Key points
- Not all chemotherapy drugs cause hair loss; before treatment starts, ask your care team whether your drug does [1].
- Hair loss with classic chemotherapy happens in about two out of 3 patients and is usually reversible [7]; hair often grows back 2 to 3 months after chemotherapy ends [1].
- Scalp cooling (a cold cap) kept hair in about half of the women with breast cancer in a careful study; without the cap nobody kept their hair [2]. It did not increase the risk of cancer coming back in the scalp either [6].
- Gentle washing, a soft brush, avoiding hair dryers and straighteners, and protecting the scalp from sun and cold are recommended [1].
- In some patients, especially after regimens containing a taxane, hair loss is permanent; this too can be assessed and treated [7].
Why does chemotherapy cause hair loss?
Many chemotherapy drugs target cells that divide quickly. Hair root cells (hair follicles) are among the fastest-dividing cells in the body, so they are damaged and hair falls out [5]. As well as chemotherapy, radiotherapy (only in the area treated), some targeted drugs, immunotherapy, stem cell transplant and hormone therapy can also cause hair changes [5].
Hair loss may not be limited to the scalp and can also affect the eyebrows, eyelashes and hair elsewhere on the body [1]. Hair usually grows back 2 to 3 months after chemotherapy ends and 3 to 6 months after radiotherapy ends. New hair is very fine at first and may be curlier, straighter or even a different colour; with time it usually returns to how it was. After very high-dose radiotherapy, hair in the treated area may be thinner or may not grow back at all [1].
Caring for your hair and scalp
Things that help
Be gentle with your hair
Use a soft brush or a wide-toothed comb and a mild shampoo. Wash your hair less often and pat it dry gently with a soft towel. Avoid hair dryers, straighteners, gels and clips that hurt the scalp [1].
Cutting or shaving
Some people cut their hair short before it starts to fall out, to make it easier to manage; some shave their heads. If you shave, use an electric razor so the scalp is not cut [1].
Wig, scarf or hat
If you want a wig, get it before your hair falls out so you can match it to your own hair colour. If a wig feels hot or itchy, try a soft scarf or turban [1].
Protect your scalp
Use sunscreen or a hat outdoors and keep your head warm in cold weather. If your scalp is itchy or sensitive, lotions and moisturisers help [1].
Talk about your feelings
Anger, sadness or embarrassment about hair loss are very normal. Talking with family, friends or people who have been through it helps. Tell your children and those close to you beforehand that your hair may fall out [1].
When hair grows back
Be gentle with new hair; limit heavy brushing, perms and hair dryers [1].
Scalp cooling (cold cap)
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In this method, a temperature-controlled cap is worn on the head before, during and after the chemotherapy infusion. The cold narrows the blood vessels in the scalp and reduces the amount of drug reaching the hair roots [5]. In one study, cooling started 30 minutes before each session, the scalp temperature was kept at about 3 °C throughout the infusion, and cooling continued for 90 to 120 minutes after the infusion ended [3].
Who is a cold cap most suitable for? Most of the evidence is in women with breast cancer having regimens containing a taxane or an anthracycline [2]. Results are reported to be better with regimens without an anthracycline [3]. The ESMO guideline (2021) on skin toxicities of anticancer drugs recommends scalp cooling to prevent hair loss in patients with solid tumours having chemotherapy [4].
Side effects: usually mild: feeling cold, a mild headache and discomfort [2, 3]; only a small percentage of patients stopped because of the cold [3]. Even with a cold cap, some thinning of the hair after each cycle is common [8].
For physicians
Scalp cooling evidence for physicians
- The SCALP randomised trial (182 patients; 142 evaluable at the interim analysis; about two thirds on taxane-containing and one third on anthracycline-containing regimens): hair preservation (CTCAE grade 0 or 1) after 4 cycles in 48 of 95 patients in the cooling group (50.5%; 95% confidence interval 40.7 to 60.4%) versus 0 of 47 in the control group; no difference in quality-of-life scales was seen; all device-related adverse events were grade 1 or 2 [2].
- Cohort study by Rugo and colleagues (regimens without an anthracycline): hair loss ≤50% (Dean scale) in 67 of 101 patients (66.3%) versus 0 of 16 patients; 3 of 5 quality-of-life measures were better one month after treatment; mild headache in 3.8% of patients and stopping because of the cold in 2.8% [3].
- TC regimen (docetaxel and cyclophosphamide), small study: 90% of patients with scalp cooling had hair loss of less than 50% [8].
- Meta-analysis of the risk of scalp metastasis in breast cancer: 0.61% (95% CI 0.32 to 1.1%) with cooling versus 0.41% (0.13 to 0.94%) without it; P=0.43 [6].
Permanent hair loss and your doctor's role
In a small group of patients, hair does not fully come back after chemotherapy ends. This is seen most often after regimens containing a taxane, and in most cases it looks like inherited (androgenetic) hair loss; treatment with minoxidil on the scalp or by mouth, sometimes with anti-androgen medicines, improves hair density, although the response is partial [7]. Hormone therapy can also cause thinning hair [5]. If your hair has not grown back six months after treatment ends, or you have new thinning during hormone therapy, ask to be referred to a hair and skin specialist.
For physicians
Persistent chemotherapy-induced alopecia (pCIA)
- In a case series of 100 patients with persistent hair loss after breast cancer treatment, 92% had received taxane-containing regimens, and their hair loss was more severe; most cases had an androgenetic-like pattern [7].
- Topical or oral minoxidil, sometimes with anti-androgens, significantly improved hair density, but the response was partial [7].
Myths and facts
| Common belief | Fact |
|---|---|
| All chemotherapy causes hair loss. | Only some chemotherapy drugs make scalp hair fall out; ask your care team about your own drug [1]. |
| A cold cap lets cancer reach the scalp. | In a review of breast cancer studies, the rate of scalp metastasis was very low and similar with and without a cold cap [6]. |
| Hair that grows back is exactly the same as before. | New hair may be finer, curlier or a different colour at first, and usually returns gradually to how it was [1]. |
| Permanent hair loss cannot be treated. | Treatment with minoxidil (sometimes with anti-androgen medicines) improves hair density, although the response is partial [7]. |
When should I call my doctor?
- A temperature of 38 °C or higher during chemotherapy; this is an emergency and may be a sign of infection [9].
- Redness, swelling, pain, discharge or sores on the scalp or anywhere else on the skin, especially when your white blood cells are low [9].
- Severe distress or signs of depression because of the change in your appearance; your care team can refer you to a counsellor or support groups [1].
- Your hair has not grown back six months after chemotherapy ends, or it is slowly thinning during hormone therapy; this can be assessed and treated [7].
Frequently asked questions
When does hair grow back?
Usually 2 to 3 months after chemotherapy ends and 3 to 6 months after radiotherapy ends [1].
Is a cold cap suitable for every patient?
Does hair loss mean the chemotherapy is working?
Which shampoo should I use while my hair is falling out?
A mild shampoo, washing less often and patting dry gently with a soft towel are recommended; if your scalp is itchy, a lotion or moisturiser helps [1].
Related cancer types
References
9 referencesShow all references, 6 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 8Efficacy of Scalp Cooling in Preventing Chemotherapy-Induced Alopecia in Breast Cancer Patients Receiving Adjuvant Docetaxel and Cyclophosphamide Chemotherapy
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This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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