Anagen effluvium: hair loss caused by chemotherapy and other cancer treatment

Hairs grow in cycles. The growing phase is called anagen, and the shedding of hairs that have finished growing is a normal, continuous process. The NHS notes that it is normal to lose hair, that we can lose between 50 and 100 hairs a day, often without noticing, and that hair loss is not usually anything to be worried about.

Anagen effluvium is different from that everyday shedding. The term describes loss of hairs that are still in their growing phase, which is why it tends to be rapid and extensive rather than gradual. The classic cause is chemotherapy, which targets fast-dividing cells and can therefore affect the cells in hair follicles. This is a different pattern from telogen effluvium, which is shedding after a trigger such as illness, stress or weight loss.

The NHS lists several causes of temporary hair loss: an illness, stress, cancer treatment, weight loss and iron deficiency. Cancer Research UK describes hair loss as a common side effect of some cancer treatments. Whether any individual loses hair depends on the specific treatment they receive, so the team treating you is the best source of information about what to expect.

The NHS chemotherapy page lists temporary hair loss alongside other side effects such as tiredness, feeling sick, a sore mouth and a weakened immune system, and advises people to let their care team know about side effects because they may be able to give treatments to ease them.

Hair loss is often the side effect people feel most strongly about. Cancer Research UK says losing your hair during cancer treatment can be devastating, and that it can be very stressful. It points to practical things that help, including different ways to cover your head: a wig is the most obvious choice, while some people prefer hats, scarves or baseball caps.

Hair loss itself is not an emergency, but the treatment that causes it can be. The NHS chemotherapy page says to call your care team now if you have a high temperature, and gives other warning signs of infection or blood clot, saying these may need to be treated quickly. It says to call NHS 111 if you are not sure how to contact your care team.

For hair loss without cancer treatment, the NHS advises seeing a GP if you are worried. The GP may be able to tell you what is causing it by looking at your hair, and you can tell them if it is affecting your wellbeing and ask what treatments are available. The NHS adds that it is worth seeing a GP to get an idea about the cause before thinking about a commercial hair clinic.

The NHS says most hair loss does not need treatment and is either temporary and will grow back, or a normal part of getting older. It says hair loss caused by a medical condition usually stops or grows back once you have recovered. It also cautions that no treatment is 100% effective and that not all treatments are available on the NHS.

The NHS lists treatments such as finasteride and minoxidil for pattern baldness. These are not treatments for chemotherapy-related hair loss, and the NHS notes that they do not work for everyone and only work for as long as they are used. If you are on chemotherapy, ask the team treating you before using any hair-growth product.

The NHS also describes other approaches that are sometimes used for hair loss in general, such as permanent make-up (micropigmentation), which uses a tattoo to look like short hair and eyebrows. Whether any of these is appropriate during or after cancer treatment is a question for your oncology team.

The NHS compares synthetic and real-hair wigs. It says synthetic wigs last 6 to 9 months, are easier to look after, can be itchy and hot, and cost less. Real-hair wigs last 3 to 4 years, are harder to look after, look more natural and cost more. Some wigs are available on the NHS, and you may have to pay unless you qualify for financial help.

Cancer Research UK points to organisations and suppliers of wigs and other head wear, and mentions that some people donate their hair to make wigs for people with cancer or hair loss. The NHS also points to support groups, noting that Alopecia UK lists groups near you, and says your GP may be able to help you get counselling. Cancer Research UK adds that it is common to struggle with your mental health when you have cancer, and that it has information to help.

People receiving chemotherapy on the NHS are looked after by an oncology team, which is the right place to ask about hair loss, wigs and whether any measures to reduce hair loss are suitable for the particular drugs involved. Some people also use private wig suppliers or private cosmetic services. The NHS warns that commercial hair clinics should come after seeing a GP, so that the cause of hair loss is understood first.