Chemotherapy and hair loss

Chemotherapy and hair loss: What to expect during treatment

You might not think of your hair's importance in your everyday life until you face losing it. And if you have cancer and are about to undergo chemotherapy, the chance of losing your hair is very real. Both men and women report hair loss as one of the side effects they fear most after being diagnosed with cancer.

Whether or not your hair falls out from your chemotherapy depends mostly on the type and dose of medication you receive. But whether you can maintain a healthy body image after you hair falls out depends a lot on your attitude and the support of your friends and family.

Chemotherapy and hair loss: Why does it occur?

Chemotherapy drugs are powerful medications that attack rapidly growing cancer cells. Unfortunately, these drugs also attack other rapidly growing cells in your body — including those in your hair roots.

Chemotherapy may cause hair loss all over your body — not just on your scalp. Sometimes your eyelash, eyebrow, armpit, pubic and other body hair also fall out. Some chemotherapy drugs are more likely than others to cause hair loss, and different doses can cause anything from a mere thinning to complete baldness. Talk to your doctor or nurse about the medication you'll be taking. Your doctor or nurse can tell you what to expect.

Fortunately, most of the time hair loss from chemotherapy is temporary. You can expect to regrow a full head of hair six months to a year after you stop treatment, though your hair may temporarily be a different shade or texture.

Chemotherapy and hair loss: What should you expect?

Hair usually begins falling out 10 to 14 days after you start treatment. It could fall out very quickly in clumps or gradually. You'll likely notice accumulations of loose hair on your pillow, in your hairbrush or in your shower drain.

Your hair loss will continue throughout your treatment and up to a month afterward. Whether your hair thins or you become completely bald will depend on your treatment. You generally need to lose about 50 percent of your hair before it's noticeable to other people.

It takes about four to six weeks for your hair to recover from chemotherapy. In general, you can expect about a quarter inch of growth each month.

When your hair starts to grow back, it will probably be slightly different from the hair you lost. But the difference is usually temporary. Your new hair might have a different texture or color. It might be curlier than it was before, or it could be gray until the cells that control the pigment in your hair begin functioning again.

Chemotherapy and hair loss: Can hair loss be prevented?

No treatment exists that can guarantee your hair won't fall out during or after chemotherapy. The best way for you to deal with impending hair loss is to plan ahead and focus on making yourself comfortable with your appearance before, during and after your cancer treatment.

 

From MayoClinic.com

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What is male hair loss

What is male hair loss (male pattern baldness/androgenic alopecia)?Male hair loss is the most common type of hair loss. It is caused by increased sensitivity to male sex hormones (androgens) in certain parts of the scalp, and is passed on from generation to generation. In the past, baldness was often seen as something unfortunate or undesirable. However, this attitude has changed over the years and nowadays a clean-shaven head is usually considered both fashionable and attractive. What causes male hair loss?Some men have areas on the scalp that are very sensitive to the male sex hormones that circulate in men's blood. The hormones make the hair follicles - from which hair grows - shrink. Eventually, they become so small that they cannot replace lost hairs. The follicles are still alive, but are no longer able to perform their task. The condition usually starts in men aged 20 to 30 and follows a typical pattern. First, a receding hairline develops, and gradually the hair on top of the head also begins to thin. Eventually, the two balding areas meet to form a typical U-shape around the back and sides of the head. The hair that remains is often finer, and does not grow as quickly as it used to. Can male hair loss be prevented? Male hair loss is genetically determined (passed on from parents). Although a doctor can offer medical treatment to improve the condition, this may have side effects. What can be done at home? You need to decide how you feel about hair loss. Male hair loss affects a large part of the male population and people react very differently to it. It is important to try to accept hair loss for what it is - something natural. Rather than trying to camouflage bald spots with remaining hair or a wig, it is probably a better idea to leave your hair as it is, or shave it off completely. If, however, you decide to try to regain your hair, possible medical treatments are discussed below. How is male hair loss treated? Baldness is generally regarded as natural, and not a disease. So if a person decides they wish to try to get their hair back, they will probably have to pay for the lengthy, expensive procedure themselves.
Treatment with medication Minoxidil lotion (Regaine regular strength or Regaine extra strength) is applied twice daily to the scalp. Minoxidil was originally invented as a treatment for high blood pressure; the hair growth is a side effect that, in this case, has proved useful. It is not available on NHS prescription, but can be purchased over-the-counter. About 60 per cent of patients benefit from it to varying degrees and its effects start to wear off as soon as it is stopped. Finasteride (Propecia) is a medicine taken in tablet form that partially blocks the effects of the male hormones (an 'anti-androgen'). It is used in a higher dose to reduce the size of the prostate gland in men with benign prostatic hypertrophy. Propecia has been shown to halt further hair loss and promote re-growth of scalp hair in approximately 80 per cent of patients after three to six months. Treatment must be continued to sustain the improvement in hair growth. It is only available on private prescription and a months supply costs around £30.Plastic surgeryPlastic surgery may be the only reliable way to replace lost hair, and techniques for restoring hair growth are constantly improving. These include: a transplant, where the surgeon moves non-sensitive hairs from the back of the head to the top. This is best for men whose hair loss is limited to the front of the scalp. Factors that determine whether a person is a suitable candidate include age, hair colour, the nature of hair loss, and whether the hair type is straight or curly. scalp reduction, a technique that is most suitable for men with a small, well-defined bald spot on the top of the head. flap-surgery, which involves making the part of the scalp that still contains hair larger. This is a possibility in cases of hair loss over a small area.Hair loss in womenWomen can also suffer hair loss, especially those with many relatives who are also prone to losing their hair.The female pattern sets in at a later age than in men and is usually limited to the top of the head. Total baldness is rarely seen in women.The only treatment licensed for hair loss in women is Regaine for women.

Based on a text by Dr Flemming Andersen

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Hair Loss in Women

The Causes of Hair Loss in Women

Diffuse Hair Loss

The most common type of hair loss in women occurs in a diffuse pattern. Diffuse hair loss is most often hereditary, but it can also be caused by underlying medical conditions, medications, and other factors.

Common or "hereditary" baldness in women, also called female pattern alopecia, is genetic and can come either the mother’s or father’s side of the family. It is caused by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-a reductase (which is found in both women and men).

The action of 5-a reductase is the main cause of androgenetic alopecia in men, as this enzyme converts the hormone testosterone to DHT. DHT is responsible for the miniaturization (shrinking) and gradual disappearance of affected hair follicles.

Women have half the amount of 5-a reductase compared to men, but have higher levels of the enzyme aromatase, especially at their frontal hairline. Aromatase is responsible for the formation of the female hormones estrone and estradiol. It also decreases the formation of DHT. Its presence in women may help to explain why the presentation of female hair loss is so different than in males, particularly with respect to the preservation of the frontal hairline. It may also explain why women have a poor response to the drug finasteride (Propecia), a medication widely used to treat hair loss in men that works by blocking the formation of DHT.

Women’s hair seems to be particularly sensitive to underlying medical conditions. Since "systemic" problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, be properly evaluated. Medical conditions that produce a diffuse pattern include:

Medical conditions that can cause diffuse hair loss in women
• Obstetric and gynecologic conditions such as post-partum and post-menopausal states or ovarian tumors
• Anemia – iron deficiency
• Thyroid disease
• Connective tissue diseases such as Lupus
• Nutritional - crash diets, bulimia, protein/calorie deficiency, essential fatty acid or zinc deficiency, malabsorbtion, hypervitaminosis A
• Stress – surgical procedures, general anesthesia, and severe emotional problems

A relatively large number of drugs can cause “telogen effluvium,” a condition where hair is shifted into a resting stage and then several months later shed. Fortunately, this shedding is reversible if the medication is stopped, but the reaction can be confused with genetic female hair loss if not properly diagnosed. Chemotherapy causes a diffuse type of hair loss called “anagen effluvium” that can be very extensive, but often reversible when the medication is stopped.

Drugs that can cause diffuse hair loss in women
1. Blood thinners (anti-coagulants), such as warfarin and heparin
2. Seizure medication, most commonly dilantin
3. Medication for gout, colchicines and alopurinol (Xyloprim)
4. Blood pressure medication, particularly the b-blockers (such as Inderal) or diuretics
5. Anti-inflammatory drugs such as prednisone
6. Medications that lower cholesterol and other lipids
7. Mood altering drugs - lithium, tri-cyclics, Elavil, Prozac
8. Chemotherapy
9. Thyroid medications
10. Oral contraceptive agents, particularly those high in progestins
11. Misc. – diet pills, high doses of Vitamin A, street drugs (cocaine)

Localized Hair Loss

Although there are a host of dermatologic conditions that cause hair loss, they produce a pattern that is different from the diffuse pattern of genetic hair loss commonly seen in women and are easily differentiated from it by a dermatologist.

Localized hair loss in women may be sub-divided into scarring and non-scarring types. Alopecia Areata is a genetic, auto-immune disease that typifies the non-scarring type. It manifests with the sudden onset of discrete round patches of hair loss associated with normal skin. It can be treated with local injections of steroids.

Scarring Alopecia can be caused by a variety of medical or dermatologic conditions such as Lupus, Lichen Planus, or local radiation therapy. Hair loss from injuries, or from local medical problems that have been cured, are usually amenable to hair transplantation. Radiotherapy can cause both scarring and non-scarring localized hair loss and it also can be treated with surgical hair restoration if the area is not too large.

Localized female hair loss that occurs around the hairline after face-lift surgery may be permanent. Traction Alopecia, the hair loss that occurs with constant tugging on the follicles, can also be permanent if the habit persists for a long period of time. Both of these conditions can be treated with hair transplantation.

Patterned Hair Loss

Women with this type of hair loss have a pattern similar to what we observe in men. In other words, they have thinning in front or on top of their scalp with preservation of the hair in the permanent zone around the back and sides of the scalp. Thus, the balding is in a characteristic "pattern" rather than generalized. Women with patterned hair loss and a stable donor area may be excellent candidates for surgical restoration.

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