Will I lose my hair ? - Talking to your medical team
Some suggested questions for your nurse or doctor: It may be a good idea to write down any questions for your care team and make a note of their replies so that you are clear about hair loss. Please remember that if you are having more than one type of treatment (e.g chemo and hormone therapy you will need to ask questions related to each type of treatment as well.
For your clarification we recommend you ask the following: • Does my chemotherapy drug cause hair loss?
• I understand that my hair will start to grow back once chemotherapy is complete? (This is nearly always the case)
• Is it true that I may lose hair anywhere else on my body as well as my scalp and head and could that also include my eye lashes and eyebrows and body hair (as well as facial hair for men)?
• If it does happen, will this be complete hair loss leading to baldness or patchy hair loss or hair thinning? (some chemotherapy drugs cause hair thinning-not leading to complete baldness)
• Is the Scalp Cooling an option for me to help reduce hair loss?
• When should I prepare myself for hair loss? At what stage in my treatment do you think this will occur? (Hair loss can sometimes be a few weeks into treatment – so best you find out)
• If hair loss is upsetting me can you make any other suggestions to help me?
• Will I be entitled to a wig with NHS financial support and what do I need to do about this?
• Do you have any leaflets about headwear suppliers or hair care support groups that you can tell me about?
Hopefully your care team will provide you with the answers you need. But if not, there are also some other good facilities, such as cancer charities who can inform you about hair loss as a side effect of chemotherapy.
A kind word of warning. There is an abundance of information, reports and criticism about all forms of cancer treatment. So before looking on the Internet or researching, it is always best to speak to your medical team first. However if you need more information Breast Cancer Care and Macmillan are excellent charities with nurses you can speak to over the phone.
Understanding chemotherapy and hair loss
Remember that not all chemotherapy drugs cause hair loss. But when it does the explanation below may help you to gain a better understanding:
In our experience, when people have an overview of what is actually happening inside the body it helps to get rid of their fear of the unknown. So let’s try and get an understanding of what causes the hair loss to occur.
What goes on inside the body to cause hair loss? It is usually a temporary disruption to your normal system of hair growth as the hair nearly always grows back after chemotherapy treatment. Let’s try and explain the science bit:
Chemotherapy works by attacking cancer cells to get rid of them from the body and eradicate the cancer. Because this treatment enters the blood stream it means that other normal cells in the body can also be affected. Chemotherapy treatment attacks the quick growing cancer cells in the body. Unfortunately it also attacks other normal quick forming cells in the body. Hair is one of these quick forming cells and thus is affected.
When the sensitive hair bulb, which holds the hair root, is attacked, it affects the hair in different ways. This can include hair being brittle and dry, thinning and falling out which results in hair loss.
Will my hair grow back? Yes - it normally always does so.
Unfortunately hair loss and hair thinning can be a very common side effect of certain types of chemotherapy (but not all). But as treatment to get rid of cancer is essential it is a necessary measure.
The good news is that it nearly always grows back. In other words, the hair is only temporarily affected and it is very rare for the hair not to grow back at all. This is so very rare that most advice sheets will not mention it – occasionally and very rarely hair doesn’t grow back. This can be as a result of long term medication or could be another hair problem where the person may have been affected by hair loss regardless of the cancer treatment - BUT most of the time is does grow back.
So the rule of thumb is that we plan for hair to grow back as it nearly always does so. The hair commonly starts to grow back after treatment when the hair is not being affected by the chemotherapy drugs.
What is the difference between hair loss and hair thinning?
As we know some chemotherapy drugs can cause complete hair loss, hair thinning or no effect to hair at all.
Hair loss tends to refer to complete loss of hair resulting in none 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.
Hair thinning means that your hair may look thinner than normal and have less volume. This means that some hair may fall out, but that you won’t experience complete hair loss.
A little bit more about 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 in other areas of the web site. Remember the hair follicle where the root grows from is not normally damaged, so the hair usually starts to grow back after treatment is complete.
Is it just the hair on my head that may fall out? What about body and facial hair?
Unfortunately your body hair can also be affected and if your chemotherapy causes hair loss it is most likely that this will be the case.
Hair can grow everywhere except for the tongue, soles of the feet and palms of the hands. As chemotherapy drugs travels through the blood system it means that anywhere hair grows on the body can be affected.
It can include possible hair loss or hair thinning on the scalp, face, eyebrows, eye lashes and the rest of the body, including pubic hair. There are many ways of coping with these changes and they are normally just for a period of time. Take a look in Eyebrows & Lashes for advice and ideas.
When will my hair grow back?
Normally very soon after treatment is complete so the good news is that this disruption to the hair growth system is usually only temporary. So you should plan for your hair to grow back as this is nearly always the case.
The exception to this is, very, very rare , but if you have had extremely high dosages of chemotherapy, the hair may not grow back. Or perhaps you could be someone who may have experienced hair loss regardless of treatment. However, we must stress that this is so rare that most advice booklets and web pages don’t mention it. If you are affected in a permanent way this web site will help you cope.
For the majority of people, once their treatment is completed, the hair starts to grow almost immediately. Within a matter of weeks a fine layer of hair may be visible and whilst this new re-growth may be thinner, thicker, or a different texture and colour, you can normally expect to see a good re-growth covering the scalp within 4 - 6 months. Most people will see they have a short crop style forming over this period of time.
The other good news is that hair cells grow rapidly but the hair cells on the scalp tend to be the fastest growing of all, which is great in terms of hair growing back.
Other areas of body hair such as underarms and pubic hair can be slightly slower, but again you will normally see some hair quite quickly.
On the scalp, even an inch in length is enough to have a very short style. We have created an entire section called New Hair Growth that will guide you through everything you need to know about looking to the future and taking care of your new hair.
Scalp Cooling and is there anything I can do to prevent hair loss?
Occasionally, if suitable, Scalp Cooling also known as a ‘Cold Cap’ can be used to help prevent or reduce hair loss. This is only available in a limited number of hospitals and will only be offered to you if your doctor is sure it will not have any negative effects on your treatment.
If it is available, and you are offered it, this is a technique of rapidly cooling the scalp. This may be in the form of a very cold ice pack hat, or a machine that looks like a traditional hood dryer. With particular chemotherapy drugs it can help to avoid or reduce hair loss on the scalp. But firstly you need to know if your particular chemotherapy treatment is likely to cause hair loss, then we can look at hair loss prevention and if the cold cap may work for you.
If a cold cap is not available or suitable, then unfortunately there is currently no other way to prevent hair loss. Do remember that if your doctor tells you that your hair will grow back then trust that it will. You will find further details about scalp cooling in the section Scalp Cooling which is dedicated to just this subject.
We can help you look good no matter what is happening to your hair - we will be here with advice.
Does it hurt when the hair falls out?
When the hair first starts to fall out (normally within the first few weeks) some people say the scalp feels very sensitive and can feel a sensation rather like prickly heat, others don’t notice any painful sensation.
If it is painful, whilst not pleasant, it is normal and will usually stop once the hair has all fallen out. It can be explained by understanding that the hair is moving through the dermis (skin) layer as it falls out. Your skin may be more sensitive as a result of chemotherapy. The scalp can feel prickly and irritable until the skin calms down. If you experience this, try using a mild tea tree lotion or shampoo or Aloe Vera gel to calm and soothe. Remember that this will stop soon.
You can always chat to your nurse if you feel you need any pain relief or indeed if your scalp becomes very sore or spotty. In this case your doctor may prescribe you a specialist shampoo or moisturiser.
Wearing soft and comfortable headwear can really help as your scalp may feel too sensitive for a wig at this time. When sleeping remember to have a hat or scarf that doesn’t have a knot at the back or any seams that will irritate your sensitive scalp.
Getting ready for hair loss -Shall I cut my hair short?
On both an emotional and practical level there are several considerations when getting prepared for hair loss. These range from dealing with how you feel about it, to getting organised with a hair cut, a wig, headscarf or looking good with a bare scalp.
Taking control of your decision As a hairdresser who offers advice to people about cutting hair short before treatment, I have experienced all kinds of responses. Some people dig out the clippers and whip it off as a spur of the moment thing. Others prefer to wait until it is actually falling out, and some just book a time and place to have their hair cut.
With a bit of planning, taking control of your hair loss can help you to feel on top of things and open you up to a host of ideas for your new image. The main thing is to make a decision. Read more about this in our section Getting ready cutting hair short.
Cutting hair short – your options explained
Who will cut it - hairdresser or self cut? If your nurse has advised that you get your hair cut, there shouldn’t be any reason other than your personal preference why you can’t either visit a hairdresser, cut your hair yourself, or get a friend to help.
Let’s look at the options:
Finding a hairdresser(or wig supplier who offers hair cutting service)
Most people prefer to go to a professional hairdresser for a wider choice of styles and personal advice and naturally there is less mess to deal with. Sometimes it is nice to hand the practical side of this over to someone who knows what they are doing.
You may like to think about having some privacy and sometimes a hair salon is not the best place to be when having to face hair loss. On the other hand your hairdresser may be able to offer you a private room or come and see you at home.
Wig suppliers may offer hair cutting services Your local wig supplier may offer hair cutting services, so it is well worth asking.
A home hairdresser may be a good option where you may feel more comfortable. For more tips on finding a good hairdresser or one who has experience in working with people who are experiencing hair loss take a look in our section Find a hairdresser
Cutting your hair yourself at home or getting a friend to help Many people decide to cut their hair themselves or with the help of a partner or friend. If you do take this option, then the easiest way is to use a set of clippers with a cutting guard/attachment on them.
We don’t advise completely shaving the head as this may cause cuts and abrasions on the scalp, leading to possible infection and difficulties during treatment.
The other option is for you or a friend to cut your hair using hairdressing scissors and a hair cutting book – but this really is quite tricky and not really recommended.
If you decide to go for the clipper see the next section for our guide
A guide to Clipper Cuts
The great thing about a clipper cut is that it is quick, easy (when you have a few tips) and you can do it yourself or get a friend to help. Here are a few tips to help your cutting to be as smooth as possible. Read our guide to clipper cutting.
Can I make my hair into a wig? Generally speaking, the collection of human hair to be made into wigs is a very specialised area and there are currently only around 12 people in the UK who specialise in this. If your hair is more than shoulder length long, in very good condition, and you have plenty of it, then you may like to ask if your hair could be made into a wig.
Most of the time the answer will be ‘no’ and even if it is a ‘yes’ then it would take at least 10 weeks to make and be very expensive. You can donate your hair to a wonderful charity called Little Princess.
Covering up is also practical as it helps to keep warmth in the body and limit exposure of the scalp to the elements, particularly the sun.
Let us advise you…you need to know what is available to you so that you feel confident in your selection. We have dedicated an entire section to Covering up to introduce you to these fantastic ways to cover up and keep your sense of individual style and choice.
Wigs and NHS support for chemotherapy wearers
It may be that you will qualify for help towards costs of a wig from the NHS because your hair loss is due to a side effect of medical treatment. If so you will normally be limited to using a supplier that is recommended by your local NHS authority. These are suppliers who have the contract agreement with the NHS to supply you a wig and follow a code of conduct and standards agreed by the NHS. You will normally receive a referral letter which will tell you the details of agreed suppliers.
Alternatively if you are happy to pay in full there is nothing to stop you from buying a wig from any supplier you wish. You may decide to do this if you don’t like the options offered to you by the NHS supplier, want a real hair wig or decide you wish to go elsewhere.
Let us help you understand the NHS wig supply system.
Did you know that there is no such thing as an NHS wig? The NHS do not make wigs - they ou source the supply to various wig shops.
Visiting an NHS wig supplier Most NHS wig suppliers will offer you a range to chose from that is covered by your NHS prescription. You may have to pay a prescription charge (see below) – normally £60.00 but the rest is funded by the NHS. They will normally also have other ranges which are not available within your prescription and so need to be paid in full privately should you prefer one of these.
Sometimes you need to go to the wig supplier who will have a shop or salon. Other times they may visit you or run appointments at your local hospital. Speak to your nurse or consultant about your referral letter and details of your NHS wig local supplier.
The good thing about an NHS approved supplier is that they will have a vast experience of helping people dealing with cancer with wig choices.
Privately funding a wig or visiting a non NHS supplier If you are visiting an NHS supplier but can’t find what you want in the range they offer then you could ask to see a range that you will have to fund privately. BUT because of a strict code of ethical conduct and genuine wish to try and find you something within the NHS budget, most suppliers will do their best to arrange something within the NHS allocation.
However it is important to understand that you do have choice and you should ask to see a private range if you wish.
How to find a good wig supplier Speak to your nurse or consultant about your referral letter and details of your local NHS wig supplier.
There are many companies, online stores and high street shops selling wigs. So as wigs are becoming a more mainstream item for fashion it is important to find a supplier who has experience in advising people going through hair loss and cancer treatments (as it is completely different from wearing a wig as just a fashion look).
These individuals are trained to offer this service and normally do so with care, passion and empathy for your situation. Take a look in our directory for some idea.
Budgeting As well as your wig don’t forget to budget for the items below as these will not normally be covered by your NHS prescription so you will need to fund these costs yourself.
• Wig stand from £4.99 upwards • Care and styling products from £3.00 upwards • Wig brush and styling aids from £3.00 upwards • Wig/skull cap from £0.50p Upwards • Accessories from £1.00 upwards
To understand more about NHS funding read below:
Who qualifies for a NHS funded wig? The NHS may be able to offer you help towards the full or partial cost of a wig. The NHS only funds “Synthetic (acrylic) wigs” unless you are allergic to these. In other words if you prefer a human hair wig then you would need to fund this in full privately.
If NHS funded then most wig suppliers will offer you a range which you may choose from that is covered by your NHS prescription. They will normally also have other ranges which are not available within your prescription and so need to be paid for in full privately.
Many people ask why wig suppliers won’t allow them to use their wig prescription towards a wig that is not within the NHS prescription range. But unfortunately the wig suppliers have a limited resource and strict regulations and so can’t offer a top up system. In other words you need to choose a wig from the NHS covered range or pay in full yourself.
If you are having financial problems you may be able to get help from charitable organisations such as Macmillian.
Do remember to ask your nurse or contact the NHS to find out what you are entitled to.
Part payment • NHS prescription (This means that you will pay a prescription charge – around £60.00) You will be entitled to a new wig every 6 months
• Your consultant will give you a prescription normally in the form of a referral letter, you may then be asked to take this to another department such as “Surgical appliances” whom will send you a letter with details directing you to the local supplier/s who offer a NHS prescription service
• You will normally need to book an appointment with the wig supplier
• You will need to pay a prescription charge which is normally around £60.00, the remaining cost of the wig is covered by the NHS
• There is normally a range of wigs offered to you that are available within the budget of your NHS prescription. This means that most suppliers will also have a range that are not covered by prescription and would require you to pay a full private payment
• You will normally be directed to a particular supplier/s who hold the NHS contact in your area. If you want to go elsewhere you will need to pay in full
• The NHS will only fund a synthetic wig unless you have an allergy
Free wigs Full payment is covered by NHS for those who qualify for full cover of prescription charges. You will be entitled to a new wig every 6 months. Briefly, you may be covered in full for the cost if:
• You are staying in hospital as an inpatient and are in hospital when the wig is supplied
• You or partner are claiming particular benefits such as income support
• You have an NHS tax credit exemption certificate
• You are named on an HC2 certificate
• You are under 16 years of age or aged between 16 – 19 and in full time education
• If you do not qualify for full costs you may be given an NHS prescription – see below
• The NHS will only fund a synthetic wig unless you have an allergy
Other suggestions - Non NHS • Ask your Macmillan nurse for help with financial support • Talk to your medical team and make sure you are receiving what you are entitled to within the NHS
Private payment – meaning that you pay in full (sometimes minus VAT) You may not be offered an NHS prescription or you may decide that you wish to select a wig that is not covered by your NHS prescription such as a real hair wig or a wig outside of the NHS range on offer. All people who need a wig for medical reasons are exempt from paying VAT. You may need to ask your supplier to provide you with a VAT exemption form - please note that not all suppliers offer this – especially smaller organisations. If your supplier can not offer you this then you are entitled to contact the VAT office for a refund of the VAT charged.
Dealing with hair thinning
Hair thinning generally means that your hair may look thinner than normal and have less volume. This means that hair will fall out, but that you won’t experience complete hair loss.
You may find that one particular area of your hair feels and looks thinner, or you just have less hair overall. The amount that your hair thins by is individual to you and your natural amount of hair. Depending on how much your hair has thinned, and how you feel about it, will determine how you deal with it. Here are some ideas: Hair style
A good hair cut and some tips on blow drying, styling and fixing your style in place can make all the difference. You may be able to visit a regular hairdresser or you may need to see a specialist. In general a haircut should be tailored to your hair type and how your hair has thinned. What you should bear in mind is that if making your hair look as full as possible or disguising hair thinning is your priority, then you may need to have a change of style.
Colouring and perming can also help to add volume and texture BUT, generally speaking, you will have to wait until you have completed all chemotherapy treatments as most doctors will not allow this due to possible allergic reactions at a time when your sensitivity may be heightened. However there are a number of colouring possibilities such as sprays and coloured mousses that may be a temporary option.
Specialist hairdressers There are hairdressers who specialise in styling hair for people with hair loss and thinning. They normally work at specialist clinics that offer wigs, hair replacements and hair loss extensions. It doesn’t mean that they will suggest these options but they also offer very specialised cutting techniques and are experienced in dealing with thinning hair. Take a look in our section Hair Care Experts to read more about this option.
Hair pieces, extensions and weaves If your doctor agrees, you may be able to use some form of hair piece, extensions or weaves to try and help add bulk and volume to your hair. However you would be best advised to first seek the approval of your doctor and then see a specialist in hair loss as they will have the best experience for dealing with this. Sometimes your doctor or hair specialist may need you to wait until active treatment is complete before attaching any false hair.
Looking after your scalp It’s really important to take good care of your scalp. Sometimes due to a side effect of chemotherapy, wig wearing, or generally feeling unwell you may see spots, flaky, itchy and sore areas on your scalp, and this isn’t pleasant but is fairly common, so to be expected. Let’s look at how we can make that better. Take a look in our hair and scalp care section for more advice.
Emotions and Feelings For some people hair loss really is the most upsetting side effect of their treatment.
On the flip side, some people say they experience unexpected positive feelings such as courage and inner strength. Whether you are worried about facing your friends and family with hair loss, or finding the practicality of wigs and head scarves overwhelming we have created an entire section called your feelings and stories.
Here you can share in the wisdom, experiences, knowledge and individual ways of coping from others just like you. When it comes to dealing with hair loss, talking about and sharing your problems can shed a whole new light on the situation and really can offer you some great support. Take a look in our section your feelings and stories.
Looking to the future - plan your new hair growth
Do bear in mind that nearly everyone who experiences hair loss as a side effect of chemotherapy will also, once treatment is complete, experience hair re-growth. It is well advised to sometimes plan into the future and read a little about new hair growth.
One of the biggest fears I hear from people is that although they have been told by their doctor that the hair will grow back, they have a fear that it won’t. Apart from a few rare cases the hair always grows back. It is quite often a different texture, may be less or more in amount and volume or be a different colour than before but it does grow back.
So whilst you may now be planning your hair loss, why not take a look at our section New Hair Growth when you get a chance. This may help to put your mind at rest and get a good overview of what to expect.
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Please kindly note that Cancer Hair Care and The Caring Hair Boutique are not designed to provide medical advice. You should always consult with your doctor if you have any medical concerns or queries.