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Hair loss FACT SHEET

Hair Loss Fact Sheet 864.04 Kb  Because it's visible to others, hair loss (alopecia) can be one of the more distressing aspects of your treatment for breast cancer. We understand because we've been there ourselves - and we hope you'll find this information helpful. What can I do to prepare myself for hair loss? Whether or not you lose your hair depends on the types of chemotherapy drugs prescribed for you. Some cause complete hair loss, some cause the hair to thin out, while others have no effect on your hair at all. Ask your oncologist or oncology nurse how your chemotherapy will affect your hair. On the last page of this fact sheet you will find a list of common combinations of chemotherapy drugs used to treat breast cancer, along with their likely effect on your hair. You know, I didn't mind losing my breast as much as I minded losing my hair. I know that might sound odd but it's how I felt - I cried and cried. Losing my hair made my breast cancer so public. Sarah Being prepared, and talking about how you feel with others, can help you adjust to this temporary change in appearance. If you have children, it's also important to prepare them for this change. If your hair is likely to thin Use gentle shampoo and conditioner. Dry your hair naturally or use a cool setting on the hair dryer. Brush or comb hair gently (one of the reasons for hair loss is the hair breaking off at the scalp). Some women prefer to cut their hair into a short style as this can give the appearance of greater hair volume. Other women prefer to grow their hair during the months of treatment so that if the hair does thin, it can be pulled back and secured with a hair fastener, allowing ‘strategic' covering of the scalp. Protect your scalp from the sun. Avoid heated rollers or curling wands. Avoid perming or straightening your hair. If you colour your hair, ask your hairdresser to use/recommend a vegetable hair colour rather than a chemical dye. These may have to be ordered in for you. If you're considering a hair piece, be careful that it doesn't put too much pressure on the hair at the scalp or that the clasp doesn't cause the hair to break off.   If you're likely to lose all of your hair My scalp was tender for a few days when my hair was falling out. I found that a satin pillow-case was more comfortable to sleep on. Julie Hair usually starts to fall out about two to three weeks after the first treatment, and it generally happens quickly. First, your scalp may become tender or itchy. The tenderness may cause discomfort when you're resting your head on a pillow or against a hard surface. If necessary, you might want to take some mild pain relief tablets such as paracetamol. For some women, the first sign that they're about to lose their hair is finding large amounts of hair clogging the drain after a shower. Others notice hair on the pillow when they wake up or find that they can pull hair out in clumps with gentle pressure. At this stage, some women choose to shave the rest of their hair. This way, you'll have less mess to deal with, and it gets the hair loss process over and done with in one go. You might find you look better with no hair than with wispy bits of straggly hair on a bald scalp. If you shave your hair, your scalp might feel a bit ‘prickly' for a few days, which could make a wig uncomfortable. Wig suppliers and some oncology units sell ‘chemotherapy caps' to be worn under a wig to ease this discomfort. Rather than shave your hair, you could wear a turban to contain the hair and wait until most of it has fallen out on its own. Once there is just a little hair left, you may want to shave this off. I chose to have my hair shaved off. That way I felt I had some control. Ellena If you decide to have your hair shaved off, your oncology nurse or hairdresser might be able to do it for you. You might want to see if this can be done in a private place - some hairdressers will come to your home. They will need to use electric clippers to prevent cuts or nicks to the skin. For most women, this is a very emotional time. Be sure you have the support you need. Dealing with hair loss is a very individual thing. Some women don't want to wear a wig or cover their heads at all. Others couldn't imagine being seen by others without a wig, hat, turban or scarf. There are no rules - just decide what's right for you. As hair loss usually happens over just a few days, it helps to have arranged appropriate head covering before your hair begins to fall out. Apart from how you look, keep in mind that hair helps the body retain heat in the cold and protects the scalp from the sun. You'll probably need some head covering during winter at night or when you're in the sun. Options for covering your head include wigs, hats, scarves, beanies and turbans. If you prefer not to cover up, remember the sunscreen. Wigs I thought I was emotionally prepared to lose my hair although I never truly understood how much it was a part of my identity until it was gone. Helen Wigs can be made from synthetic fibres, real hair or a combination of both. They vary in price from around $80 to many hundreds of dollars. The most expensive are not necessarily the best. Remember that hair loss is temporary - you only need the wig to last for six to 12 months. There are many specialty wig suppliers who are experienced in fitting wigs for women receiving chemotherapy. For more information, talk to your oncology doctor or nurse, call the Cancer Council Cancer Helpline 13 11 20 or talk to other women who've had chemotherapy. When you go to try on wigs, you might want to take someone with you whose opinion you trust. Wigs are deliberately made with too much hair so that you can have the wig styled to suit your face. This can be done by a specialist wig supplier or your hairdresser. Even if you think you won't want to wear a wig, it's a good idea to have chosen one in case you change your mind. If you don't feel like trying wigs on, keep some of your hair so that you can match the colour if you do change your mind. Wig accessories You will probably require a wig brush. Wig shampoo is available, but generally baby shampoo works just as well. Many women find that putting their wig over a bottle at night has the same effect as a wig stand. A thin ‘chemotherapy cap' worn under a wig should help reduce any itching. Hats, scarves and turbans At 26 and single, losing my hair was overwhelming. How would I cope? Wigs, beanies and scarves became my accessories. And they were fun. I could be someone different everyday! I didn't look too bad bald either! Jo You may not always want to wear your wig so it's good to have other options ready. In the warmer months, hats or scarves may be cooler than a wig. In the cooler months, you might need to wear a turban to bed. Take a trusted, creative friend with you when you go shopping for hats and scarves. Play around with different styles and looks. The Look Good Feel Better program (see below) can help you with creative ideas for wearing turbans, hats and scarves. Scarves should be made from cotton or similar non shiny material so they don't slide around.   Stockists:  Turbans are available from many wig suppliers and from most State Cancer Councils (13 11 20).  Hats and scarves are available from department stores and markets.  Scarves can be bought or simply made yourself by edging a piece of fabric you like.   What will it cost? If you have private health insurance, check with your insurer - some policies cover the cost of wigs and accessories. If you are covered, you will need a letter from your doctor stating that you require the wig on medical grounds. Make sure your receipt is itemised. Some hospitals have arranged for their patients to receive a discount from specialist wig suppliers - check with your oncology doctor or nurse. Some State Cancer Councils or large oncology units offer wigs at no cost as part of a wig library program. Ask your oncology nurse or contact 13 11 20 for details. Eyelash or eyebrow loss I was devastated by the loss of my eyebrows and eyelashes. I looked featureless. I attended the Look Good Feel Better program and quickly learned to love eyeliner. I was really excited when they started to grow back. I swear I'll never take my eyelashes for granted again. Pam Eyelashes normally protect your eyes from grit and dust - without them it's a good idea to wear glasses or sunglasses when you're outdoors. Artificial tears (available from pharmacies) may help to keep your eyes lubricated. Some women choose to ‘create' eyebrows with an eyebrow pencil. Looking good, feeling good For most of us, our hair is an important part of our identity and influences our self image. It can be a real challenge to feel good when you don't have any. We encourage you to do whatever you need to do to feel good. Some women find that by wearing lipstick and/or earrings the attention of others is drawn away from the scalp. Look Good Feel Better programs help you to learn about skin care during treatment, makeup and wigs, hats, scarves and turbans in a safe, supportive and fun environment. They're free, and they run throughout Australia. Call 13 11 20 for details of the program nearest to you. What to expect when your hair grows back Remember, hair loss from chemotherapy is temporary. Your hair will grow back once chemotherapy has finished. You can expect to feel a fine ‘fuzz' on the scalp five to six weeks after your final treatment. Six weeks after that you should have a short but thick covering of hair over the entire scalp. At this stage it helps to leave the wig off as much as possible to encourage hair growth. Occasionally hair will start to grow back before treatment has finished. This does not mean that the treatment is less effective. Your hair will continue to grow at its normal rate - which for most people is about 1cm a month. Sometimes the hair comes back a different colour - and sometimes it's curly when it used to be straight. These curls may be temporary or permanent.   I know I should be grateful to have hair after 6 long, mostly cold months without it, but I'd give anything to have my old hair back. It's now curly. People who I haven't seen for a while don't recognise me until I speak and then they can recognise me by my voice. No-one ever prepared me for that. Jenny Your new hair will probably be beautifully soft and healthy, and some people recommend avoiding chemical dyes or perms in the first few months. There's no real evidence that these will damage the hair or cause it to fall out, but you may prefer to forego the perm and use more gentle vegetable dyes for a while. You could also ask your hairdresser to test a small area of hair before colouring your whole head.   My hair was growing back but I wanted instant length. I decided to have hair extensions and was rapt with the result. I figured I'd saved so much over the months not needing colours or cuts; this was my treat to myself. Jo  Many Australian women experience hair loss as a result of treatment for breast cancer each year. You can make contact with other breast cancer survivors or a breast cancer support group through the Cancer Council's Cancer Helpline (13 11 20). Chemotherapy treatments and hair loss   Amount of hair loss to expect When hair is likely to fall out AC (Adriamycin, Cyclophosphamide) or (EC) Epirubicin, Cyclophosphamide   Complete hair loss on scalp. Possible loss of eyebrows, eyelashes and pubic hair. Hair under the armpit and on the legs tends not to fall out. Usually starts within two to three weeks of 1st chemotherapy treatment. The hair falls out rapidly over the course of a few days. CMF (Cyclophosphamide, Methotrexate, 5FU)   Most women will experience some degree of hair thinning of head hair over the course of the treatment. About 10-15% of women will experience hair loss significant enough to warrant a wig or head covering. Loss of eyebrows and eyelashes is not common. Gradual hair thinning over the course of treatment. AC followed by Taxotere or Taxol   Complete hair loss on scalp. Complete loss of eyebrows, eyelashes, pubic hair, and hair on legs, arms and armpits (axilla) is common. Usually starts within two to three weeks of 1st chemotherapy treatment. Hair falls out rapidly, over the course of a few days.   Last updated  May 2004