supplier chooses where they get their stock of wigs from. If you qualify for a prescription, the NHS provides help towards the full or partial cost of wigs, usually in the form of a prescription that is exchanged with a wig supplier. Read more in our Wig Guide about Visiting your local NHS supplier.

How can I care for my scalp?

Whether you are wearing a wig, head covering or beautifully bare it is important to take good care of your scalp. This will help improve both the way your scalp looks and feels and can help to promote a healthy situation to encourage new hair growth. Take a look in our section Scalp care.

How can I speak with my medical team about hair loss?

Your cancer nurse will often be the person who will offer you ideas and guidance about hair loss and hair loss prevention (scalp cooling). Take a look at our guide to Talking to your medical team for some helpful tips.