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Dealing with Hair Loss from Cancer Treatment

Radiation therapy causes hair loss only in the area being treated. For instance, if your lower body is being treated, you likely will lose pubic hair or leg hair. If your chest or a breast is undergoing radiation, hair on and under your arms will come out. If your head or neck is being treated, you likely will lose scalp hair, and you may also lose your eyebrows and eyelashes.

Depending on the type of radiation and the dose, hair loss that results from radiation may be permanent. Often, the hair cannot grow back because the hair follicles are damaged too severely.

Pampering your hair while you have it

While you still have hair, you want to treat it well. Here are some tips that will help keep your hair — and your scalp — healthy when you begin radiation treatments:

  • Invest in a mild shampoo.
  • Brush your hair with soft strokes using a soft hairbrush.
  • Refrain from dying, perming, or relaxing your hair.
  • Put away the brush rollers.
  • Use only the low setting on your hair dryer.
  • Protect your scalp from the sun.

Even before you lose any hair, your skin will be more sensitive during radiation therapy.

Working up to the reality

Because hair loss is such an emotional experience (for men as well as women), spend some time getting used to the idea of yourself without hair, especially if your doctor expects the loss to be permanent. The idea is to figure out how to maintain a positive body image after your hair is gone. For obvious reasons, this is easier to do before you lose your hair.

Choosing a wig

If you are a woman, think about whether you will want a wig. If you want a wig and you think you will prefer to recognize yourself in the mirror, visit a wig shop before your hair falls out so you can match your current style and color. You may think that visiting the wig shop will be a grim expedition. It doesn't have to be. Take a friend who makes you laugh, and then go out for lunch afterward. You may even decide to try a wig that is a totally new style and color of hair for you. If price is not an issue, get two!

Most insurance companies pay for one wig — which they call a prosthesis — for people undergoing radiation therapy. If your insurance company will not pay for a wig or you don't have insurance, contact your local branch of the American Cancer Society. Women who have recovered from cancer often donate their wigs and other head coverings, and these are available for free. Also, some medical centers have a wig "exchange" where you can find an attractive covering for your head.

Sometimes, wigs cause a rash on the scalp, especially in summer when your scalp perspires under the wig. The best way to treat this rash is to expose your bald head to the open air as often as possible. Rub on a mild, over-the-counter cortisone cream if needed. If that doesn't work, by all means speak with your doctor. When you want to wear the wig, place a piece of clean cotton fabric between your scalp and your wig — an old, well-washed bandanna, folded to fit, is perfect. It won't show, and the cotton will absorb the moisture that caused the rash.

Choosing an alternative head covering

A wig is not your only option:

  • Some women prefer to wear a scarf or turban instead of a wig after they lose their hair.
  • Most men — and a few women — go about with bald pate gleaming. Will people stare? Some may; if they do, just flash a confident smile and go on your way.
    Going "topless," of course, is fine when you're at home. If your bare head gets cold at night, consider buying or making a stretchy, cotton knit cap that will keep your head warm and your dreams in place.
  • Some people invest in a signature hat to wear outdoors to protect their bald scalps from sunburn, which is important all the time but especially so during cancer treatments.

All these decisions are personal, so do whatever feels right for you. There are no rules except those you make, and you can always change the rules to suit yourself.

Cutting your hair

You may want to make an appointment to have your hair cut short. This proactive approach provides you with an emotional way station between having a full head of hair and none at all. If all your hair comes out, it's easier to manage losing short hair than long — for a while, anyway. And if only a little of your hair ends up falling out, the hair that is left will look thicker and fuller if it's short.

Hair falls out in single strands and in clumps. Once it starts coming out, hair will lie on your pillow, litter your collar, and coat the walls of your shower. Frankly, it's a mess — such a mess that you may find yourself dialing your hair stylist and asking for an appointment to have your head shaved.

If you suspect that you may become weepy while having your head shaved, ask if you can schedule the appointment after hours or if there is a private room where you can get the job done and then don your wig or head covering before leaving the salon. Keep in mind that you are not the first person to make this type of call, and you will not be the last. Most stylists are happy to do what they can to help you through this difficult appointment.

Replacing eyebrows and lashes

Whether to replace your eyebrows and lashes is a personal decision: Some women choose not to bother, and some feel comforted when they look in the mirror and see the eyebrows and lashes they expect to see.

If you are a woman accustomed to running an eyebrow pencil over your brows to thicken or darken them, you may do fine when it comes time to draw them on from scratch. If you've never owned an eyebrow pencil, you may want to buy one before treatment begins and pay attention to that bony arch above each eye. That's where the brow goes. Usually, a natural brow starts out fairly thick near the bridge of the nose, thickens slightly right above the iris, and then tapers off on the other side. You can actually buy a set of eyebrow stencils and play around, seeing what shape suits you. Some people opt for permanent cosmetics, or tattooed eyebrows. If that interests you, make an appointment before your eyelashes fall out so the aesthetician can match the color and shape of your natural brows.

As for eyelashes, you could invest in a pair of false eyelashes or glue on false lashes one at a time, though that strikes us as a lot of trouble. You could also put a little eyeliner on the edge of each upper and lower lid. Another option is tattooed eyeliner, which you would have forever.

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