Chemotherapy Fact Sheet

The word 'chemotherapy' conjures up fear in patients but it should be looked upon as a course of treatment doing good and not harm.

Chemotherapy is a medical term for a course of treatment and is normally a combination of medication given to patients either in tablet form or by injections, which are prescribed by a specialist at a hospital.

While on the course of treatment, changes are taking place within the body. The main change that I deal with on a regular basis is the possibility of diffuse hair loss and in some cases total hair loss, including facial and body hairs.

When your hair starts to fall out

It is usually after the second treatment, but this can vary from patient to patient and the hair loss is normally of a diffuse type. It is important to remember that, once the hair starts to shed, it will not be affected by handling, such as brushing or shampooing although some patient think that, if they do not handle their hair, it will not fall out. In fact this is not the case. This type of diffuse loss means general thinning all over the scalp and body and not in patches. This diffuse hair loss can be upsetting not only to the patient but also their close family and friends and it has been my experience that the older the child in a family where hair loss occurs the more they appear to be affected by the visual effect of the changes with hair thinning and total hair loss. Also at this time the patient may be having feelings of mixed emotions, such as anger, panic fear and trying to keep things as normal as possible when lots of things are going on around them while they are not feeling at their best.

Maintaining scalp cleanliness during hair loss

During the period of shedding it is best to keep the scalp clean by shampooing as normal, as hair may become entangled as it falls away from the hair follicles. Shampooing does not increase the hair loss but makes the scalp feel more comfortable and, when the hair starts to regrow, the scalp is also in the optimum condition. The other reason that the hair or scalp should be shampooed regularly is that, if you decide to wear a hat or wig, then the scalp has a covering of sebum (sweat) and this can leave the surface sore along with an odour.

Many years ago I visited a patient in hospital who would not allow anyone to touch her hair but she was in a lot of pain as the lost hair had become entangled with hair that was still securely anchored within the follicles. I sat and spent an hour or more listening to her concerns with the main one being that she felt that, if her hair was cut, she would never have it back and she would not feel feminine. I explained that she would feel more comfortable and there would be less chance of infection if the hairs that were under tension were removed. She agreed and I cut away the matted hair and fitted a wig, which was then cut and styled to suit her. A few months later, the lady came to see me. Her hair had re-grown and she said that it had really helped to discuss her fears and that the wig helped her through this not only physically but also emotionally difficult period in her life.

The resting phase and regrowth

Whilst on the chemotherapy treatment all the hair is put into its resting phase known as Telogen. Every one, at whatever age, who has hair undergoes this Telogen phase every day with most people losing 50-150 hairs but, due to the medication within the treatment, the hair follicles stay in this resting phase and remain dormant until the time that the course of treatment has been completed. Once you have completed your course of treatment you usually start to see fine white vellous hairs which can resemble soft baby like down approximately within 4-6 weeks.

When the course of treatment is completed, the hair will start to grow back. It is at this point that the hair is fine (vellous) and normally white in colour but very soon, maybe within 4-6 weeks, returns to its natural shade and texture (terminal) as it was before the treatment had commenced and some patients have reported that their hair is better than before their treatment started. Once the hair is in the terminal stage it will take 12 months for the hair to reach the length of 6 inches, as hair grows at ½ inch per month.

Considering a temporary wig

At the hospital you may be advised to consider wearing a wig by either the Doctor or the nursing staff. It is at this point that you may feel that you will never have your own hair back again: this is not so. The hair will re-grow after the course of treatment has been completed. The staff at the hospital may be able to arrange for you to see a wig supplier before you start to lose your hair, and if you are an in-patient there is normally no charge (please ask the Ward Clerk or the Appliance Officer). It is best to consider this as early as possible, as you need time in choosing the right colour and style.

If you are looking for a stock wig there is no difference between the quality of wigs supplied by the NHS provider or those being purchased privately. However, in most cases, the cost is reflected in the aftercare such as alteration, cutting and styling. To have a bespoke (made to measure) wig normally is not covered under the terms of the NHS. but some patients do decide to have custom made wigs along with the monthly fitting and cleaning programme. This must be balanced out with the financial and travel commitments that this type of service offers the individual.

Wigs do look more natural if they are fitted correctly such as having alterations to the foundation, cutting and styling to the individual’s requirements. If you take time to chose the basic style then have it altered to suit you it can be the most uplifting part of your treatment. Not only do you feel and look like you did before but your family and friends can also feel more at ease. Wigs look more natural if they are one shade lighter than your own hair colour, as your skin tone does change whilst under going any intensive medical treatment.

Patients can also consider using the Intralace™ system which at first may act as a wig but as soon as hair starts to regrow, this system will allow full integration with the new hair coming through. This system or a Hair wig would be used until the hair was long enough for a short hair style or patients can consider fine hair extensions to increase their newly re-grown hair length. Hair length needs to be 4 – 5 inches for the successful application of hair extensions.

However some patients are more at ease not wearing a wig. It must be said however that the head can suffer from direct sun light and in the cooler weather feel extremely cold and for this reason then it may be necessary to wear hats, turbans or scarves

Finally, the wearing of Intralace™ system, wigs, hats, turbans or scarves does not stop hair growth. In fact, keeping the head covered and warm encourages hair growth.

If you require any further help or advice please contact Lucinda Ellery Consultancy to arrange a consultation.

Information supplied by
Carol P Walker L.C.G.I. M.I.T. Cert.Ed.
Consultant Trichologist