Childhood Cancer

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Childhood Cancer Survivors

Hair And Nails

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).

My hair never seemed to fully come back after I lost it. It is very fine and thin, and that makes it difficult to style. I am hesitant to dye it or color treat it because I don’t want to risk damaging the follicles even further and losing the hair completely.

 

My daughter had 30 rounds of proton radiation and 4 rounds of intense chemotherapy. She had radiation first which started the hair loss on her scalp and then chemotherapy which continued the hair loss all over her body including her eyelashes. Her hair started growing back about 4 weeks after chemo was finished. It is thinner than before treatment but most people don’t notice it. She has a small bald patch behind her left ear where the focused radiation beam hit her. She also has a bald patch over the scar from her tumor resection on the back of her scalp about 4 inches long. It is not visible unless she has her hair in a higher ponytail.

Damage to hair and hair loss

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.

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). Children and teens who take cyclosporine for extended periods of time can have excessive hair growth.

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.

Medical management of hair damage or hair loss

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 chemicals to straighten or curl your hair. If you do, ask your hairdresser to use the most gentle type to 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.

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