05 Mar, 2025
05 Mar, 2025
This article is medically reviewed by Dr. Abhishek Charan, Consultant – Medical Oncology, HCG Cancer Centre, Jaipur.
Many assume that chemotherapy and hair loss go hand in hand. In many cases, doctors see chemo patients worrying about losing their hair as they undergo the treatment.
It is important to note that not all patients undergoing chemo lose their hair. Hair loss due to chemotherapy depends on various factors, such as the type of drug, dose, the number of chemotherapy cycles recommended, the mode of administration, and other factors.
In this article, let’s explore the different aspects of chemotherapy-induced hair loss. Be it the question of “Does chemo cause hair loss?” or “Does hair grow back after chemo?” You will find your answers here.
Distinct regions in the hair follicles affect hair growth and sensitivity to chemotherapy. The infundibulum and isthmus are present in the upper hair follicle, while the hair bulb is present in the lower hair follicles. The lower hair follicles also contain matrix keratinocytes that produce the hair shaft. Chemotherapy affects these rapidly dividing cells, resulting in chemotherapy-induced alopecia (CIA) or hair loss.
Damage caused by mild chemotherapy causes dystrophic anagen. Hair production at this stage pauses and resumes with altered pigmentation, poor quality, and slow recovery. Severe damage caused by chemotherapy triggers dystrophic catagen, which causes sudden and significant hair loss due to chemotherapy. Hair regrowth depends on transitioning through various growth phases.
The severity of hair loss due to chemotherapy depends on the type, dosage, and regimen of chemotherapy. Intrafollicular damage pathways trigger reduced cell proliferation and enhanced apoptosis in the hair matrix, thereby disrupting hair growth.
Chemotherapy-induced hair loss varies among patients. It depends on the type of drug and its dosage and individual factors. Studies reported that cisplatin and docetaxel resulted in hair loss in 44% of the patients. It has also been reported that almost 31% of the patients retained their hair, irrespective of the type of cancer and drugs used.
Because of their high mitotic activity, the most affected sites include the scalp and beard hair. Dystrophic hair does not shed immediately. Some recover and grow temporarily. Additionally, pubic hair and eyebrows may also be affected.
Drug potency and androgenetic alopecia also influence hair loss due to chemotherapy. Women with milder androgenetic alopecia report more intense hair loss due to chemotherapy, while men with severe androgenetic alopecia experience significant shedding and a slower progression to complete hairlessness.
It is important to seek medical attention when patients experience symptoms that suggest the presence of throat cancer. These symptoms include persistent sore throat, persistent wear pain, unexplained weight loss, altered voice, persistent cough, and fatigue. In most cases, these symptoms are caused by less serious conditions. However, it is important not to ignore these symptoms and to consult an ENT specialist to rule out serious conditions.
The patterns of hair loss due to chemotherapy depend on the severity of damage. Mild to moderate damage results in telogen effluvium (excessive hair shedding), and severe damage causes dystrophic anagen effluvium (hair loss that occurs during the growth phase). Chemotherapy may impact hair growth in many ways, causing alopecia, pigment (hyperpigmentation or depigmentation), growth alterations, and textural changes (straight hair to brittle or curly hair).
Patients on targeted therapy have slow hair growth, resulting in fine and fragile hair. EGFR and pan-FGF receptor inhibitors result in excessive periocular hair, longer eyelashes, and hirsutism. Some patients may experience hirsutism due to hormone therapy.
In most cases, the hair begins to grow back a few weeks after the end of chemotherapy. The new hairs may be slightly darker, lighter, or curly. These changes are temporary in most cases. The hair growth speed on the scalp is faster compared to eyelashes or eyebrows.
Patients may experience uneven post chemo hair growth of the eyelashes during the initial period of growth. They may take almost a year to grow fully. Some people may have completely grown eyelashes within six months post-treatment.
After chemotherapy, patients may expect initiation of hair regrowth within a few weeks. However, the hairs may look different from the original hairs. The type of hair regrowth also depends on ethnicity. The hairs may be curly or straight and may have changes in thickness or color.
Although most people have a temporary deviation from their original hair, it is permanent in some people, as treatment affects each patient differently. Patience during the hair regrowth period is important, as it is difficult to predict when the hair will grow fully after stopping the treatment.
Patients have several methods to cover their hair if they experience hair loss during the treatment. The most popular choice is wigs; however, patients may have itching or feel hot, especially in summer. Wearing a soft inner cap under the wig may provide comfort. Patients may also use sticky pads to keep the wig in place.
Scarves, hats, and baseball caps are other alternatives to covering the head. Some patients prefer to leave their head uncovered.
Whether to choose hats, scarves, wigs, or baseball caps or keep the head uncovered is a patient's personal choice.
Various measures help the patients to cope with hair loss due to chemotherapy. These include:
It is important to follow a care routine during new hair growth. Patients are advised to avoid bleaching, coloring, or using heated tools during the early stages of hair growth.
Patients should gently massage the scalp to enhance blood circulation and stimulate hair growth. It is recommended to use the fingers in a circular motion to remove dry skin and promote a healthy scalp. Use a gentle conditioner weekly. Choose a conditioner designed for damaged hair to maintain good hair health.
Various treatment options are available for hair regrowth after chemotherapy. These include topical drugs, physical methods, and alternative therapies.
1. Drugs: Various drugs are available to stimulate hair growth. Some of these drugs are minoxidil and bimatoprost. While minoxidil is generally used to promote the growth of scalp hair, bimatoprost is applied for eyelash growth.
2. Photobiomodulation Therapy (PBMT): This therapy involves the use of a low-level laser. It accelerates hair growth through the stimulation of mitochondrial activity. A study reported its efficacy in accelerating hair regrowth after chemotherapy in patients with breast cancer.
3. Platelet-Rich Plasma (PRP): Injections of PRP promote the growth of hair follicles. A recent study reported that PRP enhances hair density in endocrine therapy-induced alopecia and permanent chemotherapy-induced alopecia in patients with a history of breast cancer.
4. Alternative Treatments: Certain ingredients, such as caffeine, amino acids, curcumin, garlic, melatonin, onion juice, vitamins B6, B7, D, and E, and zinc, have been shown to be effective against alopecia. A study reported the efficacy of a topical solution containing citrus, guarana, cocoa, and onion on hair density and thickness in breast cancer survivors. There are no individual supplements to prevent hair loss during chemo.
Hair loss due to chemotherapy is one of the most common and distressing side effects of chemotherapy. It usually starts within 2 to 4 weeks after starting the treatment. Before initiating the treatment, patients need to understand how chemotherapy is going to work on their body and what its possible side effects are. Patients should also take good care of their hair during the hair regrowth phase. Lastly and most importantly, patients should understand that hair loss due to chemotherapy is not permanent in most patients and that regrowth starts within a few weeks after treatment.
Dr. Abhishek Charan
Consultant – Medical Oncology
MBBS, MD, DM (Medical Oncology)
Dr. Abhishek Charan is an experienced medical oncology consultant practicing at HCG Cancer Centre, a leading cancer hospital in Jaipur. He specializes in treating a broad spectrum of cancers using systemic therapies, namely chemotherapy, immunotherapy, and targeted therapy. His expertise lies in the areas of head and neck oncology, gynecological oncology, breast oncology, gastrointestinal oncology, pediatric oncology, and supportive care.
To book an appointment with Dr. Abhishek Charan, please click here.
