Treatments for hair loss after cancer

Learn why hair loss can occur in patients receiving cancer treatment, including chemotherapy and radiotherapy, what measures may help reduce it, how likely the hair is to regrow and which treatments may be considered when hair loss persists.

Hair loss is a common adverse effect of some anticancer treatments, particularly certain chemotherapy regimens. Its frequency and severity depend on factors including the type of treatment, dose, combination of medicines and individual patient characteristics.

Cancer treatment-related alopecia can have a considerable psychological and emotional impact and may significantly affect quality of life.

Hair loss can also make the illness more visible to other people, which may add to the emotional burden experienced by some patients.

As Dr Rocío Gil, a member of Grupo Pedro Jaén’s Hair Disorders and Hair Transplant Unit, explains, hair usually begins to regrow after chemotherapy has ended, although persistent hair loss can occur in a minority of patients. When hair loss is a concern during cancer treatment, it is important to discuss it with the oncology team rather than interrupt or modify treatment independently.

Chemotherapy and hair loss: why does it happen?

Many chemotherapy medicines act on rapidly dividing cells. Because cells within actively growing hair follicles also divide rapidly, some chemotherapy treatments can interrupt the normal hair growth cycle. The most typical pattern is known as anagen effluvium.

Hair shedding may begin within days or a few weeks of starting treatment. The scalp is usually the most visibly affected area, although eyebrows, eyelashes, beard hair and body hair can also be affected depending on the treatment. Some patients also experience scalp sensitivity or discomfort during this period.

In most cases, chemotherapy-induced anagen effluvium is temporary and hair begins to regrow after treatment has finished. The new hair may initially differ in colour, texture or curl pattern from the patient’s previous hair. These changes may be temporary or, in some cases, persist.

Some patients choose to cut or shave their hair before or during treatment because they find this gives them greater control over the process. Scarves, hats, wigs and other hair prostheses can also be used according to personal preference.

Does hair grow back after chemotherapy?

In most patients, hair regrowth begins after chemotherapy is completed. However, persistent or permanent chemotherapy-induced alopecia has been described, particularly with some treatment regimens.

The likelihood depends on factors such as:
the specific chemotherapy drugs used;
cumulative dose;
combination with other treatments;
individual susceptibility;
previous or underlying hair disorders.

Persistent alopecia has been particularly associated with some taxane-containing regimens and with certain intensive conditioning treatments used before haematopoietic stem cell transplantation. In some patients treated for breast cancer, endocrine therapy may also contribute to persistent hair thinning. When hair recovery is incomplete several months after treatment, assessment by a dermatologist expert in hair disorders can help determine the pattern of alopecia and whether treatment may be appropriate.

Can chemotherapy-related hair loss be prevented?

Scalp cooling can reduce chemotherapy-induced hair loss in appropriately selected patients receiving certain chemotherapy regimens. The technique involves cooling the scalp before, during and for a period after chemotherapy.

Cooling causes vasoconstriction and reduces metabolic activity within the hair follicles, which can decrease their exposure and susceptibility to some chemotherapy agents. Scalp cooling has been studied particularly extensively in patients receiving chemotherapy for breast cancer, although it is also used in selected patients with other solid tumours.

Its effectiveness varies according to the chemotherapy regimen and individual patient. It does not prevent hair loss in every case. Some people also find the treatment uncomfortable because of the prolonged cold sensation, headache or scalp discomfort. Whether scalp cooling is appropriate should therefore be discussed with the oncology team.

Treatment of persistent hair loss after chemotherapy

When hair density does not recover as expected following chemotherapy, treatment depends on the type and pattern of alopecia and the patient’s general medical and oncological circumstances. Any treatment should be coordinated with the patient’s oncology team where necessary.

Minoxidil

Minoxidil may be considered in selected patients with persistent hair thinning after cancer treatment. Topical formulations are commonly used, while low-dose oral minoxidil may be considered in selected cases following an individual medical assessment. The aim is to support hair growth and improve the calibre or density of existing hairs. Response varies between patients, and oral treatment requires consideration of potential cardiovascular effects and other contraindications.

Antiandrogen treatment in selected patients

Some patients develop a pattern resembling androgenetic alopecia, particularly in association with endocrine treatments for hormone-sensitive cancers. In carefully selected cases, medicines with antiandrogenic activity may be considered. However, their use depends on the type of cancer, ongoing oncological treatment, hormonal status and individual risk profile. For this reason, they should only be prescribed after appropriate assessment and, where necessary, coordination with the oncology team.

Low-level light therapy

Low-level light or laser therapy has been investigated as a treatment for several forms of hair loss. It uses red or near-infrared light intended to influence cellular activity within the hair follicle. Evidence is more established for some forms of androgenetic alopecia than for persistent chemotherapy-induced alopecia. Its role after cancer treatment therefore remains more limited and should be considered on an individual basis.

Microneedling

Microneedling creates controlled microinjuries in the scalp using fine needles. The technique has been studied mainly as an adjunctive treatment in androgenetic alopecia. Evidence for persistent chemotherapy-induced alopecia is much more limited. It should therefore not be considered a standard treatment in every patient following chemotherapy.

Platelet-rich plasma

Platelet-rich plasma (PRP) is prepared from a sample of the patient’s own blood, which is processed to concentrate platelets before being injected into selected areas of the scalp. PRP has been investigated in several forms of alopecia, particularly androgenetic alopecia. However, evidence for its use specifically in persistent chemotherapy-related alopecia remains limited. Although the material is autologous, this does not mean the procedure is completely free from adverse effects. Temporary pain, swelling, bruising or inflammation can occur.

Hair loss associated with endocrine cancer treatment

Some hormone-sensitive cancers, particularly certain breast cancers, are treated with medicines that alter oestrogen signalling. These include selective oestrogen receptor modulators and aromatase inhibitors. In some patients, these treatments can produce diffuse thinning with a pattern similar to androgenetic alopecia.

Typical features may include reduced density over the crown and widening of the central parting. The degree of hair loss varies and does not occur in every patient. Management should be individualised and coordinated with the oncology team so that treatment of hair loss does not interfere with the patient’s cancer therapy.

How can newer cancer treatments affect the hair?

Modern cancer treatment increasingly includes targeted therapies and immunotherapies in addition to conventional chemotherapy.

These medicines act through different biological pathways and therefore have different adverse-effect profiles.

Some cause less diffuse hair loss than traditional cytotoxic chemotherapy, but changes in hair can still occur. Reported effects include:
reduced hair density;
altered growth rate;
changes in hair texture;
changes in curl pattern;
changes in pigmentation.
The frequency and type of change depend strongly on the specific drug. For this reason, the effects of newer anticancer treatments on hair cannot be generalised across all therapies.

Hair loss caused by radiotherapy

Radiotherapy can cause hair loss when the hair-bearing skin lies within the treatment field. Hair loss usually begins several weeks after treatment starts. Whether the hair grows back depends primarily on the total radiation dose, fractionation, treatment area and individual patient factors. At lower doses, regrowth may occur. Higher doses can permanently damage hair follicles and lead to persistent localised alopecia.

When hair loss after radiotherapy is permanent, treatment options depend on the condition of the irradiated scalp and may include cosmetic camouflage or, in carefully selected patients, hair transplantation. Not every irradiated scalp is suitable for transplantation, so assessment of skin quality, vascularity and tissue fibrosis is essential before surgery is considered.

Cosmetic solutions for hair loss after cancer treatment

Some cases of persistent alopecia do not respond sufficiently to medical treatment, while other patients may prefer a non-medical option. A range of cosmetic solutions can help improve the appearance of hair density.

FAS hair integration system

The FAS system is a customised hair integration system designed for patients with significant hair loss.

Natural hair is incorporated into a personalised base manufactured according to the shape and characteristics of the patient’s scalp.

The system is then attached to the scalp and requires regular specialist maintenance. The aim is to reproduce the colour, density and texture of the patient’s hair as naturally as possible.

Grupo Pedro Jaén offers the FAS system as one of the cosmetic options available for selected patients with hair loss.

Wigs, hairpieces, extensions and hair fibres

Other options include full or partial hair prostheses, wigs and hairpieces. Their suitability depends on the pattern and extent of hair loss. Extensions may be appropriate in some cases where sufficient healthy native hair remains, although they should not be used when traction could worsen fragile or thinning hair.

Keratin hair fibres can be applied to areas where native hair is still present. The fibres adhere to existing hair shafts and can temporarily reduce the visibility of the scalp. They do not stimulate hair growth or treat the underlying alopecia.

Micropigmentation
Scalp micropigmentation can create the visual impression of greater hair density by depositing pigment into the skin. Micropigmentation techniques may also be used for eyebrows in selected patients. As with any procedure involving pigment implantation, the indication, timing and condition of the skin should be assessed carefully, particularly in patients who have recently undergone cancer treatment.

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