Hair and nails are made of dead cells from the epidermis (outer layer of skin). Individual hairs grow from living roots in hair follicles. Except for the root, the entire hair is made of dead cells. Nails grow from living roots underneath the cuticle (fold of skin at the base of nails).
Chemotherapy usually causes hair to fall out. When hair grows back after treatment, it can be a different color or texture than it was before diagnosis. Most survivors treated only with chemotherapy get a lush growth of hair after treatment ends.
Trevor had beautiful light-blond straight hair when he was diagnosed. He lost it twice, but now has the thickest, light-brown, wavy hair. Every time I take him in for his haircut, all the gals say, “Oh, I would love to have his hair!” So it came back totally different, but totally gorgeous. The only weird thing about it is the texture. The chemo made it coarse and dry. Trev’s skin is also still very dry.
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As a young boy, Joel’s hair was blond and wild. It was thick and stuck up and out and every which way. As a baby, it used to look like he had a halo with all that blond fuzz around his head. The hair stylist who cut his hair struggled for years trying to figure out a way to cut it so it looked good, but no matter how much gel was used, as soon as it was dry it popped up. It became a part of him, his mischievous grin and wild hair.
After losing his hair during his treatment (ages 14 to 17), we joked that maybe he’d get good hair when it grew back. And it worked. His hair grew in a little darker, but also more fine and much more manageable. It would even lie down! The good hair has stayed, until losing it again this summer after relapse. It is just now coming back in and it looks even darker. Maybe it will be curly this time.
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Jamie’s hair was light brown and thick before diagnosis. When it grew back 9 months later, it was jet black and thin. It feels like velvet. I could spend hours rubbing his head, it’s so soft!
Most children who have only chemotherapy prior to a stem cell transplant have full regrowth of hair. Very rarely, children who had busulfan and Cytoxan ® to prepare them for a stem cell transplant have permanent baldness (called alopecia). 5 Children and teens who take cyclosporine for extended periods of time can have excessive hair growth.
My 6-year-old daughter had a bone marrow transplant when she was 4 years old. She stayed shiny bald for a long time. When it started to come in, it was very thin and it has never improved. It’s very wispy and there is undergrowth, but the under part stays very short. She’s starting to say she doesn’t like the way she looks. So I got her a wig that looks pretty natural, but she was still so young that she tended to take it off out in public. We recently upgraded to the best synthetic wig you can get. She wears it to school and church and then immediately takes it off.
Radiation damages the hair follicles. The higher the dose, the more risk of permanent damage. Children or teens who had 1800 cGy or less radiation to the head usually have normal hair growth. Those who had more than 1800 cGy may have permanently thinned hair. Hair may not grow back in areas that had high-dose radiation (more than 3000 cGy). For instance, medulloblastoma survivors usually have bald areas on the back of the head where they got the most radiation. Survivors who had rhabdomyosarcoma of the parotid gland may have a hairless rim around the ears.
I can see exactly where they did the radiation to my son Chris’ head. He looks like an older gentlemen who is losing his hair; he has a little there, but not much. There is a bald band from behind one ear in a strip to the other ear. We let his hair above grow longer to cover it. He has lots of scars to cover: where they did the ventriculoscopy in the front of his head, the shunt and brain surgery scars on the back side, and the VP (ventriculoperitoneal) shunt scar on the side.
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Robby, being half-Indian, had black hair so dark it was blue. It was very soft and very thick. He never lost all of his hair during chemotherapy, but could pull it out in handfuls.
Prior to BMT, he had cranial-spinal radiation and all his hair fell out. He was a little fuzzhead. When his hair finally came back in, it was still very dark, but dark brown, and very stiff and coarse. He has many colors of hair now—white, blond, red, and one big blond patch behind his right ear. There is even some gray splattered throughout. Apparently the radiation has damaged certain hair follicles. He now keeps it very short and has some very strange cowlicks that never lie down.
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My daughter Rachel’s hair has stayed very thin and wispy in the years since her bone marrow transplant. The hairdresser who cuts her wig suggested we cut Rachel’s hair short all over and try to mousse it and it might look like a regular short haircut. Rachel doesn’t like that idea, as she likes long hair, even sparse long hair. And long to her is barely touching her neck! She still is not happy with her hair.
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My son had a BMT to treat his relapsed leukemia. He has no problems with skin or hair, only that he seems every year to have more and more moles. Other than that, he’s got nice skin and is pretty hairy! Full head of thick hair, facial hair, hair now growing on chest and legs.
Permanent loss of hair cannot be reversed; however, in the last decade, plastic surgeons have worked on new techniques to transplant hair. These hair transplants use micrografts from parts of the head that still have thick hair growth. If you are interested in exploring this option, ask your doctor for a referral to a plastic surgeon with extensive experience using these new methods.
Survivors share the following tips about managing hair:
If your hair is thin or wispy, ask your hair stylist to recommend hairstyles and hair products that can help the hair appear fuller.
Don’t dye your hair, as this can dry out and damage the hair shafts.
Don’t use perms. If you do, ask your hairdresser to use the most gentle type she has so you can minimize breakage.
If you have very thin hair, it looks fuller if you keep it cut relatively short.
If you have scars or bald spots on your head, you can grow your hair to cover the area.
Table of ContentsAll Guides
- 1. Survivorship
- 2. Emotions
- 3. Relationships
- 4. Navigating the System
- 5. Staying Healthy
- 6. Diseases
- 7. Fatigue
- 8. Brain and Nerves
- 9. Hormone-Producing Glands
- 10. Eyes and Ears
- 11. Head and Neck
- 12. Heart and Blood Vessels
- 13. Lungs
- 14. Kidneys, Bladder, and Genitals
- 15. Liver, Stomach, and Intestines
- 16. Immune System
- 17. Muscles and Bones
- 18. Skin, Breasts, and Hair
- 19. Second Cancers
- 20. Homage
- Appendix A. Survivor Sketches
- Appendix B. Resources
- Appendix C. References
- Appendix D. About the Authors
- Appendix E. Childhood Cancer Guides (TM)