Why is it a thing to go bald?

From a receding hairline to a bald head

Therapy with cytostatics can therefore cause all scalp hair that is currently in the metabolically active phase to break off at the root after one to two weeks. The remaining hair will fall out over the next few months - a dramatic side effect for many women.

Dr. Kristina Drinkut, assistant doctor at the Clinic for Gynecology and Obstetrics at the Hannover Medical School (MHH), told the PZ from her medical experience: »Hair loss during chemotherapy also has a negative effect on the quality of life. The women feel stigmatized that they can now be seen to have cancer. It usually makes the patients feel even sicker. ”The constant need to explain oneself is also uncomfortable.

A small consolation can be that the hair loss is temporary. "Four to eight weeks after the end of chemotherapy, the hair usually grows back, sometimes in a different color, sometimes thicker," confirms Drinkut. Not only the hair on the head is affected, but sometimes also eyebrows, eyelashes, armpit, leg and pubic hair.

An important note (6): Not every chemotherapy brings this psychologically stressful side effect with it. For example, ifosfamide and doxorubicin are known for this. The dose of medication also plays a role.

Counter hair loss with a cool head

In addition to educating women about possible side effects of chemotherapy, pharmacists can help them prepare for hair loss. There are several ways to hide the cosmetic problem. Every woman must find the path that is right for her.

This can be a wig, for example. It is often helpful if the second hairs are as similar as possible to the natural ones. The patient should have the wig made individually according to her wishes before the start of therapy. Many health insurance companies take over or subsidize the costs if the doctor prescribes the aid. Other women prefer a chic hat, headscarf or cap.

If eyebrows and eyelashes also fall out, a beautician can give tips on how the patient can make the loss less noticeable by applying make-up correctly (6). Some patients also use drugs against falling eyelashes. Active ingredients such as bimatoprost, which are approved for the treatment of glaucoma, stimulate the growth of the eyelashes as a side effect. However, this use of the prescription drug takes place outside of the approval (off-label use) (7). Possible side effects include increased blood flow to the conjunctiva, irritated and itchy eyes, persistent increased iris pigmentation and change in eye color, and headaches.

New developments could make it possible to prevent massive hair loss under chemotherapy in the future. Researchers at the Hannover Medical School (MHH) achieved good results with a scalp cooling method. With the system used, cooling fluid circulates 30 minutes before, during and one hour after chemotherapy through a flexible cap that the women put on their heads. This causes a local narrowing of the blood vessels and a slowdown in the metabolism. Not only do fewer therapeutic agents reach the hair roots, but their effectiveness is also reduced.

"Our own analysis and the data from other studies show convincing results for patients who receive the standard chemotherapy for breast cancer, ie epirubicin and cyclophosphamide, followed by paclitaxel," says Drinkut. The data are also convincing for weekly treatments with a taxane and the standard regimen for ovarian cancer (carboplatin and paclitaxel). According to the results of the evaluation of photo documentation and questionnaires, those affected would only lose around 30 percent of their hair thanks to the cooling cap. "The patient hardly notices this amount in the mirror or even outsiders," the expert knows. She hopes that this will give women under chemotherapy a higher quality of life in the future and avoid patients hesitating to agree to life-saving therapy for fear of losing their hair (6, 8).

A general recommendation for preventive treatment cannot yet be made. The reduced supply of chemotherapy drugs to the scalp could prevent the drug from working fully against disrupted tumor cells. Since this risk has not yet been ruled out, non-critical use is not recommended (6).