More than 50% of cancer patients are treated with radiotherapy [1], as this treatment can help reduce the size of tumours and delay disease progression with limited damage to surrounding healthy tissue.
However, some such collateral tissue damage cannot be avoided. Hair follicles are especially sensitive to radiation, so radiotherapy does tend to cause hair loss [2]. But since this treatment only affects a limited area of your body, your scalp and/or facial hair could only fall out if you are receiving radiation to your head and neck.
In some patients, radiotherapy hair loss is temporary and leads to full regrowth a few months post-treatment. However, in others, this type of alopecia can take longer to treat or even become permanent [3]. This article will tell you all you need to know about radiotherapy-induced hair shedding, such as:
Radiotherapy is a medical treatment used primarily to treat cancer (though it can sometimes be prescribed to treat other conditions, such as benign tumours or vascular malformations). It uses a specific kind of high-energy radiation (ionising radiation) to attack and destroy tumour cells by breaking some of their DNA molecules. This causes severe and often irreparable damage to the cells and prevents them from growing and dividing [4][5]. Cell death often starts within days or weeks of treatment and can last for months after the end of the radiotherapy course.
There are two main kinds of radiotherapy that can be used, depending on the type of cancer, the size and location of the tumours and the patient’s medical history. It can be:
Radiotherapy can be a standalone treatment or accompany other therapies, such as chemotherapy, for enhanced results. However, unlike chemotherapy, which involves systemic medication that can affect your entire body, radiotherapy mostly affects the part of the body it targets. This means it can have fewer systemic side effects.
However, there are still many adverse reactions associated with this treatment. Depending on the radiation dose and treatment duration, radiotherapy can cause a variety of side effects, depending on the part of the body it is directed at.
For example, when targeting tumours in your head and neck, it can cause fatigue, mouth ulcers, skin changes, taste changes, throat problems, scalp dermatitis and hair loss [6]. But these side effects may be a small price to pay, considering that 75% of patients getting radiotherapy for head and neck cancers benefit from this treatment. It can even avoid the need for surgery if performed in the early stages of the disease [7].
Radiotherapy will often cause scalp and/or facial hair loss in patients receiving treatment for head and neck tumours. It can also cause localised body hair loss in those getting it on other parts of the body. That is because it targets rapidly dividing cells, which are found in cancer tumours, but also in your hair follicles. Follicle cells are very sensitive to the ionising radiation used for this treatment, so they can easily get destroyed, triggering a process called anagen effluvium [2].
Since radiotherapy is targeted, alopecia doesn’t always affect your entire scalp, as it would with chemotherapy. It may only affect the portion of your head hit directly by the radiation beam (and in some cases, the opposite side, where the beam exits your head after it passes through).
While in most patients, radiotherapy hair loss is temporary, it can also sometimes become permanent [2]. The likelihood of your hair growing back after falling out as a result of this treatment depends on several factors. The most significant is the dose of radiation that your scalp has been exposed to.
Lower doses of radiation give your hair follicles a chance to heal over time and repair the DNA damage they have suffered. However, higher doses have an increased chance of causing permanent hair loss.
Other factors that can influence this process are treatment duration, your hair follicles’ sensitivity to radiation, your genes, your medical history, and the presence of another type of alopecia (e.g. male pattern baldness or female pattern baldness).
In most cases, patients begin to experience hair shedding 2-3 weeks into their radiotherapy process. They may also develop scalp dermatitis in response to tissue inflammation, or their symptoms may worsen if they already have it [2].
However, this can vary from one patient to another, depending on the radiation dose, treatment duration, and individual genetic and biophysical characteristics. Some may see the first signs of hair thinning and balding within just a few days after starting treatment, while for others, it can take over a month.
If your radiotherapy-induced hair loss is temporary, you can expect to start seeing regrowth 2-3 months after treatment completion [2]. However, if you are receiving other treatments during this time, such as chemotherapy, or other medications that can cause hair loss, it can take longer for your hair to regrow.
If your hair still hasn’t grown back or you are experiencing patchy, incomplete hair growth 6 months after the end of radiotherapy, you may be experiencing permanent radiation-induced alopecia. The best thing you can do in that case is to see a trichologist to assess your hair loss and explore your hair restoration options.
There are several treatments a trichologist can recommend if you are experiencing permanent hair loss or incomplete hair regrowth after your radiotherapy treatment.
This medication is very effective for hair growth in several types of alopecia. Minoxidil works by dilating the small blood vessels in your scalp to allow more oxygen and nutrients to reach your follicles. This provides them with more resources to help them heal from the radiotherapy damage and start producing new hair.
One small study performed on 71 cancer patients with radiotherapy-induced hair loss showed that 82% of them experienced hair density improvement after treatment with Minoxidil 5% [8].
Platelet-rich plasma contains an abundance of growth factors that can help repair the damage caused by radiation to your hair follicles and stimulate hair growth. PRP hair treatments are performed by extracting the platelet-rich plasma from a small sample of your own blood and injecting it into the balding areas on your scalp. It is often used alongside other surgical and non-surgical hair restoration treatments to treat radiotherapy-induced hair loss.
If your radiotherapy hair loss does not respond to non-surgical treatments, you could still be a good candidate for a hair transplant [8]. However, this is only possible if you have enough healthy hair left in your donor area and your health condition allows it.
This safe and simple outpatient surgery involves harvesting healthy follicles from a part of your head where you still have sufficient hair and implanting them in your bald spots. While you may have to wait 9 months – 1 year to see your final results, hair transplants are permanent, so you can enjoy your hair restoration for years to come. And if you qualify for this procedure, the best hair transplant clinics in the UK have an excellent success rate and a record of almost no serious post-surgical complications.
Unfortunately, there are no known preventive measures at this time that you can take to reduce the likelihood or extent of radiotherapy hair loss.
Eating a healthy diet for hair and using hair growth oils to nourish and strengthen your hair follicles may help reduce unnecessary hair shedding. But there is no protective device that you can wear or medication you can take to actively keep your hair from falling out from the radiation. Unfortunately, while cold caps can sometimes work for chemotherapy by contracting the blood vessels in your scalp to reduce the amount of medication that reaches the hair follicles, they cannot stop radiation, which is not blood-borne [13].
The good news is that scientists are currently working on developing such preventive measures. Recent research has found that radiotherapy can block or disrupt signals sent to hair follicle cells that prompt them to start creating new hair. So, in theory, by enhancing these signals and ensuring they get through, scientists hope to prevent or reduce radiation and chemotherapy hair loss in the future [9]. However, extensive further research and testing is necessary to determine how this can be achieved in practice.
Yes. Although it’s not common, radiotherapy can also damage the cells in your hair follicles responsible for hair pigmentation (the melanocytes), causing temporary or permanent hair discolouration [10][11]. Greying is usually noticed as your hair starts to grow back after the end of treatment.
While several avenues for reversing radiotherapy-induced hair greying are currently being explored, further research is needed before effective treatment can be developed to reverse or prevent this process.
Regardless of whether it is temporary or permanent, radiotherapy hair loss can take a significant toll on your mental health. It has been associated with higher rates of depression, anxiety, social withdrawal and decreased self-esteem. Here are some helpful tips on how to cope with this new reality [12].
Hair loss can be difficult to adjust to, especially while you are already fighting a serious illness. That is why getting the help and guidance of a therapist in processing your emotions can be very important. Moreover, opening up to your loved ones or a cancer support group about your experience with alopecia can help you get the support and encouragement you need.
Wear your bald head proudly if you feel comfortable doing so. However, if you would prefer to conceal your radiotherapy hair loss, there are many good non-surgical hair replacement options that you can try. Advancements in wig and hair system technology have made some of these products extremely comfortable to wear and virtually indistinguishable from your real hair. And if you are worried about the costs, there are public and private institutions that offer free or discounted wigs for cancer patients.
Be sure to treat your remaining hair (and your regrowing hair, when the time comes) gently and keep it nourished and moisturised. Wash it frequently with mild shampoo for sensitive skin (e.g. baby shampoo) and let it air-dry. Brush it very patiently, with a soft-bristled brush. Avoid heat-styling, because it’s very difficult to fix heat-damaged hair.
If you are experiencing scalp dermatitis, seek treatment for it and use it as per your doctor’s instructions. And if there are exposed areas of your scalp, use a hydrating cream to keep them moisturised and cover your head or use sunblock when going outside in hot weather, to avoid sunburn.
If you have finished a course of radiotherapy longer than 4-6 months ago and you have absent or insufficient hair regrowth, it is time to get professional assistance. Don’t hesitate to book a consultation with one of our dedicated hair doctors at your most convenient clinic location.
They will run diagnostic trichology tests to determine whether your alopecia is permanent. And if this is the case, they will recommend the most effective, personalised treatments that can help restore hair growth and let you know whether you could benefit from getting a natural-looking hair transplant.
If you would like to find out more about radiotherapy hair loss, you may find the information you need among the answers to these frequently asked questions.
While both radiotherapy and chemotherapy can cause hair loss through anagen effluvium, there are some important differences.
Firstly, chemotherapy hair loss often affects the entire scalp and sometimes the face and body hair, because it uses systemic medication that enters your bloodstream. Radiotherapy is targeted and therefore only affects the area of your body that the radiation is directed at.
Secondly, radiotherapy has a greater risk of causing permanent hair loss than chemotherapy in the areas directly subjected to radiation and there are no preventive measures you can take to reduce it (with chemotherapy, cooling your scalp during treatment can sometimes help prevent or reduce hair shedding).
Yes. In some patients, hair that grows back after radiation therapy can be thinner and shorter. Sometimes it can even have a different texture. While in most people this is temporary, these hair changes can sometimes become permanent.
If you are looking for expert tips to choose the most suitable wig for your radiotherapy hair loss, be sure to check out this complete guide to buying a human hair wig. It will tell you all you need to know about how to get a wig of the right type, length and texture to match your face shape, needs and preferences.
Yes, if the radiation beam passes through your face, it can also cause beard hair loss and/or eyelash and eyebrow hair loss. Just like in the case of scalp hair, beard loss and madarosis can be temporary or permanent.
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