Why Radiation Can Cause Hair Loss? Hair loss (Alopecia) and Radiotherapy

Radiation therapy, while a vital tool in cancer treatment, unfortunately carries the risk of hair loss, also known as alopecia. This occurs because radiation, in its effort to eradicate cancer cells, can also inadvertently damage healthy hair follicles within the treatment area. Consequently, these damaged follicles are unable to hold onto existing hair or produce new growth, leading to hair thinning or complete hair loss in the specific region targeted by the radiation beams.

Why Radiation Can Cause Hair Loss?

Radiation therapy leads to hair loss because the high doses of radiation used to target and destroy cancer cells can also harm other rapidly dividing cells in the body, including those within hair follicles.  This damage primarily affects the keratinocytes, which are essential for protecting the hair follicles.  When these cells are compromised by radiation, the hair follicles weaken and can no longer effectively hold onto the hair, resulting in hair loss. Furthermore, the damage to the hair follicles disrupts their normal cycle of cell division, which is necessary for hair growth. Consequently, even after treatment ends, it takes time for the healthy cells in the hair follicles to recover and resume their normal function of producing new hair.

The extent of this damage and the subsequent impact on hair regrowth depend on the total dose of radiation administered and the specific area of the body that received treatment.  Higher doses of radiation are more likely to cause significant damage and potentially longer periods of hair loss, and in some cases, permanent hair loss can occur if the damage to the follicles is severe.

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Which Factors Influence Hair Loss During Radiotherapy?

Several factors play a significant role in determining the extent and severity of hair loss experienced during radiotherapy. The total dose of radiation administered is a primary factor; higher doses are generally associated with more pronounced hair loss. Secondly, the area of the body being treated is crucial, as hair loss typically only occurs in the region where the radiation beams are directed or where they exit the body. For instance, radiation to the scalp is highly likely to cause hair loss there, while treatment to other areas may only affect local body hair.

The frequency and duration of the treatment schedule can also influence hair loss, with longer courses potentially leading to more significant effects. Finally, individual differences among patients, such as their overall health and the sensitivity of their hair follicles to radiation, can contribute to the variability in hair loss experienced.

Ven et al. (2022), in a study published in Clinical and Translational Radiation Oncology, developed a method to visualize predicted radiation-induced alopecia in brain tumor patients receiving cranial radiotherapy. The pilot study found that a total physical dose of 4 Gy for hypofractionated (HF) and 12.6 Gy for conventionally fractionated (CF) radiotherapy was predictive of alopecia 4 weeks after treatment. Validation in two cohorts showed accurate alopecia prediction in 86% of HF and 96% of CF patients, with an overall accuracy of 90% across 147 patients. The authors concluded that this method accurately predicts alopecia, which may reduce patient stress before cranial irradiation.

Is Radiation-Induced Hair Loss Permanent?

Radiation-induced hair loss can vary in its duration, ranging from temporary to permanent, depending largely on the intensity of the radiation and the specific location of the treatment. In many cases, hair loss resulting from radiotherapy is temporary. This is because the radiation primarily affects the hair follicles’ ability to function during the treatment period. Once the radiation therapy concludes, these follicles often recover, and hair regrowth typically begins within a few months. However, the texture or color of the regrown hair might differ from the original.

Permanent hair loss is more likely to occur when patients receive high doses of radiation. The higher the dose, the greater the potential for irreversible damage to the hair follicles, preventing them from ever producing hair again. Additionally, certain treatment locations, particularly those involving direct radiation to the brain or high doses to the head and neck area, carry a higher risk of permanent hair loss. Therefore, while many individuals can expect their hair to grow back after radiation therapy, the possibility of permanent hair loss exists, and this risk is closely tied to the specifics of the treatment.

Can You Predict Hair Loss Before Radiotherapy?

Predicting with absolute certainty whether a patient will experience hair loss before radiotherapy is challenging; however, healthcare teams can assess the likelihood based on several indicators. The most significant predictor is the radiation treatment plan itself, specifically the treatment area and the anticipated radiation dose. If the scalp or areas with hair follicles are within the radiation field and the dose is high, hair loss is more probable.

While genetic predisposition and the individual’s hair cycle phases are factors that influence overall hair health and regrowth, they are not typically used as direct predictive tests for radiation-induced hair loss. However, understanding that hair follicles are in different stages of growth (anagen, catagen, telogen) might offer some insight into the variability of hair loss and regrowth. Follicles in the active growth phase (anagen) are generally more susceptible to damage from radiation.

During the radiation planning phase, doctors carefully map out the treatment beams to target the cancer while minimizing damage to surrounding healthy tissues. This planning process is crucial in understanding which hair-bearing areas will be exposed to significant radiation and thus are at risk of hair loss. Patients should discuss these plans with their care team, who can provide a more personalized expectation of potential hair loss based on the specifics of their treatment.

Read OncoDaily’s Special Article About Radiotherapy Side Effects

Coping Strategies for Hair Loss During Treatment

Coping with hair loss during radiotherapy involves a combination of practical scalp care and seeking psychological support.

Scalp Care During Radiotherapy

To minimize discomfort and manage hair loss, it’s crucial to treat your scalp gently. Opt for mild shampoos and use a soft-bristled brush or a wide-tooth comb. Instead of blow-drying, allow your hair to air dry or gently pat it dry with a soft towel. Avoid harsh treatments like perms, coloring, or bleaching, and refrain from using heated styling tools such as curling irons or straightening irons.

Additionally, protect your scalp from sun exposure by wearing hats, scarves, or sunscreen. If your scalp feels itchy or tender, gentle lotions or conditioners may provide relief. Consider cutting your hair short before treatment begins, as this can make the subsequent hair loss feel less drastic. Some individuals even choose to shave their heads. Sleeping on a satin pillowcase can also reduce friction and be gentler on the scalp.

Psychological Support and Resources

Experiencing hair loss can be emotionally challenging. It’s important to acknowledge these feelings and seek support. Talking openly with your healthcare team about your concerns is a good first step, as they can offer advice and connect you with helpful resources. Sharing your feelings with family and friends can also provide comfort. Many individuals find it beneficial to connect with support groups or other people who have gone through similar experiences with cancer treatment and hair loss.

Organizations like the Look Good Feel Better program offer valuable support in managing the appearance-related side effects of cancer treatment. Exploring options like wigs, scarves, and hats can also help you feel more comfortable and in control. Remember that there is no right or wrong way to manage hair loss; it’s about finding what makes you feel most comfortable and supported during this time.

Promoting Hair Regrowth After Radiotherapy

Promoting hair regrowth after radiotherapy often involves a combination of gentle care and, in some cases, medical interventions.

Medical Treatments for Hair Regrowth

For individuals experiencing persistent hair loss after radiation therapy, particularly after high doses, medical treatments may be considered. Some recent research suggests that hair-stimulating therapies can be effective even in cases of long-term radiation-induced alopecia. Physicians specializing in hair restoration may offer prescription-strength, custom-blended hair regrowth medications. Additionally, regenerative medicine techniques, such as platelet-rich plasma (PRP) therapy, which involves injecting concentrated platelets into the scalp to stimulate hair 1 follicles, might be an option.

Low-level laser cap therapy, designed to increase blood flow to the scalp, is another potential treatment to encourage hair growth. In cases of permanent, patchy, or localized hair loss, hair transplantation using advanced techniques like NeoGraft®-assisted follicular unit extraction (FUE) may be recommended. Consulting with a hair loss expert is crucial to determine the most appropriate medical strategies based on individual circumstances and the extent of hair loss.

Nutritional Support for Hair Health

While not a direct treatment for stimulating regrowth after radiation, ensuring adequate nutrition can support overall hair health as it begins to grow back. A balanced diet rich in essential vitamins and minerals, such as biotin, zinc, iron, and vitamin D, can provide the necessary building blocks for healthy hair. While dietary changes alone may not reverse hair loss caused by radiation, they can contribute to the strength and vitality of new hair growth once the follicles recover. It’s advisable to discuss any significant dietary changes or the use of supplements with your healthcare team.

Scalp Massage Techniques

Gentle scalp massage may help to stimulate blood circulation in the scalp, which could potentially encourage hair follicles as they begin to recover after radiation therapy. Using your fingertips to gently massage the scalp in circular motions for a few minutes each day might improve blood flow to the area. However, it’s important to be very gentle, especially if the scalp is still sensitive or tender from the radiation treatment. While scalp massage is a low-risk practice, its direct impact on accelerating hair regrowth after radiation is not definitively established and should be considered a complementary approach to other strategies.

How Long Does It Take for Hair to Grow Back After Radiation?

The timeline for hair regrowth after radiation therapy is highly variable and depends significantly on the total dose of radiation received. For individuals who have undergone lower doses of radiation, hair often starts to grow back approximately 2 to 3 months after the completion of treatment. In many cases, a noticeable amount of regrowth occurs within 3 to 6 months.

However, with higher doses of radiation, the damage to the hair follicles can be more substantial, and regrowth may take longer, sometimes ranging from 6 to 12 months or even longer. In some instances where very high doses of radiation have been administered, the hair follicles may be permanently damaged, resulting in incomplete regrowth or permanent hair loss in the treated area.  The texture and color of the regrown hair can also differ from the original hair; it may come back thinner, curlier, straighter, or a different color.

Preventive Measures for Hair Loss During Treatment

Unfortunately, there are no definitive methods to completely prevent hair loss during radiotherapy when the treatment area includes the scalp or other hair-bearing regions. However, certain strategies can be employed to potentially minimize the extent of hair loss and promote scalp health during treatment.

Scalp Cooling Caps

One approach that may help reduce hair loss during chemotherapy, and is sometimes explored in the context of radiotherapy to the scalp, involves the use of scalp cooling caps. These specialized caps work by cooling the scalp, which can reduce blood flow to the hair follicles.

The theory is that this decreased blood flow limits the amount of radiation that reaches the follicles, thereby potentially lessening the damage and subsequent hair loss. However, the effectiveness of scalp cooling during radiotherapy can vary depending on the radiation dose and the specific treatment area. It’s crucial to discuss with your oncology team whether scalp cooling is a suitable option for your particular treatment plan and to understand its potential benefits and limitations.

What Are the Differences Between Radiation-Induced Hair Loss and Chemotherapy-Induced Hair Loss?

Radiation-induced hair loss and chemotherapy-induced hair loss differ in several key aspects. The mechanism of hair loss varies significantly; radiation therapy typically causes hair loss only in the specific area of the body being treated or where the radiation beam exits, directly damaging the hair follicles within that field. In contrast, chemotherapy is a systemic treatment, meaning it circulates throughout the body and can affect all rapidly dividing cells, including hair follicles all over the body, leading to more widespread hair loss, often including the scalp, eyebrows, eyelashes, and body hair.

In terms of severity, radiation-induced hair loss is usually localized to the treatment area and its intensity depends on the radiation dose. Lower doses might cause temporary thinning, while higher doses can lead to complete hair loss in that region, and in some cases, it can be permanent. Chemotherapy-induced hair loss, on the other hand, is often more extensive and can result in complete baldness over the entire scalp.

Can Hair Transplants Help After Radiation Therapy?

Yes, hair transplantation can be a viable solution for addressing permanent hair loss that occurs after radiation therapy. If the radiation has caused irreversible damage to the hair follicles in a specific area, preventing natural regrowth, a hair transplant can offer a way to restore hair to that region.

The process involves taking healthy hair follicles from a donor area of the scalp (typically the back or sides of the head, which are usually less affected by radiation) and surgically implanting them into the areas of permanent hair loss. For the transplant to be successful, the scalp in the recipient area needs to have adequate blood supply and be healthy enough to support the growth of the transplanted follicles.

Hair transplant procedures, such as Follicular Unit Extraction (FUE), can be particularly useful in treating localized areas of permanent hair loss caused by radiation. While multiple sessions might be necessary to achieve the desired density and coverage, many individuals find hair transplantation to be an effective way to improve their appearance and quality of life after radiation-induced alopecia. Consulting with a hair restoration specialist experienced in treating post-radiation hair loss is crucial to determine if you are a suitable candidate and to develop a personalized treatment plan.

Are There Any Experimental Treatments for Hair Regrowth After Radiation?

In a 2014 study published in the International Journal of Cancer, Cheryl M. Soref and William E. Fahl investigated preventing radiotherapy- or chemotherapy-induced alopecia using topical vasoconstrictors. Topical application of epinephrine or norepinephrine to rat skin, followed by either 7.1 Gy whole-body radiation or systemic MNU, resulted in up to 95% coat retention in treated areas, compared to 0% in controls.

Histological analysis supported these findings, showing normal anagen follicle density in treated areas versus dystrophic follicles in untreated areas. Epinephrine was less effective against systemic Cytoxan, which has a longer half-life than MNU, with only 16% coat retention. The study suggests that topical epinephrine or norepinephrine could be a convenient and inexpensive clinical strategy to prevent cancer therapy-induced alopecia.

Nuh et al. (2021), in a study published in the Annals of Plastic Surgery, investigated the protective effects of adipose-derived stem cells (ASCs) and platelet-rich plasma (PRP) against radiotherapy (RT)-induced damage. The study found that ASCs reduced RT-induced adverse effects like impaired wound healing, alopecia, skin atrophy, and fibrosis in mice by suppressing inflammation, dystrophy, degeneration, connective tissue synthesis, and apoptosis, while increasing cellular proliferation, differentiation, and signaling. Importantly, these protective effects were enhanced by co-administering ASCs with PRP. The authors concluded that combining ASCs and PRP prevented RT-induced adverse effects in mice, suggesting potential clinical applications.

Understanding the Emotional Impact of Hair Loss

The experience of hair loss due to radiotherapy can have a significant emotional impact, often extending beyond just the physical change. For many, hair is closely linked to their sense of identity and body image, and its loss can lead to feelings of anger, sadness, embarrassment, and even depression. This added distress can be particularly challenging on top of dealing with a cancer diagnosis and treatment. Concerns about appearance and how others perceive them can affect self-esteem and social interactions.

Coping with the emotional aspects of hair loss involves a multifaceted approach. It’s helpful to acknowledge and express these feelings, whether to healthcare professionals, family, friends, or support groups. Connecting with others who have experienced similar hair loss during cancer treatment can provide understanding and shared coping strategies. Exploring options like wigs, scarves, and hats can offer a sense of control over one’s appearance and help manage feelings of self-consciousness.

Some individuals find that taking proactive steps, such as cutting their hair short before it starts to fall out or even shaving their head, can provide a sense of agency. Ultimately, finding what makes you feel most comfortable and supported is key to navigating the emotional challenges associated with hair loss during radiotherapy.

Is There a Way to Prevent Radiation from Affecting Hair Follicles?

While completely preventing radiation from affecting hair follicles in the treatment area is often not possible, radiation therapy teams employ several strategies to minimize the impact on healthy tissues, including hair follicles. Meticulous radiation planning is paramount, where the treatment beams are precisely targeted to the cancerous area, aiming to reduce the exposure of surrounding healthy tissues as much as possible. This careful mapping helps to limit the radiation dose received by hair-bearing regions that are not the primary target.

Shielding techniques can also play a role in protecting certain areas from radiation. For instance, if hair follicles are located near the treatment site but not within it, specific shields might be used to block or reduce the radiation reaching those areas. However, the practicality of shielding depends on the location and size of the treatment area and the need to ensure adequate radiation delivery to the tumor.

Written By Aren Karapetyan, MD