Chemotherapy / Radiotherapy and Hair loss

Chemotherapy and Radiation Therapy are advantageous cancer fighting treatments.
It is unfortunate that hair losses may sometimes follow.
Please understand that hairloss following chemotherapy is usually temporary
and full recovery will occur.

Radiotherapy may cause permanent hair loss in very small areas -TTS

Chemotherapy (the blood borne cancer treatment) attacks fast growing cells and can therefore cause temporary but sometimes major losses of hairs in their growth cycle (anagen effluvium). Hair thus lost will usually regrow spontaneously once treatment has finished.
Hair losses initiated by chemotherapy usually commence within the first few weeks. Regrowth will initially be of baby fine white hair which will develop into pigmented terminal hair within months. This new hair may develop unfamiliar physical characteristics (e.g. changes in the levels of straightness, waviness etc). These changes are usually temporary.

Each of the many chemotherapeutic drugs (listed below) is capable of initiating a hair loss response ranging from little or no hair-loss to major losses of scalp and body hair. Tolerances and susceptibility to hairloss in patients will vary with individual drugs and some cocktails of drugs. The following is however a guide to the anticipated response:

The drugs (some older) likely to cause hair loss include:

Adriamycin, Actinomycin D (Cosmegen Lyovac), BiCNU, Busulphan (Myleran), Carboplatinum, Cyclophosphamide (Endoxana), Cisplatinum, Cytoxan, Daunorubicin (Cerubidin®, DaunoXome®), Doxorubicin hydrochloride (Adriamycin), Dacarbazine (DTIC-Dome®, Epirubicin (Pharmorubicin®), Etoposide (Eposin®, Etopophos®, Vepesid®, VP-16®), Fludarabine, Idarubicin (Zavedos), Ifosfamide (Mitoxana®), Irinotecan (Campto®), High dose Methotrexate(Matrex®), Mitomycin, Mitoxantrone, Paclitaxel (Taxol®), Streptozocin (Zanosar®), Taxotere, Topotecan (Hycamtin®), Velban, Vindesine (Eldisine®).

The drugs following which hair loss is less common include:

Amsacrine, Busulphan, Cytarabine, Dacarbazine (DTIC-Dome®), 5-Fluorouracil, Liposomal Doxorubicin (Caelyx®, Myocet®), Lomustine, Methotrexate(Matrex®), Temozolomide (Temodal®), Thiotepa, Treosulfan, Vinblastine (Velbe®), Vincristine (Oncovin®), Vinorelbine (Navelbine®), etc.,

The drugs least likely to cause hair loss include:

Altretamine (HMM, Hexalen), Bleomycin, Busulphan (Myleran), Capecitabine (Xeloda), Carmustine, Crisantaspase (Erwinase), Cisplatin, Dacarbazine (DTIC-Dome®), Fludarabine (Fludara®), Gemcitabine (Gemzar®), Hydroxyurea (Hydrea®), Irinotecan(Camptosar, CPT-11), Leustatin, Hydroxyurea (Hydrea®), Mitomycin C, Mercaptopurine (Puri-Nethol®), Methotrexate (Matrex®), Mitomycin (Mitomycin C Kyoma®), Mitoxantrone (Novatrone®, Onkotrone®), Navelbine, Procarbazine, Raltitrexed (Tomudex®), Gemcitabine (Gemzar), Rituxan, Steroids, STI-571, Tegafur-uracil (Uftoral®). Tioguanine /Thioguanine (Lanvis®), Topotecan (Hycamtin).

Hair loss prevention (not always effective). The cold cap cools the scalp surface. At 17°C the subcutaneous tissue temperature will register 20°C.

At this reduced skin temperature, circulation of blood to hair follicles is reduced thus limiting exposure to the high chemotherapy dose during the initial phase of the treatment.
Cooling in this way also reduces the metabolic rate of hairfollicles.

The combined effects may prevent or reduce hair loss.

The Cold Cap treatment commences fifteen minutes prior to the chemotherapy session and is continued for up to 120 minutes after its completion.
Cold Caps are not tolerated well by all patients.
Cold Caps are not successful with all chemotherapy drugs.


The drugs listed above and others may be given in conjunction with radiotherapy to increase the efficacy. Radiotherapy itself may cause diffuse or total hair loss depending upon dosage and frequency of treatment required. It is most usually employed where surgery would be either disfiguring or too dangerous. It is considered an effective treatment.
Radiotherapy may be used in the destruction of deep brain tumours. The radiation is administered through the scalp at two or more points. Small permanently bald patches may result at these points. These may be effectively concealed using hair restoration surgery techniques – later.
General hair losses may follow a course of radiotherapy. Regrowth will usually commence within six- twelve weeks.
Hair recovery following Radiotherapy administered directly to the scalp may take longer. the re-growing hair may exhibit changes in texture, colour, straightness or waviness etc.

Things to do-

Wigs are an ideal acquisition. Consider also specialist headwear (Bandanas turbans etc). See Patient Resources


During the six month period following chemotherapy, organic hairdyes should be avoided due to a potential risk of systemic poisoning. There is also concern over a possible link with exposure to organic hair dyes and bladder cancer.

Be philosophical therefore ! Post-chemotherapy new hair (which may have a displeasing colour) will rarely exceed a length of 6cms within the initial six month period. It is better to endure this, but if necessity demands that your hair is tinted during this period, be sure to use vegetable dyes only (e.g. Henna). The colours available may not be those of choice and the hair may feel different, but they are considered safe.

Remember – hair loss resulting from Chemotherapy treatments is usually temporary.

© B Stevens FTTS Contact the author