Hair loss is a serious concern for 77% of cancer patients about to start treatment [1]. However, that is normally in anticipation of treatment-induced alopecia, not a symptom they are already experiencing. In the vast majority of cases, hair loss is not a sign of cancer, but a side-effect of the treatments and therapies used to cure this condition. Find out everything you need to know about the connection between cancer and alopecia.
This article will set your mind at ease that cancer does not normally cause hair loss. It will also provide all the information you need about the extremely rare cases where alopecia is indeed a symptom of this condition, and the red flags that you need to look out for. Cancer-related hair loss is normally treatment-induced. We will tell you all about the type of alopecia you can expect with common cancer therapies, how you can prevent this side effect and the treatments that work best against it.
Key takeaways
You will be relieved to learn that in the vast majority of cases, hair loss is not a sign of cancer. 95% of all hair loss [2] is caused by androgenetic alopecia, an unsightly but ultimately harmless condition. Other common causes include the autoimmune alopecia areata and the stress-induced telogen effluvium.
Skin cancer is a highly uncommon reason for your hair to fall out. It is the 17th most common type of cancer, and only about 7.7% of cases are localised on the scalp [3]. The majority of these are not the cause of hair loss but rather a consequence, as they appear where the already bald scalp (often as a result of male pattern baldness) is unprotected from UV radiation.
There are also extremely rare situations where certain types of cancer produce metastases on the skin (to be discussed). However, these only occur in 0.7-9% of oncology patients, and only 4% of them develop on the scalp [4].
Hair loss alone is not normally considered a diagnostic criterion for cancer; the possibility is only considered when it is accompanied by other symptoms that point towards a potential malignancy (e.g. specific types of lesions on the scalp, a history of cancer, sudden and inexplicable weight loss, a breast lump, etc).
The main reason why cancer has become culturally associated with alopecia is that its most common treatments, such as chemotherapy, often cause hair loss. Fortunately, in many cases, cancer treatment-induced hair loss is reversible once the treatment is completed.
Thus, it is normally not the cancer itself that leads to hair shedding, but the treatments and therapies used to cure it. That’s because your hair follicles become collateral victims as the medications or radiation used to improve your condition destroy the cancer cells (to be further explored).
These are the most common types of cancer where symptoms can, under exceptional circumstances, include hair loss [4][5]:
However, alopecia is not necessarily a symptom of these conditions; they can (and often do) present without any hair loss.
Hair loss caused by cancer itself, rather than its treatment, is extremely rare. However, when it does occur, it can be of three main kinds, depending on the mechanism that causes the alopecia:
Depending on where the cancer originates, the hair loss it causes can be classified into 2 main categories: primary and secondary alopecia neoplastica [4].
Primary alopecia neoplastica is caused by cancer that grows directly in your scalp [4]. Thus, it is encountered in skin cancers (e.g melanoma) and skin manifestations of certain lymphatic cancers (e.g. cutaneous T cell lymphoma). When the disease develops within the scalp itself, it can, in some cases, make your hair fall off around the cancerous lesion.
When it comes to secondary alopecia neoplastica, the cancer does not originate in the scalp, but in a different organ [4]. As it progresses, it spreads to other parts of the body, including the scalp, causing patches of hair loss. The majority of secondary alopecia neoplastica cases occur in breast cancer (approximately 85%) [4], but it can also rarely accompany other forms of cancer (e.g. colon, cervical, stomach, etc).
In some cases, the cancer does not cause hair loss directly, but it contributes to its occurrence. Thus, it can trigger certain forms of hair loss which also frequently occur in the absence of malignancy, such as [4]:
Symptoms: male pattern baldness usually starts with a receding hairline and temple hair loss, then, if left untreated, it can progress to a growing bald spot on the crown. Female pattern baldness manifests with a widening of the midline parting and a Christmas tree pattern, and if left untreated, it can progress to a bald spot on the top of the head.
Symptoms: diffuse hair thinning (less than 50% of the hair), with no specific pattern or fully bald spots.
Symptoms: round, patchy bald spots, broken hairs that look like exclamation marks, yellow or black dots on the scalp
Symptoms: patches of red, inflamed, itchy plaques over the hair follicles, sometimes accompanied by papules (bumps or fluid-filled sacs) [6].
Symptoms: Smooth bald spots, sometimes accompanied by itching, tenderness, crusting, scaling or redness.
It must be once again emphasised that the vast majority of hair loss is benign. However, should you notice the following symptoms – sometimes a sign of alopecia neoplastica – it is good to see a dermatologist or a trichologist to rule out any serious condition [4][7]:
Even if you are experiencing some of the symptoms above, that does not usually mean you have cancer. Certain common scalp problems (e.g. scalp psoriasis or ringworm) as well as some cancer-unrelated forms of alopecia (e.g. alopecia areata) can share some of them. However, it is still important to make sure that the condition is benign and that you get the right treatment for it.
Treatment-induced alopecia is by far the most common form of cancer-related hair loss. Here are the most commonly used cancer treatments that can cause hair loss, and the reason why that happens:
Researchers have found that, on average, 65% of patients undergoing chemotherapy develop temporary alopecia as a result [4][8]. However, this proportion can differ depending on the specific medications and doses used for treatment.
Chemotherapy-induced hair loss is also known as anagen effluvium, which means that your hair growth cycle is disrupted in the anagen (growth phase) [9]. When your hair follicles are in this phase, they undergo rapid cell division. Chemotherapy medication works by targeting and destroying rapidly dividing cancer cells. However, they cannot tell these cells apart from other, healthy ones that divide similarly fast, so they end up damaging your hair follicles as well.
Chemotherapy hair loss is not normally confined to the scalp; it can also affect other parts of your body covered with hair, such as your eyebrows, beard or chest hair. Moreover, since this treatment is often tough on your body, it can also trigger telogen effluvium (diffuse hair loss) starting 6-8 weeks after treatment [8].
Not all forms of radiotherapy cause hair loss. However, if the radiation is targeted at your head or neck, it can damage the hair follicles that are in the way, leading to alopecia.
Radiotherapy hair loss happens through the same anagen effluvium process that occurs with chemotherapy [4]. Your hair follicles are very sensitive to the ionising radiation used to destroy cancer cells and are also damaged by it.
However, while chemotherapy-induced alopecia affects the entire scalp, radiotherapy is targeted, so hair loss only occurs in the areas where the radiation beam enters and exits. Telogen effluvium can manifest a few months post-treatment as well.
Endocrine therapy works by diminishing the production of certain hormones that cancer cells need to grow and multiply. It is typically used in hormone-sensitive cancers (e.g. breast cancer, prostate cancer, etc.) [10]
This type of treatment can cause or worsen androgenetic alopecia, especially in women. That is because it reduces oestrogen levels in their body, creating an imbalance between their male and female hormones [11]. Androgenetic alopecia occurs as a male hormone called dihydrotestosterone (DHT) binds to hair follicles, making them shrink and stop producing hair. As women’s hormonal makeup shifts towards higher proportions of androgens, they can develop this type of hormonal hair loss.
Medications used in immunotherapy help your own immune system become more effective in fighting cancer cells. However, this can also make it more aggressive with some of your own tissue, especially in people with a history of or a predisposition towards autoimmune disorders. Thus, in about 1-2% of patients [12] who take this kind of treatment, their white blood cells start to attack their hair follicles, triggering alopecia areata.
While the proportion of people affected by this condition is low, it can be persistent when it does occur: a study shows that 31% of the patients in a case series experienced no hair regrowth within 12 months of treatment cessation [13].
Primary alopecia neoplastica, which is caused by cancer on the scalp, may start to develop as the malignant lesions start to form. This means it would be accompanying the cancer from the beginning, as growing malignant cells start destroying the hair follicles around them.
Secondary alopecia neoplastica, however, can take years to develop after the onset of the disease, especially if the cancer is slow-growing and undiagnosed. Studies show it can take between 1 and 15 years for secondary alopecia neoplastica to become visible after first becoming ill [4]. Hair loss is not normally among the earliest or most common symptoms of cancer, and reaching scalp metastases is a lengthy process, unless the disease is very aggressive.
Paraneoplastic alopecia usually takes at least a few weeks to emerge. However, more research is needed on this topic, as it is difficult to make a definite connection between conditions such as telogen effluvium or alopecia areata and underlying cancer.
However, when it comes to hair loss caused by cancer treatments, the onset of alopecia can be more closely observed. Here is how soon you can expect to encounter hair loss after the main types of treatment [4][12][14][15][16][17][18]:
Fortunately, in most cases, cancer-related hair loss does, indeed, grow back after the condition is managed or, respectively, after the treatment is completed. However, how soon you can expect this new hair growth to start depends on many factors.
There is little data about the likelihood and timeline of hair regrowth in alopecia neoplastica, as it happens very rarely. It generally depends on how affected your follicles were by the cancerous lesions. If they were fully destroyed, scarring alopecia would develop, preventing future regrowth. In some cases, this can be corrected with a hair transplant into the scar tissue (though this is not always possible). However, if they were simply damaged, they may be able to heal with treatment, within several months.
If, however, you are experiencing paraneoplastic alopecia, it should often resolve within a predictable timeframe, provided that the triggering factor is removed [4][19]:
The likelihood and speed of your hair growing back after cancer treatment can depend on the following:
Here is an average estimation based on the relevant literature of how soon you can expect your hair to regrow after each of the main types of cancer treatment [4][14][13][18]:
There are some cases where the treatment-induced alopecia can become permanent, leaving patchy regrowth on the scalp. Some of the patients experiencing this can benefit from using hair loss treatments (e.g. Minoxidil) or getting a hair transplant (to be discussed).
Unfortunately, cancer treatment-induced hair loss cannot normally be fully prevented. But with some treatments, such as chemotherapy, its extent and duration can be reduced by taking the following measures:
If you are about to undergo chemotherapy, scalp cooling caps are scientifically proven to be effective in reducing the resulting hair shedding in approximately 61% of breast cancer patients who use them [20]. The amount of hair retention it can provide depends on the types and doses of chemotherapy drugs they are using.
They work by cooling your scalp enough to make the blood vessels inside it constrict. This allows lower quantities of medication to reach your hair follicles. It is applied at least 30 minutes before your chemotherapy session and kept on for another 90 minutes afterwards.
While wearing the cooling cap can be uncomfortable for some patients and may have mild side effects (e.g. headaches, dizziness), it is generally well-tolerated. Only 4% of patients discontinue it due to discomfort [13]. It can also make some users’ hair grow back faster after the treatment is completed [21].
Eating healthy, resting well and quitting smoking are things that cancer patients are advised to do anyway, for the sake of their recovery. However, that can also help strengthen their hair follicles, reduce unnecessary hair loss (e.g. smoking can cause hair loss by reducing blood flow to your hair follicles) and support healthy hair regrowth after treatment cessation.
No, unfortunately, there is no proof that taking Minoxidil can prevent cancer treatment-induced hair loss. Moreover, if you are getting chemotherapy, it is actually contraindicated because of its potential side effects (e.g. lowering blood pressure, irregular heart rhythm) [22] and because it can allow more of the medication in your blood to reach your hair follicles. However, it can help achieve hair regrowth after the treatment is over.
After your treatment is completed, you can help stimulate and hasten your hair regrowth by trying some of the following treatments (however, always get a recommendation from your doctor to make sure they are safe for you to use):
This FDA and MHRA-approved hair loss treatment works by dilating the blood vessels in your scalp, allowing more oxygen and nutrients to reach your hair follicles. This stimulates your hair follicles for growth, giving them the necessary resources to thrive.
Research has shown that topical Minoxidil can speed up hair regrowth in women with chemotherapy-induced alopecia [23][24]. Moreover, one study found that using low-dose oral Minoxidil for 16-24 weeks led to moderate to significant improvement of alopecia in 94.4% of patients who had lost their hair to endocrine treatment [25].
Moreover, Minoxidil is known to help improve alopecia areata and telogen effluvium. So if you develop them as a result of your cancer treatment, this medication can help reduce your hair loss and/or shorten their duration.
Spironolactone works by reducing the levels of male hormones and their effect in women [13]. It is known to reduce hair loss in female pattern baldness. A recent study found that a combination of spironolactone and Minoxidil led to moderate or significant hair loss improvement in 67% of the female participants who had chemotherapy for breast cancer [24]. However, more research is needed to study the effect of spironolactone alone on cancer treatment-induced alopecia.
If you are experiencing persistent post-cancer treatment hair loss that does not improve with medications, you may be a good candidate for a hair transplant [26]. This safe and simple procedure involves harvesting healthy follicles from the back of your head and inserting them in your balding areas.
However, you would need to have enough hair in your donor area to allow for adequate coverage. You would also need to be in a good state of health to safely undergo surgery.
Patients with radiation-induced and endocrine therapy-induced alopecia are often eligible for this procedure. That is because in radiation therapy, the hair loss is rarely extensive, so you would have donor follicles left, while endocrine therapy causes androgenetic alopecia, effectively treated with hair restoration surgery.
Also known as red light therapy for hair growth, low-level laser therapy works by exposing your scalp to focused red or near-infrared light. The light is absorbed and improves blood flow to your hair follicles. It also helps optimise the activity of the cell mitochondria in your scalp, regulating your hair cycle and stimulating your hair follicles for hair growth.
Studies show that low-level laser therapy is effective in treating chemotherapy-induced hair loss [27]. 3 red light therapy sessions per week over 12 weeks were found to improve hair density and quality of life in patients who had undergone this treatment [13]. This therapy can also help improve alopecia areata that can result from immunotherapy [24].
At this time, there is insufficient evidence to show that natural supplements can be effective in treating cancer treatment-induced hair loss [13]. A small study has shown that the topical application of a specific form of Vitamin D (calcitriol) may have reduced alopecia by 50% at week 7 in 8 of the 23 participants. However, this result needs to be confirmed by further studies.
Many other natural supplements, such as caffeine for hair, or essential oils for hair growth (e.g. rosemary oil for hair), nutraceuticals (e.g. Nutrafol for hair), etc., claim to stimulate hair growth. But there are no extensive studies to show their specific effectiveness in treating cancer treatment-induced alopecia.
However, there is one safe and completely free option you can try at home and see if it works for you, even in the absence of specific studies: scalp massages for hair growth. Simply massaging your scalp gently for 10-20 minutes a day has been shown to stimulate hair production and thickness [28]. And if that doesn’t work, it is at least a good relaxation technique.
You may have heard some common misconceptions about the relationship between cancer and hair loss. Here is the truth behind them:
In most cases, the results of a thorough scalp examination and some routine diagnostic trichology tests (e.g. a dermoscopy) are enough to raise concerns with most well-trained trichologists regarding potential cancer-induced hair loss. Moreover, your hair doctor will also ask you about your health history and present symptoms, which will also help point them in the right direction.
Should your trichologist have concerns regarding the nature of your hair loss, they might perform a scalp biopsy. This involves taking a small sample from the affected area of your scalp and having it analysed in a lab. Should the results confirm the presence of cancerous cells, your trichologist will refer you to your GP or to an oncologist for formal diagnosis and treatment.
Hair loss is one of the most frequently cited concerns related to cancer treatment, shared by 77% of patients [1]. Our hair has a significant cultural importance; it is a part of our identity and a source of self-confidence. Losing it can be very distressing, even when it is a side-effect of life-saving treatments. Here are a few healthy ways to manage temporary cancer-related alopecia:
Wigs have come a long way during the past years, and a high-quality hair system has become virtually indistinguishable from your natural hair. You can get them in any colour and texture you want, and they can make you feel closer to your pre-treatment vibe. Here is the ultimate guide to selecting the perfect wig for cancer patients.
If you don’t feel comfortable wearing a wig, there is also a wide variety of scarves, turbans or lovely hats to choose from that can conceal your alopecia. Choosing a variety of colours and patterns can brighten up your day and suit your every mood.
Sometimes, even our nearest and dearest can be lost for words when it comes to cancer survivors and the visible side effects of their treatments. That is not because they don’t care, but more often because they are unsure how you feel about it and are trying to avoid saying the wrong thing, which might make you feel self-conscious. While they think they are protecting you, keeping your alopecia quiet can feel isolating.
Opening up to your friends and family about what hair loss feels like for you can encourage them to show up for you in a meaningful, empathetic way. It can help you get painful emotions off your chest and receive the kind of support you need to get through this tough period.
Grieving your lost hair is not a matter of vanity; it can have deep psychological implications during an already emotionally charged time in your life. A mental health professional can help you navigate this experience and manage the feelings that come with it. Talking to a therapist and/or joining a support group can help improve your confidence and reduce anxiety throughout your treatment process.
If you are experiencing suspicious hair loss or have persistent alopecia after undergoing cancer treatment, you need an experienced trichologist at your side. The dedicated specialists at the Wimpole Clinic are here for you with a state-of-the-art diagnostic toolbox. They will set your mind at ease about the cause of your alopecia and recommend the most effective treatment options.
Should you be eligible for a hair transplant, you can rest easy that you are in the best of hands. The Wimpole Clinic has been voted Hair Transplant Clinic of the Year for 4 years running (2021-2024), thanks to our exceptional surgeons and second-to-none patient-centred care. See some of our results for yourself in our before-and-after hair transplant gallery.
If you would like to find out more about the relationship between cancer and hair loss, the information you need may be among the answers to these frequently asked questions:
No, your hair shafts are not alive; therefore, they cannot develop cancer. You can, at most, develop scalp cancer, which can affect your hair follicles.
Hair loss is a common side effect of chemotherapy. Its presence can show that the medications you receive are interacting with your body and damaging certain rapidly multiplying cells (your hair follicles). However, it cannot predict the effect this treatment has on your cancer cells, which are not identical to your hair follicles and do not respond in the same way.
While scalp lesions rarely turn out to be cancer, the only safe way to know for sure is to see a dermatologist or a scalp and hair doctor. If you notice any concerning symptoms, never hesitate to get them checked out. At best, you get treatment for the benign condition you have, and at worst, you get a chance to treat any more serious illness as soon as possible.
Finasteride cannot treat cancer-related hair loss in men, as it is only effective in improving male pattern baldness. That is because it works by reducing the levels of dihydrotestosterone (DHT) in your blood (the hormone responsible for androgenetic alopecia). None of the common cancer treatments is known to cause male pattern baldness.
Finasteride is generally not recommended to premenopausal women, as it can cause birth defects and hormonal imbalances. And it can be especially unsafe to use this medication if you have hormone-sensitive types of cancer, such as breast cancer.
There are a few documented cases of post-endocrine-treatment alopecia being improved with Dutasteride use [29] (a drug similar to Finasteride, but more potent). However, large-scale studies regarding Finasteride and Dutasteride impact on female hair regrowth after cancer treatments are missing, and expert consensus is that they should not be recommended [30].
Yes, many people develop telogen effluvium after the stress a major surgical intervention places on their bodies. However, unless you are getting post-op cancer treatment that makes your hair fall out (e.g. chemotherapy), you should start to see regrowth 3-4 months after your procedure.
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Dr Mir Malkani MBBS, MISHRS, FRCS, aged 59, is a pioneer and leader in the field of FUE Hair Transplants in the UK. He has performed over 7,000 hair transplant procedures in the last 21 years and is an innovator in FUE surgery due to his extensive experience. In-fact, Dr Malkani is one of the first three FUE surgeons in the UK and has developed modern FUE surgery techniques and is registered with the GMC (4702052). He has been performing FUE surgery since January 2008 and for the last five years almost exclusively performs this technique. Dr Malkani takes a keen interest in every patient and their surgery results. He performs surgical aspects himself thereby ensuring a high standard of work and accountability for each individual patient whilst complying with UK Law.
After achieving a Fellowship of the Royal College of Surgeons in 1997, Dr Malkani had the opportunity to work in a range of specialties in Dublin, London, Sussex and The Midlands. This included Trauma Surgery, General Surgery, Plastic Surgery and Dermatology. Additionally, Dr Malkani has achieved qualifications in General Practice and has been a practising hair transplant Surgeon on a full-time basis since 2004. He worked for the Wimpole Clinic from 2013 to 2016 as a specialist FUE surgeon before setting up his own hair clinic in 2017 which eventually merged with Wimpole Clinic in 2019.
Since 2015 Dr Malkani has become the expert witness for the UK judicial system in order to provide expert medical opinions to the courts for hair transplant medical malpractices in the UK. He has been pivotal in helping the UK courts in improving the quality of hair transplant surgery in the UK and in patients suffering malpractice from poor unregulated work here in the UK. Dr Malkani has performed hair transplant surgery in England, Scotland, Ireland and in Sweden.
Dr Malkani has taken a keen interest in and practised facial aesthetics, body sculpting and hair loss for many years. His surgical qualifications, experience, skills and understanding of facial cosmetology has enabled him to master the most modern and advanced techniques and artistry of FUE hair Surgery. These outstanding skills have helped transform the lives of his male, female and transgender patients. He is one of the few around the world whose transaction rate (damage to grafts during extraction) is extremely low and is under 2%. This ensures a high volume of viable grafts and a good result without compromising the donor area. Dr Malkani is also one of a few surgeons in the UK who can harvest body hair in a hair transplant where there is a depleted donor area.
In 2008, Dr Malkani had the honour to be invited to lecture on The Art and Sciences of Hair Restoration surgery and Hair loss in the annual meeting of the British Association of Cosmetic Doctors at The Royal College of Physicians in London. Dr Malkani has trained others in the specialty of Hair Restoration Surgery in The United Kingdom, Italy and Asia. He has worked on thousands of hair transplant patients over the past 16 years and has kept abreast of constant new developments in the industry.
Membership of professional bodies by Dr Malkani includes full membership of The International Society of Hair Restoration Surgery and The British Association of Cosmetic Doctors and British Medical Association. He has been featured by the national press and BBC as one of the key seniors, versatile hair transplant surgeons in the UK.
GMC Registration No: 4702052
