Can immunotherapy cause hair loss as a side effect? How to cope

Yes immunotherapy can cause hair loss, but it’s less common than with chemotherapy. Hair changes from immunotherapy are usually mild and occur in a small percentage of people, often due to immune effects on hormones like the thyroid or from autoimmune-type reactions in hair follicles. ^[1] Hair loss can also occur during cancer treatment from other causes such as chemotherapy, endocrine therapy, or radiation to the head, so it’s important to identify the true cause. ^[2]

How common is hair loss with immunotherapy?

• Overall frequency is low (about 1–2% with immune checkpoint inhibitors). This is much lower than with typical chemotherapy regimens. ^[3]
• Other cancer treatments can also cause hair loss (chemotherapy, endocrine therapy, radiation to the head), so if you’re receiving combination therapy, multiple factors may contribute. ^[2]

Why immunotherapy can cause hair loss

• Immune‑related endocrine changes (especially thyroid problems) can trigger hair thinning or loss; symptoms may include fatigue, feeling cold, constipation, weight change, and hair loss. ^[1]
• Autoimmune attack on hair follicles (alopecia areata) can happen, leading to patchy hair loss on the scalp, brows, or lashes. ^[4]
• Contributing non‑treatment factors include family history, vitamin deficiencies, and hormonal changes, which may coexist with cancer therapy. ^[5]

What hair loss looks like

• With immunotherapy, hair loss is often patchy or thinning rather than complete, and may evolve gradually. ^[3]
• If chemotherapy is also given, hair loss can be more rapid and widespread (scalp, brows, lashes, body hair). ^[6]

When to contact your care team

• New or worsening hair loss plus symptoms of thyroid issues (extreme tiredness, feeling cold, weight changes, constipation, dizziness) should prompt thyroid testing. ^[1]
• Patchy hair loss suggestive of alopecia areata should be evaluated, as targeted treatments are available. ^[4]

Coping strategies and treatments

Gentle hair and scalp care

• Use a mild, fragrance‑free shampoo and conditioner; wash every 2–4 days, rinse well, and pat dry with a soft towel. ^[7]
• Brush gently with a soft‑bristle brush; start at the ends and work up to reduce breakage. ^[7]

Cosmetic options

• Consider shorter hairstyles to make thinning less noticeable and easier to manage. ^[8]
• Use camouflage products (hair fibers, tinted sprays) to cover thinning areas and improve confidence. ^[8]
• Wigs, scarves, and hats are effective, comfortable options while hair recovers. ^[9]

Scalp cooling

• Scalp cooling helps reduce chemotherapy‑related hair loss, but evidence for immunotherapy alone is limited; it may still be considered if chemotherapy is part of your regimen. ^[8]

Treat underlying causes

• If thyroid dysfunction is found, treating the thyroid problem can improve hair health over time. ^[1]
• For alopecia areata patterns, dermatology treatments may include topical medicines, steroid injections, or other therapies, and hair often regrows over months. ^[4]

Emotional support

• Hair loss can be distressing; support groups and counseling can help you cope during treatment. ^[9]

Will hair grow back?

• Regrowth is common, especially when an underlying trigger (like thyroid dysfunction) is treated or when alopecia areata is mild. ^[4]
• With chemotherapy, hair usually starts to regrow within weeks after treatment ends, though texture and color can change. ^[10]

Practical checklist for you

• Track hair changes and any new symptoms (fatigue, cold intolerance, constipation, weight change). ^[1]
• Ask your team about thyroid labs if you notice hair loss with systemic symptoms. ^[1]
• Consider a wig consult or hair camouflage options early to plan ahead. ^[9]
• Use gentle hair care routines consistently during treatment. ^[7]
• If hair loss is patchy, request a dermatology referral to discuss targeted treatments. ^[4]

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Quick comparison: hair loss by treatment type

Treatment type	How often does hair loss happen?	Typical pattern	Notes
Immunotherapy (immune checkpoint inhibitors)	Uncommon, about 1–2%	Thinning or patchy (autoimmune‑type)	Check for thyroid or autoimmune causes; dermatology may help. [3] [1] [4]
Chemotherapy	Common (varies by drugs; often significant)	Diffuse scalp and body hair loss	Scalp cooling may help; regrowth usually begins weeks after completion. [6] [8] [10]
Endocrine therapy	Possible	Thinning	Slower, milder changes; supportive hair care and cosmetics. [2]
Radiation to head	Common in treated field	Localized to radiation field	Regrowth depends on dose and area treated. [6]

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Key takeaways

• Immunotherapy can cause hair loss, but it’s relatively uncommon and often linked to immune effects on the thyroid or hair follicles. ^{[1] [3]}
• Most people can manage it with gentle care, cosmetic options, and by treating underlying issues like thyroid dysfunction or alopecia areata. ^{[7] [1] [4]}
• If hair loss is sudden, patchy, or accompanied by systemic symptoms, tell your care team promptly so they can evaluate and treat the cause. ^{[1] [4]}