How Does Chemotherapy Cause Hair Loss

how does chemotherapy cause hair loss
Photo Credit: Rhoda Baer,

Chemotherapy is the use of drugs to kill fast-growing cells. It is used in the treatment of cancer because cancer cells grow more rapidly than other cells.

It can be used alone to combat cancer or in combination with other methods like surgery, radiation therapy, and hormone therapy.

Sometimes, it can be used only to alleviate pain and pressure from cancerous cells and to shrink tumors.

Apart from using chemotherapy to treat cancer, it may be used as a procedure for marrow transplant and to control immune system disorders.

A lot of people are curious about how chemotherapy cause hair loss or thinning and how to prevent or manage it.

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How Does Chemotherapy Work?

Chemotherapy works in the following ways:

Prevention of Cell Division 

Chemotherapy kills cancer cells by damaging the DNA (deoxyribonucleic acid) or RNA (ribonucleic acid) of the cells. The DNA and RNA of a cell contain all the information that the cells need in order to copy, produce a new cell, and divide.

Cancerous cells are known for their uncontrollable cell division patterns. Normal cells control their cell division by contact inhibition. This means that normal cells stop dividing once they encounter a similar cell.

Cancer cells cannot stop dividing even when in contact with similar cells.

Inducement of Apoptosis (Self-Death) 

Chemotherapy makes the cells to release Cytochrome c and undergo apoptosis, which means to kill itself.

There are two main factors that will make a cell kill itself…

  1. When the mitochondria release cytochrome c. due to a signal from the brain.
  2. When it receives signals from nearby cells, it starts to die.

Destruction of the Enzymes And Hormones 

Chemotherapy drugs target the enzyme sources of cancerous cells and stop their production. These enzymes and hormones serve as food sources of these cancer cells.

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How Is Chemotherapy Given?

The different means by which chemotherapy drugs can be given are:

  1. By mouth, swallowed by mouth or to be taken sublingually (kept under the tongue).
  2. Intravenous injections administered directly into the bloodstream through the veins.
  3. Subcutaneous injections, administered in-between the skin and the muscles.
  4. Intramuscular injections, administered through the skin to the muscles.
  5. Intraventricular treatments, administered into the cerebrospinal fluid by making a hole in the skull and inserting a catheter.
  6. Intrathecal treatments, administered between the skin and the muscles of the scalp.
  7. Intraperitoneal treatments, administered directly into the abdominal cavity that surrounds the organs but not to any organ particularly.
  8. Intra-vesicular treatments, administered into the bladder.
  9. Intra-arterial treatments, administered to the arteries supplying blood to the tumor.
  10. Intra-pleural treatments, administered on the lining of the lungs.
  11. Topical applications applied on the skin.
  12. Implantable treatments, placed and left in the cavity after brain tumor surgery.

Before chemotherapy is performed, several tests are carried out to determine the following:

  • The stage of the tumor
  • Immune levels
  • The type of cancer
  • Previous cancer treatments successes
  • The purpose of the therapy

What are the Side Effects of Chemotherapy?

Some of these side effects are:

  1. Hair loss
  2. Pain
  3. Loss of appetite
  4. Mouth and throat sores
  5. Constipation
  6. Diarrhea
  7. Vomiting
  8. Fatigue
  9. Nervous disorders
  10. Cognitive dysfunction
  11. Skin and nail dryness and itchiness
  12. Hearing difficulty
  13. Infertility
  14. Low libido
  15. Low blood count.

Many of these side effects can be prevented or treated. There are newer drugs that are more specific in action and cause milder side effects.

The side effects of chemotherapy differ from person to person. The type of cancer, location of the tumor, drug dosage, and immunity determine the severity of the side effects.

How Does Chemotherapy Cause Hair Loss?

Chemotherapy affects all cells that grow rapidly in the body. Cancer cells are known to divide more rapidly than normal cells do.

Some normal cells in the body like blood cells, stomach, and digestive system cells, hair follicles, and mouth cells also grow and divide rapidly.

Hair follicles divide every 1-3 days, which makes it susceptible to the effect of chemotherapy drugs.

Unfortunately, there are no specific parameters that the drugs can use to differentiate between cancer cells and other normal cells. 

These cells get affected in chemotherapy since they all divide more than normal ones do.

Partial or total hair loss can occur after a few weeks of treatment.

Some people might not lose their hair after chemo while some may regrow their hair a few months after cancer treatment.

The loss of hair after chemotherapy may happen gradually or in clumps. The hair of the pubic areas, armpits and eyebrows could also be lost.

The scalp might become quite sensitive and itchy after hair loss. Sometimes pimples might develop.

When hair begins to grow again, it may become a different color and texture. With time, the hair will return to its original state.

This video explains how chemotherapy causes the hair to fall off.

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What are the Drugs That Cause Hair Loss in Chemotherapy?

i. Cytoxan and 5-fluorouracil cause hair loss but in little quantity. Some people may lose a lot of hair.

ii. Adriamycin could cause total hair loss on the head, usually during the first few weeks of treatment. Eyelashes and eyebrows could also be lost.

iii. Methotrexate causes hair thinning in some people. Complete hair loss from this drug is usually a rare occurrence.

iv. Taxol usually causes complete hair loss on the whole body.

Other cancer treatments that can cause hair loss are

i. Radiation: Treatment of cancer with radiation can cause hair loss especially at the area being treated or the point where the radiation beam exits the body.

The quantity of hair loss in this therapy depends on the size of the area being treated, the dose of radiation and the exposure time

ii. Tamoxifen: a hormonal therapy drug that may cause thinning of hair, but not baldness.

How to Cope With Hair Loss By Chemotherapy

  1. Scalp cooling (scalp hypothermia): This is the process of wearing a cap connected to a cooling unit. The cooling liquid fills the cap and creates a cooling effect while chemotherapy is going on. This can be used to reduce or even prevent hair loss.

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2. Use of mild shampoo and cream. The use of harsh or harmful products might cause irritations and prolong the period for hair regrowth.

3. Hair cut before chemotherapy may boost confidence, bring about mental preparedness, and control.

4. The use of cotton or satin pillowcase is advised. Nylon materials would irritate the scalp.

5. Comb and brush hair with soft bristles and gentle strokes.

6. Healthy diets and proper hydration will help in the regrowth of hair.

7. Protect the scalp from direct sunlight on sunny days

8. Avoid frequent use of a hairdryer, curling iron, or hot combs

9. Avoid wearing a ponytail or tight braids

10. Always reach out to a support group or family and friends when feeling down because of it.

For other causes of hair loss and their remedies, check out these articles:

Final thoughts…

Chemotherapy is one of the methods used in the treatment of cancer. These drugs attack rapidly dividing cells such as the hair follicle.

The effects of chemotherapy differ from person to person. While some chemotherapy drugs might cause severe hair loss to a person, it might cause little or no hair loss to another.

It is also a clever idea to explain to your family members what is expected from the sessions. This is to enable them to offer their full support when the process of hair loss and other side effects kick in.

How Does Chemotherapy Cause Hair Loss — Related FAQs

Why does hair fall out after chemotherapy?

Chemotherapy cause hair to fall off because the drugs target rapidly dividing cells.

Since cancer cells, hair follicles, cells of the mouth, and stomach divide rapidly too, chemotherapy attacks them all.

Hair follicles are cell structures present in the skin and scalp from which hair grow. They divide every 1-3 days which makes them prone to attack by chemotherapy.

The rate of hair loss from chemotherapy can be slow or sudden and differ from person to person.

Some drugs might cause minimal hair loss or hair thinning while others can cause total hair loss, including the eyebrows and pubic hairs.

Hair lost due to chemotherapy can regrow with time but the color and texture of the hair might change.

How can I keep my hair during chemo?

To keep your hair during chemotherapy, you can wear a scalp cooling cap. It is best to wear this cooling cap about 15 minutes before the start of chemotherapy. You should continue wearing the cooling system during and after the chemo.

A cooling cap is a hat designed like a helmet that is worn on the head. It contains a cooling gel of about -26 to -40 degrees Celsius.

A scalp cooling cap can reduce the rate of hair loss in chemotherapy by reducing the temperature of the scalp. This reduction in temperature causes the blood vessels in the scalp to be narrow.

The narrowing of the blood vessels will prevent a higher quantity of the chemo drugs from reaching the hair follicles. The low temperature of the scalp cooling cap will also prevent the high cellular activity of the hair follicles.

When there is low cellular activity, these cells will not divide as they normally do. This will reduce the effect of chemotherapy on them.

The cooling cap should be replaced often during chemotherapy when they become warm. A cooling system can be set up that constantly transports coolant to the cap.

The cost of the cooling cap or the cooling system differs from one manufacturer to another.

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How long does chemo stay in your body?

Chemo drugs stay in the body for about 3 days. However, the side effects of chemotherapy will last longer than this.

Chemotherapy is used to target and kill cancer cells but it also has its side effects. Cancer cells divide rapidly and chemotherapy is used to stop their activities.

There are also other cells of the body that divide as often as the cancer cells and are therefore affected by chemotherapy. Some of these the hair follicles, the stomach cells, and the nails.

Chemotherapy affects the hair follicles and causes hair thinning and loss. It affects the stomach lining and causes diarrhea, constipation, and digestive disorders.

Other side effects that can be experienced from chemotherapy are fatigue, nausea, mouth sores, sore throat, insomnia, and irregular menstrual periods.

Do eyelashes grow back after chemo?

Eyelashes grow back after chemotherapy. They could start growing as early as one month of chemotherapy.

Not all chemotherapy drugs can cause eyelashes to fall off. But when they do, they are very likely to grow back. Although the eyelashes are lost alongside other hairs on the body, the hair on the scalp tends to grow back earlier.

The texture of the hair that will regrow is not going to be the same as before. The color might not be the same also.

You can use makeup to enhance them until the side effects wear off. You can also talk to your doctor about using a hair growth product.

How can I make my hair grow faster after chemo?

You can use hair growth medication like Minoxidil sold as Rogaine. This topical medication works as a vasodilator. This means that it widens the blood vessels and allows more blood to be supplied to the hair follicles.

The use of Minoxidil for 2 months can produce visible results. The two concentrations of Rogaine sold over the counter are 2% and 5%.

Remember that it is a clever idea to talk to your doctor or dermatologist before using any hair regrowth product after chemotherapy.

Other ways you can grow your hair after chemotherapy is by scalp massages and proper hydration. Scalp massages stimulate the blood vessels that supply oxygen and nutrients to the hair follicles.

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