It's Not "Just Hair": Chemo Curls and Cancer Aware

I celebrated a big milestone this week. I had my first hair cut after cancer therapy! It had been two years and six months since my family helped me shave my head before starting chemotherapy. I am incredibly grateful to be able to mark this anniversary.

As a dermatologist, I regularly diagnosed and treated hair diseases and loss. Every patient I saw with hair loss experienced significant stress from hair loss. It is ok to be worried about your hair! You are not being vain. Hair is a part of our identity, dignity, and self-expression.

Structurally, hair is simply strands of the protein keratin anchored in a hair follicle and root (yes, we have roots like trees!).  Practically speaking, hair keeps our heads warm, eyes moisturized and debris-free, conveys facial expression, and warms the air through our noses. Let’s all take a deep breath through our noses and thank our nostril hair.

Hair is so much more than its structure or function. Our hair is tied to our outward physical persona, gender, and self-esteem. Society equates lustrous, full hair with vitality, health, and social status. There are also significant cultural and religions implications in how we style, cover, and wear our hair. A dear friend even said to me, “Look to the trees. They lose their leaves every fall, and God willing, in the spring they grow back.” Indeed, in the Bible, Mark 10:30 NIV states, "And even the very hairs of your head are all numbered," to illustrate how God loves and knows each one of us. It was comforting for me to remember this verse when I was literally holding all my tiny hair follicles in my hands after chemotherapy and knowing that there was a plan for me despite this hardship.

Chemotherapy induced scalp hair loss typically occurs within a couple weeks of initial chemotherapy dose, occurs weeks later for body, eyebrow, nose and eyelash hair, and is dependent on the type of medication used and mode of administration. Most chemotherapies work by killing rapidly diving cells. Hair and skin grow very quickly so they are greatly affected by this therapeutic class. Other commonly useds medication for estrogen positive tumors are aromatase inhibitors or estrogen receptor modulators which also have the potential side effect of hair loss and persistent miniaturization of hair follicle since estrogen receptors are found in hair follicles.

Cancer patients may choose to wear cold caps (scalp cooling systems) during chemotherapy infusions to try prevent chemotherapy induced hair loss. Cooling is believed to constrict scalp blood vessels which decreases blood flow to hair follicles and reduces the amount of chemotherapy reaching the hair follicles. Wearing a cold cap may be uncomfortable during the hours long treatments, but some of my friends have had great success in retaining their hair despite chemotherapy. It is a very personal decision to cold cap or lose one's hair, and either choice is brave. Indeed, you may have personally observed others or viewed popular media that illustrated persons taking agency during a stressful situation like a divorce, illness, or trauma by getting a dramatic hair cut. And I applaud that.

When hair regrowth occurs, it may be different in color, texture, thickness, and shape. Hair usually grows back within 3-6 months after chemotherapy and yes, “Chemo curls” are a real thing! On average, 1/3 of patients experience curly hair after chemotherapy. Chemotherapy may cause the hair follicle to behave differently with regrowth. The hair follicle shape and orientation may change from round to a flattened, elliptical-shaped follicle growing at an angle in the scalp, which alters the shaft from straight to curly. Medications or a hormone shifts with menopause can also affect hair appearance. These changes may persist, or they may be temporary.

With regrowth came the challenge of choosing new hair products to fit my new life - curly hair and cancer aware. I chose to use “clean” beauty products that did not contain possible endocrine disrupting or carcinogenic chemicals (examples are parabens, phthalates, formaldehydes - more on this in an upcoming blog post). At the point of regrowth, I had already researched and implemented so many lifestyle changes that it felt exhausting and daunting to delve into a new hair regimen. So I avoided this hard work for a really long time. When I finally mustered up the energy and focus, I used three helpful resources for “clean” beauty: the Clearya App, the Environmental Working Group’s Skin Deep Cosmetics Database, and breast cancer support organization Unite For Her’s Beauty Product Guide and the expertise of my hair stylist to create a gentle hair care routine for my new locks.

Losing my hair during chemotherapy was a very noticeable external manifestation of a significant inner battle and unanticipated life transition. Would the cancer go away? Would the hair grow back? If the hair grows back, will the cancer come back too? Will the hair regrowth look different than before? At times during treatment, I felt similar public scrutiny on my appearance that I experienced during pregnancy. Sometimes that attention was not welcome, and other times I would ask dear friends and family to feel my soft beautiful new curly hair. How amazing to witness loss and then such beautiful renewal. Let us all be gentle and kind to ourselves and others going through a big, scary, uncertain life transition. One's struggles may not be as evident as the hair on your head, but we can all

grow through challenges together and emerge untangled.

Hair cooling resources:

HairTo Stay is a national nonprofit organization that helps cancer patients afford scalp cooling. www.hairtostay.org

Wig and accessories resources:

Chemocessories provides a free set of accessories (such as scarves, turbans, jewelry) to women going through cancer treatment. https://chemocessories.org

EBeauty provides free wigs to women going through cancer treatment. You can also donate your gently used wig back for it to be refurbished and shared with another cancer patient. www.ebeauty.com

Hair We Share provides human hair wigs, made from donated hair free of charge to people who struggle with medical hair loss. https://hairweshare.org

HopeScarves provides free headscarves and offers encouragement to those in active cancer treatment. https://hopescarves.org

Sharsheret supports all women facing breast and ovarian cancer. Their financial subsidy program, Best Face Forward 2.0, includes scalp cooling, nipple tattooing, eyebrow tattoing and wigs. https://sharsheret.org/resource/best-face-forward-2-0/

The Varma Foundation provides free cap wigs for cancer patients: www.VarmaFoundation.org

Wigs and Wishes offers a free wig and complimentary styling services to women with cancer through a network of participating salons and stylists. https://www.wigsandwishes.com

Many hospitals and local organizations also have resources for free or discounted wigs and accessories for those undergoing cancer treatment. Ask your social worker or nurse navigator at your oncology office for additional resources.