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We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

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Hair Loss from Chemotherapy

Nov 01, 2013

by Dr. Radha Achalu

Chemotherapy-induced alopecia (CIA) is hair loss due to chemotherapy and it is one of the most distressing side effects of chemo treatment.

Why does hair fall out?

Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body, including those in your hair roots. And chemotherapy may cause hair loss all over your body, not just on your scalp; your eyelashes, eyebrows, pubic hair and armpit hair, for example, may also fall out. However, hair loss does not occur with all chemotherapy treatment. Whether or not your hair remains as it is, thins, or falls out depends on the drugs and dosages used.

Radiation to the brain, used to treat metastatic cancer in the brain, usually causes complete hair loss on the head.

Hormonal treatment such as Tamoxifen may cause some thinning of your hair, but not complete baldness.

How long does it take hair to fall out and regrow?

Hair typically begins falling out two to three weeks after you start treatment. You may experience either gradual loss or it can fall out quickly in clumps. Your scalp may be sensitive and feel tender.

Most of the time, hair loss from chemotherapy is temporary. You can expect your hair to regrow within 3 to 10 months after your treatment ends, though your hair may be a different shade or texture for a while. It might be curlier than it was before, or it could be gray until the cells that control the pigment in your hair begin functioning normally again.

Which medications do or do not cause hair loss?

  • Cytoxan (cyclophosphamide) usually causes hair thinning but not complete hair loss. 
  • Adriamycin (doxorubicin) generally causes hair to thin during the first three weeks of treatment, then all the hair falls out. 
  • Taxol (paclitaxel) typically causes sudden and complete hair loss all over the body, including head, eyebrows, eyelashes, pubic area, legs, and arms. 
  • Adrucil (fluorouracil) does not cause hair loss. 
  • Newer drugs, such as gemcitabine, capecitabine and vinorelbine cause less hair loss. However, as these newer drugs are usually given in combination with other drugs, hair loss is a possibility.

How should I care for my head and hair?

  • Some people find it’s easier to handle losing their hair if they cut it short or shave it off. 
  • Consider using a head cover such as a scarf, cap, or even a wig for both aesthetics and comfort. 
  • Use mild shampoos and use a soft-bristled hair brush. 
  • Avoid excess heat and cold. 
  • Use satin pillow cases to avoid friction. 
  • If you must use a hair dryer, use low heat. 
  • Don’t use brush rollers to set your hair. 
  • Don’t dye your hair. 
  • Eat foods that promote hair growth, such as walnuts, oysters, proteins, spinach, sweet potatoes, and blueberries. Talk to your oncologist about the possibility of taking biotin as well.

Can you prevent hair loss?

There are a few options to help prevent hair loss during chemotherapy. Some are more successful than others. Rogaine (minoxidil) helps stimulates hair growth, but the results of topical application for chemotherapy patients are very inconsistent. A scalp tourniquet is a technique designed to reduce blood flow to scalp hair follicles during intravenous chemotherapy.

Currently, scalp cooling is the preventive measure showing the most positive results. Scalp cooling uses an ice cap to reduce blood flow to the scalp. CCT is not yet approved by the U.S. FDA, but it is available for those interested in its use. Read on for more about scalp cooling.

Talk to your oncologist about which option is best for you.

What is scalp cooling (CCT)?

Scalp cooling, also known as “cold cap therapy” (CCT), involves wearing an ice cap on your head for intervals before, during, and after chemotherapy sessions to reduce blood flow to the scalp and the slow metabolism of chemotherapy in the hair follicles.

A recent study reported that 75% of patients receiving chemotherapy for breast cancer were able to prevent hair loss during and after their chemotherapy course. Based on other similar studies, efficacy for CCT has been estimated to be up to 90%.

Is scalp cooling right for me?

Scalp cooling is not suitable for everyone. It is not recommended for those:

  • with hematological cancers such as myeloma, leukemia, and lymphoma, as there is a high risk of cancer cells surviving in the blood vessels of the scalp and causing the cancer to come back after treatment. 
  • who need very high doses of chemotherapy, as the higher dose lowers scalp cooling efficacy. 
  • having continuous chemotherapy through a pump for several days, as this makes scalp cooling impractical. 
  • whose liver isn't fully functioning as this may lead to chemotherapy drugs circulating in the body for longer than usual. 
  • who experience severe migraines.

Scalp cooling is most likely to be effective when used in conjunction with these chemotherapy drugs:

  • cyclophosphamide 
  • daunorubicin 
  • docetaxel (Taxotere®) 
  • doxorubicin 
  • paclitaxel (Taxol®)

Talk to your oncologist about whether or not you should use CCT during your chemotherapy.

What is the risk of scalp cooling?

There is a theoretical concern that by reducing blood flow (and chemotherapy) to the scalp and skull, CCT might increase the risk of cancer cells growing into tumors (scalp and skull metastases). This is of particular concern among patients who have cancers of the blood (leukemia) and lymph (lymphoma), both of which may hide in the scalp and skull tissues. However, for most cancers, the risk of scalp and skull metastases is very low (approximately 1%). Scalp cooling does not affect cancer cells in the rest of your body.

Where can you get a cold cap?

The most widely used cold caps in the U.S. are Penguin Cold Caps. The Penguin Cold Cap system is around $1,500 (approximately $400 per month for a 3 month chemotherapy course) for the cap rental and purchase of dry ice (a recommended back-up freezing method). Unfortunately, most insurance companies don’t cover CCT. Your actual costs will vary depending on the CCT system, the number of chemotherapy session, and the number of months the caps will be in use.


Articles reviewed

  • Christodoulou C, et al. Scalp metastases and scalp cooling for chemotherapy induced alopecia prevention. Annals of Oncology. 2006. 17: 2: 359. 
  • Floortje Mols, et al. Scalp cooling to prevent chemotherapy-induced hair loss: practical and clinical considerations. Support Care Cancer. 2009. 17: 181–189. 
  • Lemieux J, et al. Incidence of scalp metastases in breast cancer: a retrospective cohort study in women who were offered scalp cooling. Breast Cancer Res Treat. 2009.
  • Van Den Hurk C et al Impact of alopecia and scalp cooling on the well-being of breast cancer patients Psycho-Oncology. 2010. 19:7: 701–709. 
  • Van Den Hurk C et al Scalp cooling for hair preservation and associated characteristics in 1411chemotherapy patients - Results of the Dutch Scalp Cooling Registry. Acta Oncologica, 2012; 51:497–504. 
  • Presentation, impact and prevention of chemotherapy induced hair loss – Dermatol 2011:6(1):109-125

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