Aside from nausea and vomiting, the side effects many chemotherapy patients dread most involve changes to their hair. Will it fall out? Will it grow back? Will it have a different color or texture when it returns? Laurie Penn, a licensed cosmetologist at the Lily Bella salon in our hospital in Atlanta, sees this apprehension firsthand, and she knows how critical the concerns are to patients struggling with self-image challenges after treatment. Her message in helping them navigate hair loss or baldness for the first time in their lives: Knowing what to expect ahead of time, and learning a few tips on hair regrowth and wig care, may go a long way toward helping patients gain control over this aspect of their post-treatment journey.
If you have these concerns, the first thing you should know is not all chemotherapy drugs cause hair loss. Your oncologist should be able to tell you whether, and roughly after how many treatments, you can expect your hair to begin to fall out, based on your specific treatment regimen. Typically, Penn says, patients notice their hair begin to shed two to three weeks after the first treatment. It may fall out gradually or in clumps, and the scalp may feel tender or itchy.
Sometimes, hair returns to its pre-chemotherapy color and texture, and sometimes it doesn’t. “Everybody is different,” Penn says. “It depends on how your body has reacted to treatment. A lot of times, it comes back with a lot of gray, and it’s usually curly, but not always. Typically, it’s just that the cells that control the pigment aren’t functioning right, so it’s gray or many shades of gray. Hair is a waste product, so all the toxins from chemotherapy and radiation come out through the hair. And cells that control texture and color sometimes aren’t functioning properly at first, so the hair may come back a different texture and color.”
Wearing a hat or scarf will not affect how your hair grows back, so feel free to experiment with the various styles and colors on the market. If you decide not to use head coverings, remember to apply sunscreen to your head. Consider using facial products that contain sunscreen, since these tend to be gentler on the skin. That's why Penn often encourages patients to use them to protect and soothe bald or thinning scalps.
Many doctors and hair loss experts discourage chemotherapy patients from using products advertised to stimulate hair growth. “Your hair is kind of like a garden,” Penn says. “You can’t grow a healthy garden from unhealthy soil. You want to cleanse, detoxify, nourish and protect it. That means keeping the scalp clean and moisturized. Use regular shampoo and conditioner. We use organic, but you don’t have to. Clean and moisturize your scalp, even when it doesn’t have hair. Treat it like the skin on your face. Use the same products. When your hair starts coming back, switch to hair care products. Until then, keep gels, hairsprays and the like to a minimum.”
Hair regrowth typically begins as soon as chemotherapy treatments end. How slowly or quickly it grows varies on the individual. Shaving your head to speed hair growth is an old wives’ tale, Penn says, though you may consider trimming it to shape, style and control short tufts of new hair that grow in unevenly. You can begin coloring your hair as soon as your doctor says it’s OK.
If you would prefer to use head coverings while you wait for your hair to grow back, Penn says wigs have come a long way over the past couple decades. She suggests getting the wig before losing your hair so your stylist can match it to your natural color and style. It’s important to find a wig that’s comfortable and easy to care for. “Look for a wig that helps you feel like yourself,” she says. “Something that looks similar to your old hair.”
Quality synthetic hair wigs typically cost $100 to $500, and some insurance policies will help cover the cost. Some organizations, including the American Cancer Society, have programs that provide free wigs to those who can’t afford one or whose insurance doesn’t cover it. “Synthetic hair wigs are so much easier than human hair wigs, which are hot, heavy, more expensive and are made from someone else’s hair, so they require more maintenance,” Penn says.
Wig maintenance is fairly simple. “Patients can wash, dry and style their wig themselves with wig shampoo, or they can have it professionally cleaned,” Penn says. “Let it air dry. Some wigs can be blown dry. After it dries, you just have to comb or brush it, and it will return to its style.” Make sure to closely follow the care instructions that come with your wig, since those guidelines are developed specifically for that product.
Penn says wigs should be washed about every 15 wears. Realize that wigs may absorb odors like smoke, sweat and perfume, and they are prone to show signs of makeup, dirt or oil that may come with normal wear, particularly near the face. Wig glue should not be necessary. Instead, you can get what’s known as an adjustable memory cap that conforms to the head. If your skin is especially sensitive, consider wearing a stocking cap under the wig.
“Until your hair comes back, try shifting your focus to another aspect of your looks,” Penn says. “Accessorize with jewelry—earrings and/or necklaces—or consider a bold scarf or cap. It’s normal to feel anxious or down about hair loss, but remind yourself that it’s temporary.
Watch this video to learn how to tie a headscarf.