Wednesday, October 10, 2012

Hair Loss (aka Alopecia) and Wigs

I'm no country music expert, but there is a country song that makes me howl absolutely every time I hear it.  It's called:  "Trashy Women" by Jerry Jeff Walker and Chris Wall.

And this is my favorite stanza:

"You shoulda seen the looks on the faces of my Dad and Mom
When I showed up at the door with a date for the senior prom.

They said, "Pardon us, son, but that ain't no kid;
That's a cocktail waitress in a Dolly Parton wig".

I said, "I know it dad ain't she cool?,
That's the kind I dig."

Dolly Parton wig, Raquel Welch wig, Eva Gabor wig, Beverly Johnson wig.  What do these ladies all have in common?   For better or worse, they have been in the wig business.


Let's talk hair loss and wigs.  The medical term for hair loss is "Alopecia".  I believe the Latin variation of the word Alopecia translates into something like:  "Crap, my hair is falling out.  Where are my Kleenex?  I want my pre-cancer life back...NOW." 

Hair loss is the number one question we get asked about and usually the very first question we hear when we start telling patients about chemotherapy.  Rightfully so.  You dig your hair and you have become accustomed to having it on top of your head.

I have cut and pasted some of what is written below from actual emails to patients about this topic, so if you are a patient of mine, you might have heard these words before, so please forgive.

A quick review from an earlier posting....

The good news: chemo kills rapidly dividing cells. Cancer cells are rapidly dividing cells. They are big, unorganized, not shaped like normal cells and they proliferate like rabbits. They grow fast and out of control. So, chemotherapy kills cancer cells.....good, that is our goal.

The bad news: chemo kills rapidly dividing cells. There are some healthy "normal" cells that also come under the "rapidly dividing" category. Your white blood cells, red blood cells, platelets in the bone marrow. Also your hair follicles, the lining of your mouth, throat, GI tract. These are all rapidly dividing cells. Chemo kills these too. On the positive side, new cells are always being produced. On the negative side of things, the chemo killing off your healthy rapidly dividing cells are why you experience side effects like hair loss, mouth and throat sores, nausea, vomiting, diarrhea. Until the reinforcement new cells arrive, you have to deal with the side effects (your doctors and nurses will tell you what you can do to tolerate most of these side effects).

If you are a breast cancer patient getting Adriamycin (Doxorubicin), hair loss usually starts right before your second cycle of chemo (when or if your hair comes out depends on the type of chemo drugs given).  Some chemotherapy drugs will not cause hair loss.  Many do.  Usually you start to feel tingling on top of your head, or your scalp feels more sensitive to touch and/or sore.  Then the hair loss starts.

Most women want to get wig procurement done asap.  Everyone wants to get the wig in place and ready for when the first hair starts falling out. The first person I would call would be your hairdresser. See if your hairdresser has any suggestions for wig shops.

We usually suggest that you cut your hair or go a little shorter if you have long a Ginnifer Goodwin kind of length.  This is because hair tends to come out in clumps.  My patients have told me that this is what they find most depressing. They see straggly long hair clumps in their shower or on their clothes or it has fallen off into their food. With the shorter hair, they have told me it is less traumatic.  It looks better than to have long thin strands with spots that are bald.  Some patients just shave their heads right off the bat and feel liberated in a way, but most of my patients like to ease into it a bit with the short look first. It is a personal choice and everyone is different.

Wigs: Yes, you need a prescription.  Your doctor or NP has to write a prescription for a "cranial or hair prosthesis" due to alopecia due to chemotherapy and it will be covered. Don't worry...they know what to write. You don't need the prescription to just go try on wigs.  But, you will need the prescription to either fax or bring to the wig place if you are ready to order the wig.

Definitely bring a friend that you trust with you. You are going to want their opinion on how things look. I would say where you get the wig doesn't matter as much as making sure you take it to your hairdresser for shaping after you buy it. The shaping or layering makes it look more real. This is because the shape is never really right when you first see it out of the box. It always looks a little too thick on top. Your hairdresser can style it for you. I've seen some ladies get creative with $40 wigs and you would never know it was a wig. And I have seen some $600 wigs that just look like bad wigs.

Many of my ladies get their "expensive" wig and then play around with a few "cheaper" versions/styles too. On the positive side....if you ever thought about going a different color or style, now is the time to try it out!!!

Don't be afraid to ask other ladies in the waiting rooms at your cancer center if you see an awesome wig that you like. I can't tell you how many ladies have found good wig shops that way.

The good part of getting your wig at one of the medical facilities is that they are experienced with the whole insurance reimbursement part of it and will often bill your insurance company directly for you, saving you the hassle of trying to get reimbursement. Depending on what your health insurance is, you should get some money toward it or complete coverage for one wig. 

Also make sure that you get the "cap" that goes under the wig, as a lot of my women say the wig can get scratchy on your head without it. There is also kind of a gel headband that can help hold your wig in place.

All of this being said,  most of my patients take off their wigs the minute they get home. Get a few cotton scarves or caps for around the house for comfort. Silk can tend to slide on your head. Cotton is soft, tends to stay in place better and can absorb perspiration if your head gets too hot.

Here is the link for the wig catalog TLC which is basically connected with American Cancer Society.  These are reasonably priced wigs and headwear.

Also some of my ladies prefer to wear a ballcap or hat and just velcro a "strip of hair" along the inside lining.  The hair strip has velcro on the top and the hat has velcro on it too. So basically your head can breathe in a nice soft hat, but you can have the look of bangs if you want to.  It doesn't look as stark as a baseball cap alone.

I haven't known anyone to try these, but they are based on the same principle as the bangs above.  They allow the top of your head to "breathe" but still make you look like you have hair.  If you lose your hat, you are apt to look like a Benedictine Monk, so maybe not the best on a windy day : )

Here are just some nice soft caps. Some may not win any fashion awards, but there are also some that look soft and comfy and are cute too.

The American Cancer Society may have some wigs available for you, depending on the state.

Try to remember this.  When chemo is over, you will get your hair back.  You will get your hair back.  You will get your hair back.  Your hair may come back a different texture, color or curlier, but you will get it back.  It may be a little patchy at first, but you will get it back.   Your baldness is temporary. 

One final note....and it's just my opinion, but if Jaclyn Smith wigs look this bad on Jaclyn Smith, there is no hope that they are going to look decent on the rest of us!!!


I'll cover cryo caps that can sometimes prevent some hair loss in a separate post.  These have not been FDA approved for anyone receiving Adriamycin, Doxorubicin, Doxil therapy.

If you have long hair and want to cut your own hair off and use it, see my post:  "So Smart".

Hope this helps!

Updated: 6/5/2020.

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