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JAMA Oncology Patient Page
August 2017

Chemotherapy-Induced Hair Loss (Alopecia)

Author Affiliations
  • 1Swedish Cancer Institute, Seattle, Washington
JAMA Oncol. 2017;3(8):1147. doi:10.1001/jamaoncol.2017.1026

Hair loss (alopecia) associated with chemotherapy and other cancer treatments is one of the adverse effects most commonly associated with cancer treatment and may be an especially dreaded marker of status as a cancer patient.

Why Does Chemotherapy-Induced Hair Loss Occur?

Not all cancer treatments cause hair loss, which may be total or partial and may include areas all over the body. Chemotherapy generally acts by interfering with the more rapidly dividing cells of the body, including not only cancer cells but also hair follicles. Though chemotherapy is a common cause of hair loss, some chemotherapy agents routinely cause hair loss that is usually complete, while others far more rarely cause hair loss.

When Does Chemotherapy-Induced Hair Loss Occur?

Though the timing depends in part on the particular treatment, hair loss commonly occurs several weeks after the start of treatment and may continue to progress gradually over 1 to 2 months. After chemotherapy is completed, hair commonly grows back, though occasionally with a different texture and/or color than a patient had previously. In a minority of patients, hair may not regrow.

Can Hair Loss Be Prevented?

In some cases, an oncologist may be able to develop an alternative regimen of chemotherapy drugs or different schedule that is associated with a lower risk of substantial hair loss. Alternatives may be associated with lower efficacy and/or different adverse effects, but it is always appropriate to discuss your personal priorities with your oncologist to fully explore the benefits and risks of all of the treatment alternatives.

One way to reduce the risk of hair loss is for a patient to wear a “cold cap” over the head that keeps the scalp cold with packed ice or by circulating a coolant over the scalp while chemotherapy is being administered. Cooling the scalp leads to constriction of the blood vessels, reducing blood flow and circulation of chemotherapy to the hair follicles in the scalp in the process. Though a cold cap does not prevent hair loss for all patients and may work more effectively with some chemotherapy regimens than for others, it reduces or prevents hair loss for many patients who use one. Some patients develop a headache or “brain freeze” as an adverse effect while using a cold cap.

Coping With Hair Loss

Discussing anticipated or possible hair loss with friends or family may reduce the emotional toll. For those patients who are losing hair, cutting short or shaving rather than losing large clumps of hair less predictably can provide a greater sense of control and make it easier to wear a wig, if desired. Choosing to wear head coverings, whether scarves, hats, or wigs, until hair grows back is a personal decision. Some insurance companies will cover wigs or hairpieces, which are considered a tax-deductible medical expense.

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Section Editor: Howard (Jack) West, MD.
The JAMA Oncology Patient Page is a public service of JAMA Oncology. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA Oncology suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call (312) 464-0776.
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Article Information

Corresponding Author: Howard (Jack) West, MD, Swedish Cancer Institute, 1221 Madison St, Ste 200, Seattle, WA 98104 (Howard.West@swedish.org).

Published Online: May 25, 2017. doi:10.1001/jamaoncol.2017.1026

Conflict of Interest Disclosures: None reported.