Introduction
Many people feel their hair is important to their appearance and self-image. Losing your hair can be a distressing experience and some patients feel anxious when they find out they have a condition, or will require treatment, that will affect their hair.
The aim of this booklet is to try to answer some of the queries you may have about how your condition or treatment may affect you and to try to help you make the best of your appearance during this time.
What are some of the causes of hair loss?
Some treatments for cancer, such as certain chemotherapy drugs and radiotherapy, may cause you to lose your hair.
Some skin or other conditions, such as alopecia areata, may also result in you losing your hair.
Hair loss during chemotherapy treatment
Chemotherapy uses anti-cancer drugs to destroy cancer cells. Unfortunately, these drugs also damage healthy cells, including the cells in the hair follicles, which is why you may lose your hair.
Many people assume that chemotherapy always causes hair loss but this is not true. Certain drugs do cause partial or complete hair loss but some drugs cause none at all. If the drugs included in your treatment plan are known to cause hair loss, the doctors and nurses looking after you will explain this to you. If you have any questions, do not hesitate to ask them.
Hair loss may start within a couple of days of beginning treatment or may not occur for some weeks. You will probably notice more hair on your brush, in the basin or shower after washing your hair or on your bed linen. Some people notice that their scalp becomes quite tender just before their hair comes out.
You may also lose your body hair, including underarm and pubic hair. If you lose your eyebrows and eyelashes, your eyes may water more easily and be more sensitive to the sun. Wearing sunglasses will help to protect your eyes.
Is there any way I can prevent my hair from coming out?
Scalp cooling is a method of preventing hair loss due to chemotherapy but it can only be used with certain drugs. Success depends on the dose of the drug and whether other drugs are given at the same time.
The procedure uses a cold cap to lower the temperature of the top of your head. The cold narrows the blood vessels and prevents the drug passing into the cells at your hair root and damaging them.
Please ask your doctor if scalp cooling can be used with your chemotherapy and ask if it is appropriate for you. You can then decide whether or not to try it.
Please note that scalp cooling is not offered to patients with blood cancers.
Hair care during chemotherapy treatment
When we are unwell or below par we often notice our hair does not have the same bounce or condition as usual.
Whatever treatment you are receiving, take care of your hair and treat it as gently as possible. Chemotherapy, in particular, may cause your hair to become dry and brittle, even if you do not lose it.
We recommend the following:
- Use a mild shampoo
- Limit the number of times you wash your hair to twice a week, if possible
- Use tepid, not hot water
- Pat your hair dry using a soft towel – do not rub it
- Use a wide-toothed comb or a soft hairbrush
- Do not be afraid to brush or comb your hair daily but remember to do it gently
- Use ribbons to tie back hair rather than elastic, which can easily damage the hair
- Do not plait your hair as this may damage it
- Do not use harsh chemicals, such as hair dyes, perms, gels and sprays
- Use milder, vegetable-based colouring products – your hairdresser may be able to advise you
- Do not use excessive heat, for example heated rollers, hot hair dryers or hair tongs/straighteners
Hair loss and radiotherapy
Radiotherapy causes hair loss in a different way to chemotherapy and only affects the specific area being treated. You will only lose the hair on your head if your head is being treated.
Although hair loss is usually temporary, for a few people it can be permanent. It depends on the dose of radiotherapy and the length of treatment you receive. If your hair loss is likely to be permanent, this will be explained to you before treatment begins.
During treatment your skin may become sore, similar to mild sun burn and it is important not to make it worse. The staff in the radiotherapy department will give you advice about how to care for your skin in the area being treated at the beginning of your course of radiotherapy. The staff will also give you advice about how to look after your hair. If you feel unsure of what to do or which products to use, do not hesitate to ask the staff looking after you.
Will my hair regrow after chemotherapy or radiotherapy?
Your hair will usually grow back when treatment is finished. The time regrowth will take depends on your treatment. Your doctor or nurse will be able to advise you on how long it will take.
Your scalp may itch more than usual while your hair is regrowing, so use a mild moisturising shampoo. Your hair may grow back slightly differently, for example a different shade or colour, curlier than before or very straight.
Alopecia areata
Alopecia areata is an autoimmune hair loss disease that affects men, women and children of any age. The onset of hair loss is often sudden, random and frequently recurrent.
The body’s immune system wrongly attacks the growing cells in the body’s hair- producing follicles, where the hair starts to grow. This stops them producing new hair and causes existing hair to fall out. The cells which produce the hair (the follicles) do still remain active, so the potential for hair to start re-growing is always there.
Pattern alopecia
In patients with pattern alopecia the top part of the scalp is particularly affected. The hair follicles gradually get smaller in size and as a result the hair may be too fine to actually see. The condition only rarely becomes severe enough for a wig to be needed.
Scarring alopecia areata
Scarring alopecia areata can be caused by a number of diseases that may affect the skin, such as lichen planus and discoid lupus erythematosis. In these diseases inflammation actually destroys the hair follicles. The scalp is normally affected in patches, which may be of variable size and may result in a wig being needed.
Hair Loss Service
United Lincolnshire Hospitals NHS Trust is situated in the county of Lincolnshire and is one of the biggest acute hospital trusts in England. Its main sites are situated in Lincoln, Boston, Grantham and Louth with services in the Community at Johnson Hospital Spalding, Skegness and District Hospital and John Coupland Hospital, Gainsborough.
When attending for your hospital appointment and you require referral to the Hair Loss Service, a referral will be made by the clinical nurse specialist for you. You will be provided with a voucher to use at one of the Salons/Suppliers (listed on the voucher) for either full or part payment of a wig.
You will be able to contact the Salon/Supplier directly in order to make an appointment to discuss your requirements. You must have an appointment to choose and have your wig fitted.
Wigs can only be provided with a voucher following referral to the service by a ULHT consultant or clinical nurse specialist. However, if you wish to purchase a wig “off prescription” no referral is needed but you will require an appointment with the Salon/Supplier.
Who can be referred to the wig service?
If you have, or are expecting to have, hair loss as a result of illness or treatment, you can ask to be referred to the wig service.
How do I get a referral to the wig service?
Referrals can be made by your consultant or by a specialist nurse on the ward or in the clinic you are attending.
How much will my wig cost?
Wigs supplied to patients through the NHS wig service are subject to a prescription charge. The voucher that you will be provided with covers the full cost of the prescription charge.
How long will I be given for my appointment?
Appointments with the Salon/Supplier are at the discretion of the Salon/Supplier owner and may vary depending on your needs and requirements.
Will I be able to take a wig home with me?
Salons/Suppliers have a range of wigs and may not always have the correct size, style and colour to suit you in stock. If this is the case then your wig may need to be ordered for you and this may take several weeks to arrive.
What are wigs made of?
The wigs supplied are made of synthetic materials, such as acrylic. Synthetic wigs are pre-styled and easy to manage. They are washable and water based styling gels can be used on them.
All wigs can be cut or trimmed to suit your exact requirements. However, it is important that the person you get to do this is experienced in cutting wigs so always ensure that you ask the Salon/Supplier for guidance or advice.
What happens if I want a more expensive wig than a standard NHS one?
The Trust will provide you with a voucher to cover the standard NHS prescription charge. If the wig you choose is more expensive, you can choose to pay the difference yourself directly to the Salon/Supplier.
How many wigs can I have?
Alopecia
Your referral allows for two acrylic wigs per year. These can be supplied at the same time.
Chemotherapy/Radiotherapy
Your referral allows for one acrylic wig per course of treatment. Should you require a wig for longer than six months you can ask to be re-referred by the oncologist or nurse responsible for your treatment.
Wigs are also available at very competitive prices, should you wish to purchase additional items.
Refunds
Please contact the Salon/Supplier directly regarding any refunds and exchanges if items are faulty. Always make sure that you are happy with your wig or other headwear before you leave the Salon/Supplier.
Will my wig fall off?
There is an adjustable band inside each wig to ensure a secure fit, so your wig should not fall off. If you are still worried you can attach it more firmly by using special double-sided wig tape.
Alternatively, if you have not lost all your hair or if it has started to grow back, you can use hair clips to help to secure your wig.
Will I lose my body hair?
This depends on the type of illness you have, or the treatment you are receiving. Please ask a member of your healthcare team about this.
If you do lose your body hair, there are various things you can do to maintain your normal appearance, such as pencilled or synthetic eyebrows and synthetic eye lashes. Please ask the wig consultant for more details.
Should I have my hair cut before it comes out?
You may find it less of a shock when you lose your hair if you have already had it cut into a short style. However, you may prefer to leave it in your normal style.
What if I do not want to wear my wig all the time?
There are many alternatives to a wig – all you need is a little imagination and a few hats, headscarves or bandanas.
You will probably find that cotton headscarves stay in place more easily than silk ones. However, silk scarves can still be used to accessorise your cotton ones.
Sources of further information
Alopecia UK
Website: www.alopeciaonline.org.uk
Cancer Research UK
Website: http://www.cancerresearchuk.org/
Lincolnshire Wig Bank
A free wig service for people with medical hair loss. Practical support pre/post treatment and providing high quality new/donated wigs, scarves and caps all free of charge
Website: www.stbarnabashospice.co.uk www.facebook.com/lincolnshire.wigbank Tel: 01522 518219
Macmillan Cancer Support
Tel: 0808 808 00 00 Website: www.macmillan.org.uk Macmillan Cancer Support – “Coping with Hair loss” booklet
Feel more like you
Website: www.macmillan.org.uk
Look Good Feel Better
Website: www.lookgoodfeelbetter.co.uk
Look Good Feel Better and Feel More Like You can provide help and support with make up tips such as eyebrow and eye lash application for patients with cancer. To book a free place on a session call : 01522 572350.