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What can you do when chemotherapy causes hair loss?

Losing your hair is a very visible sign that you have had cancer and its impact on your appearance can be devastating. In fact women often say that, on diagnosis, the thought of losing their hair was far more worrying than the loss of their breast and many are prepared to go to great lengths to preserve it. We talk to readers about how they struggled to keep their hair on and look at the alternatives for those who can’t. 

For most women diagnosed with breast cancer, chemotherapy will form part of their treatment. Usually administered intravenously, chemotherapy drugs destroy cancer cells by attacking them and disrupting their growth. Unfortunately the drugs can also affect healthy cells, including those of the hair follicles. Not all chemotherapy drugs make your hair fall out; however, some drugs cause partial or total loss on the scalp and some also affect body hair such as eyebrows, eyelashes, leg, underarm and pubic hair. While the latter three are probably welcome reductions to most women’s stock of productive hair follicles, we live in a society where appearances matter very much, and a healthy head of hair, whatever your age, is an important part of your image – affecting not just the way others see you, but also the way you see and feel about yourself. 

We’ve all had bad hair days. Most of us can recall the total embarrassment caused by a scissor-happy hairdresser taking off that bit too much, a new colour that seemed like a good idea at the time, or an ill-advised perm that would put a poodle to shame. Such beauty bungles make you want to wear a sign saying: “I don’t usually look like this!” So while it’s a look that can just about be pulled off by the young and pretty (remember singer Sinead O’Connor and presenter Gail Porter?) the thought of walking around with just a few faint wisps of hair, or without any hair at all, is horrific to most women. “It’s like wearing a sign saying ‘I’ve got cancer’,” says Debbie Francis, who lost most of her hair during her breast cancer treatment in 2009. 

If your treatment includes epirubicin, Docetaxel (taxotere), Taxol (paclitaxel) or cyclophosphamide, amongst others, you are probably facing a certain amount of hair loss. Your healthcare team will tell you what to expect – sometimes the effect is just a slight thinning of your hair, but some drugs cause it to fall out very rapidly after the first treatment, which can be particularly distressing as it gives you no time at all to adjust to your new appearance. 

Hair today 

So what options do you have if you’re likely to lose some or all of your hair? Many women decide to try and prevent or minimise hair loss, and that means scalp cooling, or the ‘cold cap’. Cooling the scalp causes the blood capillaries that feed the scalp to constrict, which minimises blood flow, thus restricting the amount of chemotherapy drug that can reach the scalp – and the hair follicles – while you are receiving your treatment.While some hospitals don’t have the facility to offer scalp cooling, most do these days, and you are quite within your rights to insist on it as part of your treatment. There are two main types – one uses a hat known as a cold cap, which is filled with gel that can be chilled, while the other is based on a refrigerated cooling system that pumps liquid coolant into a cap while you wear it. If you’re considering one, it’s worth talking to other women who have tried it, although it’s important to bear in mind that everyone’s experience will be slightly different. After all, for some women a bikini wax is nothing, while for others it’s agony! Gel-filled cold caps can be applied easily and are kept in place by Velcro. The cap can be very uncomfortable and heavy, as well as being extremely cold, and may give you a headache. It also needs to be changed every 20–40 minutes to keep your scalp cool. Caps attached to the cooling system generally feel lighter but can be restrictive, as you will need to sit by the machine while the cap is in place. However, it can be disconnected for short periods if necessary, for example if you need to pop to the loo. 

Both methods need to be worn for some time before and after the chemotherapy drugs are given, which means that each chemo session will last longer and you may have the cap on for a few hours each time. This is a tough call if, like so many of us, you hate being cold, but you will be offered blankets and hot drinks. Many women say they took some music, a book or a game to help pass the time and take their minds off the big freeze. 

Chilling out 

The big question is: does it do the job? To which we would probably answer: that depends on your perspective, your attitude and your expectations. When we asked readers to tell us whether the cold cap worked for them, we expected a range of responses from “Absolutely!” to “Definitely not!” In fact, everyone who wrote to us – and there were lots of letters and emails on this particular topic – said that it had indeed worked for them. What’s important here is how these women defined success. Some lost hardly any of their hair and were able to carry on as normal. Several found their hair became much finer but they were OK with that, while others said they preserved just enough hair to have something showing around the edges of a headscarf which, for them, still meant a positive result. 

Giggling through 

When Ginger Corbett was diagnosed in 2005, a French friend advised her to use the cold cap during her chemo. “She said ‘It’s excruciating but it works, and it’s great for your self-esteem’.” Ginger had her jaw-length hair cut quite short before chemo, as the nurses advised that this was a good way to ensure success with the cold cap: “I had a pixie cut and I really rather liked it,” she remembers. She coped with her sessions by taking a friend and a Scrabble set along with her when possible: “We’d usually get through a couple of games.” Going solo on one occasion, she giggled her way through chemo by watching Some Like It Hot on a portable DVD player. “Despite the cold, I couldn’t stop laughing – I think everyone else wondered what was going on.” Ginger was delighted with the success of the cold cap: “I did keep my hair. It got a little bit thinner, but I never needed to wear the scarves and hats that I’d bought just in case. I managed to keep the colour, too. I discovered a fabulous natural dye and my hairdresser put it on for me. I never really found the cold cap unbearable – it is pretty awful but you simply get on with it. I was just so happy that I wasn’t losing my hair.” Would she use it again? “Yes, definitely. While chemo gave me a free and painless Brazilian, the hair on my head stayed in place!” 

Facing the pain

Carol Marsh was desperate not to lose her hair so, despite warnings from the nurses that it could be pretty uncomfortable, she decided to give the cold cap a go. “I have to say that the first experience was worse than I had imagined,” she says. “The extreme cold just isn’t something you can be prepared for. After just a few minutes, you are grinding your teeth and asking yourself how you will be able to do it for another two hours!” After the first treatment, she did notice some hair loss but for at least a couple of months it was presentable enough for her to go out without a wig or scarf. “I would put on a big headband when playing tennis, which worked well for a while.” Carol bought a wig before she started chemo, visiting Selfridge’s in London with her daughter to find the ideal style and asking her hairdresser to trim it. “Somewhere between the second and third session I started using the wig,” she says. “And it was then that I decided there was little point in enduring more sessions with the cold cap. I knew I had enough hair loss that I would have to continue to wear my wig, which I got on really well with. So I thought, ‘why put myself through this?’ I do think it helped reduce the amount of hair that I lost, but I realised I needed what strength I had to help me with other aspects of my treatment and recovery.” 

Thinking ahead 

Whether the thought of the cold cap is unbearable or you find it doesn’t work for you, there are alternatives to disguise hair loss, such as scarves and hats and, of course, wigs. It’s probably a good idea to get yourself a wig at the start of your chemo, even if you do plan to try scalp cooling. When you are coping with the rigours of treatment, knowing that you can reach out for something that will instantly make you look like ‘you’ again is a comfort, and you might even come to love the ease and flexibility that wigs can offer. Donna Cunningham invested in a lovely real hair wig that looked similar to her own long, thick hair before her treatment started. “My hair did start falling out about ten days after my first session,” she says, “so I decided to take matters into my own hands.” While embracing the use of her wig whenever she wanted to look like the Donna of old, she and her boyfriend also decided to have some fun styling her own hair in ways that Donna would never have considered before. “Instead of just going for the whole chop in one go, I thought it was a perfect opportunity to try out different styles. Over a series of weeks I went from long to mid-length hair, then with a fringe to a short cropped fringe, then a bob, right the way through to a Mohican and Mohawk look. Throughout the process we took lots of pictures and it really made me feel better.” Donna actually enjoyed the experience of cutting her own hair and trying different styles: “I still have all the pictures and, now my treatment has finished and my hair is just about starting to grow back, it’s nice to look at them and visualise what styles I might have in the next 12 months or so. I found it a positive experience – it took away all my fear and dread of losing my hair. Perhaps other women in the same situation could think about taking this route instead of just shaving it all off in one go.” 

Another reader with lustrous long hair was Rosie Carter, who decided to embrace the art of scarf tying as a proactive way of confronting the spectre of hair loss. With the help of some Moroccan friends, who showed her a myriad of creative ways to tie scarves and turbans, Rosie not only came to love her new look, she also documented her discoveries in order to pass her experiences on to other women. The results, a step-by-step guide to scarf tying, and some great tips on coping with the effects of chemo, have already been used to help women at her local hospital. “When I found out I needed chemotherapy, it was probably the worst morning of my life,” says Rosie. “I was given a leaflet on hair loss that didn’t help at all. The scarf styles and the women’s faces were sketched. What I needed to see was a woman – not a model, but a real woman who understood how I felt, through her own personal experience – modelling the scarves. It wasn’t planned, but I became that woman, for other women.” 

Scarves to go

Pre-tied head scarves are an elegant and easy solution for women on the go, and Amoena’s are exceptionally comfortable to wear because there are no side seams to chafe against the skin. “Women often worry that wigs and scarves will make them feel too hot, particularly if chemo brings on flushes, but Amoena’s range of head scarves is made from breathable fabrics like silk and cotton that help prevent heat build-up,” explains Rhoda White, Amoena’s marketing manager. “Fit is also important if you are hiding hair loss – particularly if there is little or no hair to clip the scarf to for security. Look for scarves with additional stretch, because they will stay in place. Amoena’s also have a little extra material back and front, providing better coverage and a more secure fit than ordinary scarves. They also have light padding at the front to add volume, which helps create a more natural look.” The range includes plain, print and embroidered styles in stand-out brights and blend-in neutrals, some with long ties that can be arranged in a variety of ways, together with hats and caps that are great for cooler days. 

Here tomorrow 

Even though it can be devastating (after all, stylists refer to hair as ‘the outfit you never take off’, which is all very well until chemo does it for you!), hair loss is only temporary and many readers have told us that their hair got a new lease of life post-chemo, sometimes coming back thicker and better than before. So whether you decide to brave the cold cap (or ‘ice cap’ as Ginger Corbett memorably called it) or adapt your look with headwear or wigs, there are some creative ways of getting through this uncomfortable period and, who knows, you might even find a new look that you love! 

Raising an eyebrow

One option for women who lose their eyebrows as a result of chemo is to have them tattooed on while they wait for their own to grow back. We asked Sharon Morrison, author of Even The Eyebrows?, to tell us about her experience and pass on some top tips, while Diane Pyle explains why she couldn’t quite bring herself to face the needle.

Even the eyebrows? 

In 2004 I underwent chemotherapy for breast cancer and, like most women on my type of drugs, lost my hair, eyebrows, eyelashes, the lot. Everything grew back of course, although the eyebrows were a bit of a let-down. In2009 I found out that I had breast cancer again, so it was chemotherapy once more and, when the treatment finished earlier last year, I knew it wouldn’t be too long before I started to look like me again. Well my hair and my eyelashes returned, but four months later my eyebrows still refused. You don’t realise how important eyebrows are until they’re gone. They help to shape your face, give it warmth and allow you to show concern. Without them you can also look quite hard. I became quite expert at putting on my eyebrows every day but often, especially in hot weather, I’d get home with one-and-a-half eyebrows, and sometimes just half; it wasn’t a good look. I already knew, from seeing music videos of Michael Jackson as well as some of the girls in the Big Brother house, that tattoos were used effectively as semi-permanent make-up, and I decided this was now probably the only option open to me. But I didn’t want to look as though I’d been ‘done’, I wanted to look as natural as possible. So here’s what I did: 

1. Do the research 

Like most people, I trust personal recommendation above everything, but what do you do if no one you know has had their eyebrows tattooed on? Yup, I had to resort to Google, but it was impossible to make an informed decision, so I called some beauty editors and asked their opinion. The result was unanimous and I was directed to a lady called Debra Robson-Lawrence. 

2. Have a chat

Once I’d contacted Debra’s office a technician phoned to have a pre-consultation consultation. This was a friendly, reassuring chat about the treatment and what could be achieved and to manage my expectations. Then a date was fixed to discuss my treatment plan with my chosen technician (Debra in my case) and have a ‘trial run’. 

3. Decide on the ‘look’ 

I turned up at the Harley Street offices, wearing my usual make-up as requested. Debra studied my eyebrows and suggested that a different shape might work better and could she show me? First she used a ruler to take measurements from both sides of each eye up to my brow line; then with an eyebrow pencil sharpened to within an inch of its life, she drew in each hair with light, deft strokes. After only a few minutes she asked me to look in the mirror and I was amazed. By creating a brow line slightly above my natural line she was able to achieve a more-awake, open look. We discussed where we might make changes, but in the end I couldn’t fault her design; we agreed a date for the tattoo. 

4. Get tattooed 

Two weeks later I was back in Harley Street having an anaesthetic cream applied to my eyebrow area. Debra double checked that I was still happy with the shape and colour, retook the measurements and began work. I’ve never had a tattoo and was expecting to feel some discomfort, but I hardly felt anything other than a little heat now and then, and it took about 25 minutes max. I took a look in the mirror with Debra and agreed where tweaks should be made. Once done I was back on the tube, heading home, but not before I’d taken out my mirror in the middle of Harley Street and had another long look. My eyebrows were darker than expected because the skin beneath the tattoo was red from the treatment, but I quite liked that, and the shape was perfect. 

5. A two-stage process

I always knew the full effect of the tattoo wouldn’t be seen until after a second treatment. Some of the pigment used in the tattoo will flake away naturally with the top layer of skin and the overall look becomes softer and more natural. After a month a touch up is needed to deepen the colour, if that’s what you want, and fi ll in any gaps.How long the tattoo lasts depends on your skin type but in another six to 12 months I should have a colour boost to refresh them, but right now I don’t even need to touch them. At around £300 an eyebrow it’s not cheap, but for me it’s an investment I’d happily make again. 

Too highbrow for words? 

For Diane Pyle, eyebrow tattooing seemed fraught with danger. Here’s her lament of the browless woman who has to resort to the pencil each morning before she can face the world! “With millions of women, I belong to a club that I didn’t join of my own accord. I have joined the band of women (and men) who have had – and thankfully, so far, survived – cancer. That’s fine, we can cope with our ‘membership’, along with, in the case of breast cancer, my particular club activity, the add-ons such as adhesive breasts (what wonderful things those are, girls!), the thinning hair, the stretched girth (where did that come from?) and other little inconveniences. 

But oh! How I mourn the passing of my eyebrows. Let’s be clear here – they were never going to win prizes, not even in my youth. No Audrey Hepburn or Keira Knightley brows for me. No, mine have always been thin and spindly, bushy only where they should have been non-existent. But now, well, what a face looks back at me first thing in the morning. Expressionless, save for a wry inward realization that from now on, as I’m in my late-sixties, it can only get a little more disheartening face-wise on a daily basis. What can be done for the browless? It sounds like the beginning of a plaintive song. Someone, somewhere offer some guidance! I tried petroleum jelly massaged in nightly. No effect. I tried vitamins – still no wisps of brow to be seen. Penciled brows are mine now, unless someone invents an instant remedy. I have discovered that there are eyebrow tattooists, but I have ruled that solution out. Too risky, if you don’t get expert help; too expensive for most ladies, and you could end up looking surprised for life. So it’s back to the mirror for me. I’ll splash with perfume, put on some lip gloss and when I’ve got some eyebrows on I can face the world.”