Hair Loss With Cancer

    For children with cancer, the loss of hair can be important and traumatic -- and for others, especially very young children, this loss can be relatively unimportant. For teenagers, hair loss can be devastating, and you will need to do everything you can to help your teen find a satisfactory way to cope with this problem. Your child will need to know if hair loss is likely to occur because of his or her treatment, and you will need to make plans to cope with this in ways that make your child most comfortable. The good news is that there are a number of ways your child can consider in covering his or her head.

    Not all chemotherapy medications cause the loss or thinning of hair, so first ask the health care team about the recommended treatment and whether hair loss is expected. If your child must have radiation to the head, hair will probably fall out on the part of the head where the radiation is directed. In many cases, hair may not grow back in the radiated area; talk with your health care team for more information and what is likely to happen in your child's case.

    Why hair loss? In the case of chemotherapy, hair loss occurs because some anticancer drugs are made to kill fast-growing cancer cells. However, certain normal cells, like hair cells, are also fast-growing; chemotherapy affects these cells, too. For almost everyone, hair begins to grow back several months after chemotherapy ends. While the hair may initially be of a different texture and even a somewhat different color than your child's original hair, this difference is usually temporary.

Symptoms

Hair loss usually begins several weeks after the first or second chemotherapy treatment -- but this varies from individual to individual. Your child's hair may begin thinning gradually before falling out faster and in larger quantities.

Treatment

Once you and your child know that hair loss is expected, you can plan ahead.

1. Have your child's picture taken with his or her hair as it is usually worn, so if your child wants a wig, the hair stylist will have a picture to help shape the wig. Also, keep a snippet of your child's hair, to help in matching color and texture. Have your child get his or her hair cut short.
2. Once the hair is short and your child thinks she or he may want to cover the hair once it begins falling out, experiment with different hats (and scarves, for girls) to see which ones please your child. Feeling good about appearance is very important to most children undergoing cancer treatment, so take the time needed with this step to make this process enjoyable and relaxing.
3. If your child is interested in wearing a wig, first get a "prescription" from your physician for insurance company purposes. Many health insurers cover the cost of wigs if these are prescribed by a physician. Locate a wig shop or hair salon that can help with a wig for a young person; your hospital social worker can usually make recommendations to you for purchasing wigs and having them styled. Teen-aged girls can usually be helped by a hair salon for adults that also does wigs.
4. Understand that most people should not plan to wear wigs "out of the box." To fit comfortably and look good, wigs usually need some styling, trimming and other adjustments by hair care professionals. Also, wigs need to be the right size for your child to be comfortable. Talk with your wig expert to discuss whether to use natural (human) or synthetic hair for your child's wig. Generally, synthetic hair keeps it shape and requires less care than human hair, and is less expensive as well. Both kinds of hair come in a wide variety of colors and textures and you should be able to approximate your child's natural hair if you choose to do so.
5. If you lack insurance or your insurance doesn't cover the cost of a wig (called a "hair prosthesis" in insurance language), there are organizations who can help supply wigs at low or no cost. Please see Resources for information on these organizations. Also, contact your local chapter of the American Cancer Society for assistance in obtaining a free wig.
6. It may help for you and your child to talk with other children who have been through the experience of hair loss, and learn what worked and didn't work for them. Your hospital social worker can help you find children or young adults with cancer who have experienced this process.

Once your child's hair starts to fall out, consider the following steps:

1. Let your child's teacher know that he or she will be losing hair. The teacher may speak with the class ahead of time to minimize the reaction when your child returns to school. Also, some schools have prohibitions on some kinds of hair coverings and hats; speak with the school administration to secure special permission if your child wants to wear something of that nature instead of a wig.
2. As the hair falls out, wash it less frequently and only with very gentle shampoos or baby shampoo.
3. If your teen uses hair color or highlights, this must stop for now. Chemical processing can be harsh on hair that is fragile from chemotherapy.
4. If possible, avoid using blow dryers, curlers or curling irons, as these will speed up the rate of hair loss and may be uncomfortable on a tender scalp.
5. Don't forget to avoid the sun! If your child is going without a wig or other hair covering, it's important to apply sunblock to the scalp, and if possible, wear a hat or scarf when playing outside.
6. In general, try to minimize the trauma of this loss with your child. Encourage her to experiment with different kinds of hair coverings and have fun with this process -- and remember to remind your child that the hair will come back once treatment ends.

Questions for Your Doctor

In managing hair loss, your team may include a hairdresser, wig expert, nurse and oncology social worker.

1. Will my child's cancer treatment cause the loss of some or all of his hair?
2. When will hair loss start?
3. If my child does not lose her hair, does this mean the treatment isn't working?
4. What information can you provide us on managing the hair loss process and finding head coverings? Where can I find help and advice?
5. Please provide me with a prescription for a "hair prosthesis" (wig) for my insurance company.
6. If I cannot afford to buy a wig or hats for my child, where might I obtain financial advice and support?
7. How long after treatment ends will my child's hair begin to grow back?