Alopecia
What is hair loss?
Hair grows almost everywhere on the body, but it is thickest on the head. Each hair is attached to a hair follicle. On average, you lose 50 to 100 hairs per day. When a hair falls out, a new hair grows from the follicle. If a hair follicle is damaged, the hair falls out and no new hair grows. When many follicles are damaged, hair becomes thinner and bald spots may appear. Sometimes damaged follicles recover, and hair grows back. During treatment, you were likely bald because your follicles were damaged. Hair that grows back after cancer treatment may have a different color or texture, be curly or straight, grow more slowly, or be thinner. Sometimes the follicles are too damaged to recover, resulting in permanent hair loss.
Do I have an increased risk of hair loss?
Anyone, including people who have never had cancer, can experience (permanent) hair loss, but certain cancer treatments can increase the risk.
Treatments that can increase the risk of (permanent) hair loss:
Radiotherapy to the head (including TBI) may cause hair loss in the treated area. This can be temporary or permanent depending on the number of sessions and dose.
Chemotherapy can cause temporary hair loss over the whole body.
Stem cell transplantation can cause temporary hair loss because chemotherapy is given beforehand.
A combination of radiotherapy and chemotherapy increases the risk of permanent hair loss.
You can check your treatment summary to see if you have had any of these treatments. If you do not have a summary, contact the LATER clinic or the hospital where you were treated. (Permanent) hair loss is not always caused by treatment and may have other causes.
What are the symptoms and signs of hair loss?
During treatment, fast-dividing cells are affected, including hair follicles, often causing temporary hair loss. After chemotherapy, hair usually grows back, but it may be thinner or have a different texture or color. Radiotherapy to the head or scalp can cause permanent follicle damage depending on the intensity and area treated, which may also result in thinner hair or reduced hair density.
I have an increased risk of hair loss. What tests are needed and when?
No additional tests are needed if hair loss occurs.
What happens if I have (permanent) hair loss?
Hair loss can be distressing, especially if it is permanent. Unfortunately, no shampoos, lotions, or treatments can regrow hair. You can, however, make thinning hair or bald spots less noticeable. For example, you can try different hairstyles, hats, scarves, headbands, hairpieces, or wigs. Hair extensions can also be woven into your own hair using real or synthetic hair. Your hairdresser can advise you. Hair transplantation may be possible, but not recommended if your head has been irradiated, as the skin is likely thin and heals poorly. If you consider a hair transplant, discuss it with your general practitioner or LATER doctor first.
If hair loss is problematic, you can contact Stichting Haarwensen (for under 18s) or the Haarstichting.
What else can I do?
Living with (an increased risk of) (permanent) hair loss can be difficult. Talking with friends and family can help. Contact with others in a similar situation can also be supportive, for example via a patient organization such as VOX, part of the Dutch Childhood Cancer Organization.
Take good care of yourself. While it does not restore hair, a healthy lifestyle remains important. Protect your scalp from the sun with a good sunscreen (SPF >30). Take care of your mental health. Small changes can have a positive impact on your physical and mental well-being.
It is important to know that you may experience hair loss and to recognize the signs and symptoms. If you have questions or concerns after reading this information, contact your general practitioner or LATER doctor.
Where can I find more information?
This LATER website also provides information about:
Healthy lifestyle
Mental health
The PanCare Plain Language Summaries provide links to reliable information in English. You can search online for information about (permanent) hair loss, but note that it may not always be up-to-date or accurate.
Disclaimer
This information is based on the plain language summary of the guideline prepared by the PanCare Plain Information Group and has been adapted where necessary to the Dutch LATER guideline. Do not rely solely on this information if you have symptoms or concerns, but consult your general practitioner, LATER doctor, or specialist.