Chemotherapy and Hair Loss | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network
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JAMA Patient Page
February 14, 2017

Chemotherapy and Hair Loss

JAMA. 2017;317(6):656. doi:10.1001/jama.2016.21266

Chemotherapy drugs are used to treat various types of cancer, and hair loss is a common and usually temporary side effect of many of these drugs.

Chemotherapy, or chemo, is a term describing drugs that are designed to slow or block cell growth. Chemotherapy is often used in the treatment of cancer. It can cause side effects including fatigue, nausea and vomiting, hair loss, and decreases in blood cells. Previous JAMA Patient Pages provide an overview of chemotherapy drugs and common side effects. This JAMA Patient Page focuses specifically on the side effect of hair loss, also called alopecia.

Signs and Symptoms

Hair loss associated with chemotherapy mostly affects the hair on the scalp but can also affect the eyelashes, eyebrows, armpit hair, pubic hair, and hair on other areas of the body. Hair loss usually starts 1 to 4 weeks after starting chemotherapy. The amount of hair loss can range from hair thinning to complete baldness. Often, people notice their hair falling out in clumps when combing or washing it.

Some people have scalp pain, itching, or tenderness when their hair begins to fall out. In addition to this physical discomfort, hair loss associated with chemotherapy can be emotionally distressing.


Cancer cells are abnormal cells that grow and spread quickly, and chemotherapy is designed to target these cells. However, in addition to killing cancer cells, chemotherapy can also harm normal cells of the body that grow quickly, including the cells that produce hair.

Prevention and Treatment

It is best to plan for the possibility of hair loss before starting chemotherapy. Some people choose to wear a wig, and it is easiest to match the wig to your hair color and texture if it is obtained before starting chemotherapy.

Scalp cooling, or scalp hypothermia, during chemotherapy may help prevent or reduce the amount of hair loss. Two articles in the February 14, 2017, issue of JAMA describe the use of scalp cooling in women with early-stage breast cancer receiving certain types of chemotherapy. In both studies, scalp cooling was associated with less hair loss. It was unclear whether women who received scalp cooling experienced improvements in their quality of life, and additional studies of scalp cooling over longer periods are needed.

It is important to use sunscreen or wear a hat or head covering to protect the scalp from sunburn. Similarly, if the scalp is exposed to cold air, a hat or scarf can help provide protection.

Usually, hair will begin to grow back several months after the chemotherapy is stopped. Sometimes the hair does not grow back fully, and it may have a different texture or color when it does. As the hair begins to grow back, it will be fragile, so it is important to continue to be gentle with your hair and avoid treatments with harsh chemicals or products.

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Article Information

Sources: Mayo Clinic, American Cancer Society

Nangia J, Wang T, Osborne C, et al. Effect of a scalp cooling device on alopecia in women undergoing chemotherapy for breast cancer: the SCALP randomized clinical trial. JAMA. doi:10.1001/jama.2016.20939

Rugo HS, Klein P, Melin SA, et al. Effect of a scalp cooling device on alopecia following chemotherapy for early-stage breast cancer. JAMA. doi:10.1001/jama.2016.21038

Topic: Oncology