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Coping With Hair Loss

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Freephone helpline 0808 808 5555
[email protected]
www.lymphomas.org.uk

Coping with hair loss

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Many people experience hair loss as a side effect of their treatment for lymphoma.
Some men and women find this to be the most distressing side effect they have,
particularly because it is so visible. Men can also be distressed by losing their facial
hair.
The way you choose to style and colour your hair is often an important part of your
identity, so hair loss can affect your self-esteem and confidence.
‘The main thing women should not forget is, just because you are going through
chemotherapy doesn’t mean that you have to stop making yourself look beautiful.’

Lynn
Being informed, supported and practically prepared may help to make it easier to cope
at this emotional time. The information below aims to help you to manage hair loss.
In this information sheet we aim to answer questions you might have about:


hair loss due to chemotherapy



hair loss due to radiotherapy



things you can do before treatment starts



how you can cope with the hair loss during treatment



looking after your scalp



what to do when your hair starts to grow back



wigs and other headwear



getting support.

Hair loss due to chemotherapy

Why does chemotherapy cause hair loss?

Chemotherapy drugs kill lymphoma cells, but they also affect healthy cells, in
particular cells that are dividing rapidly. Hair loss occurs because chemotherapy
temporarily damages the cells of the hair follicles in the skin and the follicles are
unable to make new hair. Hair loss following chemotherapy is usually only temporary.
When treatment has finished the hair starts to grow back. In a few cases hair can
start to grow back even before treatment has finished.

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Does everyone lose their hair?
Although many chemotherapy drugs used in the treatment of lymphoma cause hair
loss, not everyone will lose their hair. Sometimes hair can thin rather than fall out
completely. Your doctor or nurse should inform you about any possible hair loss before
your treatment starts.

.

Is there anything I can do to prevent hair loss?
If you have been told that your treatment will make your hair fall out, you will be
unable to prevent this from happening. Some treatments may only cause hair thinning
rather than total hair loss. Your medical team will advise you about what is likely to
happen to you.
You may have heard of scalp cooling (the ‘cold cap’), which can be used in order to
try and stop hair falling out. It works by lowering the temperature of the skin around
the hair follicles, which diverts the blood supply carrying the chemotherapy away from
the hair. This is only suitable for use with certain chemotherapy drugs and with certain
types of cancers – it is not recommended for people with haematological cancers
such as lymphoma and leukaemia.

How much hair will I lose?

This will vary. Generally people having chemotherapy will lose all the hair on their head
but some people will only have partial loss and others none at all. Hair can also be lost
from the eyebrows, eyelashes, pubic area and under the arms.
Hair can even be lost from the nose, causing your nose to run. This happens because
the hair is no longer present to stop the mucus coming out. This can be a nuisance
and it may be helpful to carry tissues or a handkerchief.
Some men may lose hair from their beards and moustaches as well as from their
head and many men feel just as anxious as women about losing their hair.
Some people find that their hair falls out evenly whereas for others their loss is patchier.
Hair that is still growing may become dry and dull and the scalp can become tender.

When will it start to fall out?

Hair usually starts to fall out a couple of weeks after treatment has started but this
can sometimes start within the first few days. This can depend upon the type of
treatment you are having. Ask your doctor or nurse for advice. If you want to get a wig
to match your usual style and colour of hair it is important to visit the wig fitter before
your hair falls out as it is easier to get a much closer match. Trying to achieve this once
your hair has gone is much more difficult.
Some people like to take the opportunity to experience new hairstyles and colours
by trying out different wigs. If money allows, it may be possible to buy more than
one wig to enable you to change styles from day to day. People affected by hair loss
are only entitled to one NHS wig for each complete course of chemotherapy. Any
additional wigs must usually be bought at your own expense.

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‘My experience was not to try and match the wig to my own hair as this was
impossible. The best thing to do is to go for a style completely different to your own
that suits you and also gives you a boost.’

Lynn

.

How long will it take to grow back?

The hair can be very fine when it first comes back, but it will probably grow back
to a full head of hair 3–6 months after treatment has finished. Hair regrowth is
very variable between individuals and some people find it takes longer than this to
grow back. On the other hand, a few people experience hair regrowth before their
treatment is even finished.
Sometimes hair can come back finer, curlier or even a different colour. This is normal.
It usually eventually returns to how it was before treatment, but occasionally the new
appearance can be permanent.

Hair loss due to radiotherapy

Why does radiotherapy cause hair loss?

Radiotherapy uses high-energy rays which destroy cancer cells. These are like X-rays
but given in higher doses. The rays of radiotherapy cause changes to the lymphoma
cells, which stops the malignant cells from dividing. However, the radiation can also
stop hair follicle cells from dividing and making hair.

Will I lose all my hair?

Radiotherapy is a treatment which is delivered to a precise area of the body. When
you receive radiotherapy, hair will only be lost from the area of your body which is
being treated. Ask your radiotherapist (the person who gives you your radiotherapy
treatment) for advice.

When will it start to fall out?

Hair loss most commonly occurs towards the end of treatment and then the hair often
falls out quite rapidly.

Can I prevent hair loss from radiotherapy treatment?
You can not prevent hair loss. Your radiotherapist can advise you about what hair
loss to expect. Always discuss the use of any skin or hair-care products with your
radiotherapist.

How long will it take to grow back?

Hair loss following radiotherapy is usually only temporary. On average it takes
6–12 months for hair to grow back after treatment has finished. Sometimes hair will
grow back curly or with a slightly different texture.

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A few people may experience permanent loss of hair in the treated area. This
will depend on the dose of radiotherapy and the risk of this happening should be
explained to you before your treatment starts.

Care of your hair and scalp during and after radiotherapy












It is possible to gently wash your hair but take extra care and avoid rubbing the
scalp near the treated area.

.

Talcum powder can be sprinkled into the hair, left for a while and then brushed
out. The talcum powder will absorb the grease and relieve the scalp tenderness.
Take care to follow any instructions given to you by the radiotherapist, nurse or
doctor about the use of soaps, shampoos and body lotions because these can
cause a skin reaction and make irritation worse.

Looking after your hair and scalp
Before treatment

The following information on managing hair loss and on how best to care for your hair
and scalp applies to people having chemotherapy. Some of the information will also
apply to people having radiotherapy to the head and neck area. If you are unsure how
hair loss will affect you it is important to contact your doctor or nurse.












Long hair can be cut shorter prior to treatment. This will reduce the weight of
the hair pulling on the scalp and might help reduce or slow down the hair loss. It
might also make it easier to cope when the hair starts to fall out.
Men can shave their beards and moustaches before treatment starts to allow
time to adjust to a different look. It can also give you back a sense of control over
what is happening.
Order a wig as soon as possible, ideally before treatment starts. This will allow a
closer match to your natural hair colour. Wigs come in many different styles and
colours. Some people take this opportunity to explore different looks.

‘I discovered that I really suit short hair, so have kept an elfin cut ever since.’

Corrin

Once treatment starts
















Try not to brush or comb your hair too hard. A wide-toothed comb or very soft
baby brush may be more comfortable to use, especially if the scalp is tender.
Try using gentle hair products such as baby shampoo, as these will not cause
the hair to become too dry or irritate the scalp.
Wash your hair using tepid rather than hot water.
Avoid rubbing the hair dry as this will put unnecessary strain on the strands.
Try patting it instead.

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If you are having chemotherapy avoid any chemicals such as those used in hair
dyes and perms. Residual chemicals may still be present in the hair strands
which may react to the treatment you are having for your lymphoma.

Heat can cause hair to become dry and therefore to break. It is best to avoid
using heated rollers, hairdryers, hair straighteners and other hot equipment.
Allow your hair to dry naturally.



.

Do not use elastic bands or rollers in your hair at night, which might damage or
pull on the hair. Plaiting hair can also cause unnecessary strain and break. If you
need to tie hair back it is best to use softer ties such as a scrunchie.







































Try wearing a hairnet or towelling turban at night. This will catch the hairs when
they fall out and keep your head warm.
Rubber gloves can be helpful for removing hair from bedlinen. Some people use
sticky tape to remove smaller amounts.
Losing your eyelashes can make your eyes feel more sensitive. Sunglasses can
provide some protection.
Using make-up can help to boost your confidence. Eyeliner and an eyebrow
pencil can be used effectively to disguise lost eyebrows and lashes.
Avoid using perfumed deodorant as this can irritate the underarm area. Never
use deodorant if the skin is sore or still healing from treatment. Shaving may not
be necessary but it is best avoided.
A wig liner can be used under any headwear (not just wigs) for added comfort.
They are extremely soft and made from 100% cotton. Wig liners can be bought
from Luscious Lids (www.lusciouslids.com) or from other suppliers.
Tying an attractive scarf around your head can keep you warm on cooler days and
protect your scalp from the sun. They can also make a nice change from wearing a
wig or a hat. Scarves need to be at least 50 cm long to be able to cover the scalp.
Turbans are also a popular alternative. They are available in a variety of materials,
including cotton, towelling and velvet.
Some people feel more confident if other people’s attention is drawn away from
their hair and head – make-up, earrings, necklaces and brightly coloured shirts,
tops and ties are ideas to try.

Caring for your scalp

Sometimes your scalp may become sore or irritated. The following tips are for looking
after your scalp during and after treatment:








Wearing a hat can help to protect the scalp from the sun and can retain heat
during cold weather.
A sun-blocking cream is advisable if you are not wearing a hat. This is also the
case if your scalp is exposed in cold weather, as the skin will still be susceptible
to damage from any sunlight as well as from the wind and cold.



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 ● If your scalp is dry, try a mild, unperfumed moisturiser. If you find that your scalp
becomes flaky, moisten some cotton wool with natural oils such as almond oil or
olive oil and gently massage into the scalp.
Avoid frequent washing but, when you do, try using a mild baby shampoo.
Medicated shampoos can irritate the scalp.



.

Aloe vera lotion, gently massaged onto the scalp, is known to have a soothing
effect.















If you notice spots or your scalp feels moist, let your medical team at the
hospital know (you may have an infection).
Use pillowcases made of 100% cotton. Pillowcases made of man-made fibres
can irritate the skin or make you feel hot.
A chilled pillow might help to alleviate irritation of the scalp. These are available
to buy online or by telephone. The Chillow® is quite popular (www.chillow.co.uk
or ring 08700 117 174).

When your hair starts to grow back












The scalp can itch as the hair grows back. Moisturising the scalp and more
frequent shampooing may help to alleviate this.

It is advisable to wait 6–12 months after completing treatment before colouring,
chemically straightening or perming your hair. This is because residual chemotherapy
may still be present in the hair strands and this could react with the chemicals used
in the colouring, straightening and perming processes. Your hairdresser should be
able to advise you about using natural products such as henna or vegetable-based
colourants. Wash-in, wash-out types of hair colour are usually fine, but always check
these with your hairdresser.
Don’t have woven-in hair extensions put in for several months after the hair has
started to grow again because the new hair will still be weak and prone to break
off if put under strain.

Wigs and other headwear
Help with costs

People are often unsure about the financial side of obtaining a wig but many people
are entitled to a free wig on the NHS. Some people may even be entitled to a second
wig after 6 months if necessary.
The Department of Health leaflet HC11, Help with health costs and HC12, A quick guide
to help with health costs will give you more details. You can also find information
about help with the cost of wigs from Macmillan’s booklet Help with the cost of cancer.
Patients who are not entitled to a free NHS wig may still be entitled to a subsidised
wig from the hospital. However, they will need to apply for help with the costs on
a Department of Health HC1 form. All these Department of Health leaflets can be
viewed and downloaded from their website (www.dh.gov.uk), obtained from larger
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post offices or from a clinical nurse specialist or social worker at the hospital.
For those eligible, means-tested Macmillan Patient Grants of up to £500 can be
obtained to purchase a wig and/or headwear. Please call the Macmillan helpline
(contact details on page 9) for further details.

What to expect from your hospital

.

All hospitals have different approaches, procedures and contracts in place. Therefore,
some of the following may not be applicable to every hospital. Always clarify the
financial and practical implications with your hospital or medical centre before making
a decision or a purchase. Here are just a few pointers on what you might expect of
your hospital:


Some hospitals have hair-loss support workers who can demonstrate how to
wear different types of headwear, help with make-up, discuss ideas and tips.

Some hospitals or support groups run hair and beauty programmes (‘Look Good,
Feel better’ or ‘Head Start’). Ask your nurse if your hospital is running such a
programme and, if not, whether there are hair and beauty programmes at a nearby
hospital.















Some hospitals have contracts with local wig companies, where patients can
visit with their prescription forms. It is advisable to check with hospital staff to
see if there are any local arrangements in place. Some wig-fitters visit hospitals
to see people on the ward when needed.
It is important to know which wig companies have contracts with the NHS to
supply wigs on prescription; otherwise wigs may be charged at full price.
Some hospitals reimburse patients for their prescription fees from hospital
funds. Check with your own hospital if this is possible.

Taking care of your wig

‘Wearing a wig is surprisingly comfortable and from my own experience very few
people knew it was a wig. It was so like my own hair. I did not feel that everyone
was looking.’

Pat








Wigs can be made from human or synthetic hair or a mixture of both. Wigs
are very natural-looking and comfortable nowadays and come in a wide variety
of styles. Wigs made of ‘real’ human hair do not necessarily look better than
synthetic ones, and they are more expensive.

It is not necessary to buy special wig products to care for a synthetic wig. A normal
shampoo (or even washing-up liquid) will be fine. Human hair wigs will need more
careful handling and care. Ask your wig fitter about how best to care for your wig.



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Because synthetic wigs are made of plastic bres it is important to keep them
away from sources of heat and steam, such as candles, hobs, ovens and steam
irons. After washing your wig do not dry it near a source of heat – place your wig
on an upturned vase or something similar (in order to keep the shape) and allow
it to dry naturally.

Other headwear
















.

You can usually buy hats and scarves from ordinary department stores. Some
also sell turbans, but these might be easier to obtain from chemists, hospital
shops or specialist wig and headwear suppliers.
Experiment with trying on hats to see what styles suit you. Styles which are
found to be popular are baseball caps, berets, bandanas and woollen hats. Avoid
straw hats as these can be irritating to the scalp.
Not all hats come down low enough to cover where the hairline would normally
be, but you can buy fringes to Velcro into hats and scarves.
Breast Cancer Care has an illustrated section on scarf-tying (‘Great looks with
scarves’) in their booklet, Breast cancer and hair loss. Contact details on page 9.

Support

Losing your hair can be a big blow to your self-image. It can also act as a very
visual reminder that you are undergoing treatment. These things can make you feel
depressed or even angry. Often people feel guilty for having these feelings – believing
that they should be feeling grateful for having the treatment – but they are quite
normal.
Sometimes it is helpful to share these feelings with a relative or friend. Spending time
with people also helps you to build up confidence and makes it easier to adjust to
going out. Your chemotherapy nurses or clinical nurse specialist will be knowledgeable
about hair loss and will understand what you are going through, so you might feel
more comfortable talking to them.
You are welcome to ring the Lymphoma Association helpline (0808 808 5555) to talk
things through. The helpline might also be able to put you in contact with someone
who has experience of lymphoma, either themselves or as a close relative. You
may wish to speak to a ‘buddy’ like this who has experienced hair loss during their
treatment.
‘The whole issue of losing one’s hair is traumatic and it’s difficult to know how
best to prepare people for it, but knowledge of the issues involved will help in
recognising that it is a short-term problem and it does eventually return to ‘normal’.
It is a wonderful feeling to at last be able to remove one’s wig. Being able to
discuss hair loss with people who have already experienced it is very helpful.’

Jill

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Listed next are details of organisations which supply wigs and headwear, some of
which have been suggested by callers to our helpline.
Banbury Hair is a well established wig manufacturer and supplier for the NHS and
private sector. They use real and synthetic hair, offer a wig-fitting service and can
provide information, advice and details of local stockists. A catalogue is available.
Banbury Postiche Limited
Little Bourton House
Southam Road
Banbury
Oxfordshire OX16 1SR
01295 757406
[email protected]
www.banburypostiche.co.uk

.

Raoul is an established manufacturer and supplier for the NHS and private sector.
They use real and synthetic hair and offer a wig-fitting service.
Raoul
34 Craven Road
London W2 3QA
020 7723 6914
[email protected]
www.raoulwigmakers.co.uk

4myhead.com offer a mail-order headwear service aimed at people who have
experienced hair loss through illness.
4myhead.com
346a Farnham Road
Slough
Berkshire SL2 1BT
07505 028 099
www.4myhead.com

Hats 4 Heads offer a mail-order hat service which is targeted at people who are losing
their hair through illness.
Hats 4 Heads
PO Box 407
Altrincham
Cheshire WA15 9WX
0161 941 6748
[email protected]
www.hats4heads.co.uk

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Hair In-X-S staff are specially trained in the application of human and fibre hair
extensions and aftercare. For people with temporary or permanent patchy hair loss.
Hair In-X-S
41 Grenville Close
Burnham
Berkshire SL1 8HQ
 01753 859777 / 859445
www.hairinxs.com

.

Wig Bank offer new and donated wigs for sale and hire. People donate wigs they no
longer need. The wigs are washed, conditioned and sold for between £10 and £20, or
you can hire them for £5.
 01350 728030

[email protected]
www.wigbank.com
Other websites suggested by callers to our helpline:
www.bandanashop.com
www.girlyshop.co.uk
www.lusciouslids.com
www.suburbanturban.co.uk
www.hothair.co.uk
www.alternativelook.co.uk
www.wigstoreuk.co.uk
www.chemochic.co.uk
www.wigs4u.co.uk
www.beautiful-wigs.co.uk
www.wigsonlinestore.com

Some of our callers have suggested using auction sites to buy products, such as eBay.

References

Barraclough J. Cancer and Emotion. 3rd edition. 1999. John Wiley & Sons, Chichester.
Corner J, Bailey C (eds). Cancer Nursing: care in context. 2nd edition. 2008. Blackwell
Publishing, Oxford.
National Institute for Health and Clinical Excellence. Improving Palliative and
Supportive Care for Adults with Cancer. March 2004. NICE, London.

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How we can help you
We provide:
a free helpline providing information and emotional support  0808 808 5555 (9am–6pm
Mondays–Thursdays; 9am–5pm Fridays) or  [email protected]





free information sheets and booklets about lymphoma



a website with forums and a chatroom – www.lymphomas.org.uk





.

the opportunity to be put in touch with others affected by lymphoma through our
buddy scheme
a nationwide network of lymphoma support groups.

How you can help us

We continually strive to improve our information resources for people affected by lymphoma
and we would be interested in any feedback you might have on this article. Please visit
www.lymphomas.org.uk/feedback or email [email protected]
if you have any comments. Alternatively please phone our helpline on 0808 808 5555.

We make every effort to ensure that the information we provide is accurate but it
should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult
your doctor.
The Lymphoma Association cannot accept liability for any loss or damage resulting
from any inaccuracy in this information or third party information such as
information on websites which we link to. Please see
our website (www.lymphomas.org.uk) for more
information about how we produce our information.
© Lymphoma Association
PO Box 386, Aylesbury, Bucks, HP20 2GA
Registered charity no. 1068395
Produced 20.11.2012
Next revision due 2015

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