Hair Loss (Alopecia) in Childhood Cancer

Hair Loss

 

Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Hair loss, also called alopecia, is a potential side effect of chemotherapy and radiation therapy, and probably the side-effect with which we are the most familiar. Fortunately most of the time hair loss related to cancer treatment is usually temporary and will grow back after a while.

The loss of hair may occur all over the body, including on the head, face, arms, legs, underarms, and pubic area.  The hair may fall out entirely, gradually, or in sections. In some cases, hair will simply become thin—sometimes unnoticeably—and may become duller or dryer.

Causes

Cancer-related hair loss is usually caused by the cancer treatment that your child may be undergoing:

  • Chemotherapy: Not all chemotherapy causes hair loss, but certain types can because the cells that help hair grow are harmed. Most of the time the hair will begins to fall out about seven to 10 days after chemotherapy starts. After that, hair loss tends to increase one to two months into treatment. The amount of hair loss varies from person to person. Even individuals taking the same drugs for the same cancer can have a different amount of hair loss depending on the drug and the dosage; and whether the drug is being administered as a pill, into a vein, or on the skin. Hair starts to regrow about 1-3 months after chemotherapy ends. It often takes about 6- 12 months for hair to regrow completely. When the hair regrows, its texture may feel different from before; it may be thinner or coarser and the colour may also be different from before.
  • Radiation Therapy: Radiation therapy only affects the hair in the area where the radiation is aimed. Hair loss depends on the dose and method of radiation treatment. The hair will grow back after several months but it may be thinner or of a different texture than before. With very high doses of radiation therapy, hair may not grow back or may grow back thinner.
  • Targeted Therapy: Targeted therapy does not cause complete hair loss, although some targeted therapies may cause the hair to thin, become curlier or drier than usual.
  • Hormonal Therapy: A small number of individuals receiving hormonal therapy will experience noticeable hair thinning.

 

Management/Treatment

Relieving or managing side-effects is an important part of cancer care and treatment. Treatment to manage side effects is called symptom management, palliative care, or supportive care. Talk with your health care team about your child managing or coping with hair loss from cancer treatment before they start the treatment.

It may also be helpful to talk about potential hair loss with family and friends, especially other children in the family and your child’s school before it occurs. Expecting changes in the physical appearance of someone they know helps lower a child’s fear or anxiety.

With all the different hairstyles and baldness being something of a fashion statement these days, some individuals with cancer do not have a problem with the hair loss and make the most of it, but not all individuals feel the same way about it, especially girls.

Many children with cancer, especially girls, experience hair loss because of cancer treatment as more than just a change in physical appearance. To many young girls, their hair is their crowning glory, and losing it can be an emotionally challenging experience that affects their self-image and quality of life.

It is sometimes better to cut your child’s hair short before they start treatment, as this can provide fullness for a shorter hairstyle and makes the eventual hair loss a less dramatic change. It will also take less time for new hair to grow into the shorter hairstyle once it begins to regrow, and can help your child cope and move forward more easily after treatment.

 

Caring for Regrown Hair

Your child’s hair may grow back a different texture or colour than their original hair. When their hair begins to regrow, it is important to care for it carefully. At first, new hair will be much finer and more easily damaged than their original hair.

The following tips may be helpful if you are caring for your child’s regrown hair:

  • Limit washing their hair to twice a week.
  • Massage their scalp to remove dry skin and flakes.
  • Avoid hard brushing of their hair. Instead, gently use a wide-tooth comb. When styling the hair, limit the amount of pinning, curling, or blow-drying with high heat.
  • Avoid curling or straightening their hair with chemical products, such as permanent wave solutions, until the hair has regrown. Some individuals may need to wait for up to one year before they can chemically curl or straighten their hair. Before trying chemical products again, test a small patch of hair to see how it reacts, or ask your hairdresser for suggestions.
  • Avoid permanent or semi-permanent hair colouring for at least three months after treatment.

 

Tips on Preventing and Managing Hair Loss

The following tips may help your child to either not lose their hair or to better cope with the hair loss during and/or after treatment:

Cold Cap Therapy

Wearing a cap or head covering with cold packs before, during, or after chemotherapy may help prevent hair loss. The cold will narrow the blood vessels in the skin on your child’s head which may result in less of the drug reaching the hair follicles. Cold caps can be rented online for the duration of your child’s treatment.  Speak to your child’s healthcare team to find out if this approach may work for them.

Hair and Scalp Care

The following tips may help you care for your child’s hair and scalp during their cancer treatment:

  • Choose a mild shampoo, such as a baby shampoo, to clean their hair
  • Do not wash their hair every day
  • Wash their hair with gentle movements
  • Pat their hair dry to prevent damage
  • Choose a soft hairbrush and style the hair gently
  • Use sun protection (sunscreen, a hat, or a scarf) on their scalp when outdoors
  • Cover their head during the cold months to prevent loss of body heat.
  • Avoid blow-drying their hair with high heat.
  • Avoid curling or straightening their hair with chemical products.
  • Avoid permanent or semi-permanent hair colouring.
  • Choose a soft, comfortable covering for their bed pillow.
  • Talk to your child’s healthcare team before using any hair-growth creams or lotions.
  • Talk to your child’s healthcare team about taking a type of B vitamin called biotin

Wigs and Hairpieces

 Some children with cancer, especially girls who are a bit older, may prefer to wear a wig or hairpiece once hair loss begins.

There are many shops that sell wigs and hairpieces, including shops specifically dealing with people with cancer; there are also various organisations that can help in this regard.

Your child may prefer to wear a wig or hairpiece that looks similar to their own hair, so it would help to choose a wig or hairpiece before your child’s hair falls out so that it most closely matches their hair colour and style. A hairdresser can help style the wig or hairpiece.

It is best to have your child’s wig or hairpiece fitted properly at a wig or hairpiece shop, as this can help keep it from irritating their scalp.

Caps, Beanies, Bandanas and Scarves

Many younger children with Cancer are happy to rather wear caps, beanies, bandanas or scarves when they lose their hair. This can be fun, as they can change their look every day, and can gather quite a collection of fun headwear. Family and friends can make them feel more comfortable by also adopting similar headwear.

 

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