Hair Loss in Lung Cancer Treatment: What to Expect and How to Manage It

Hair loss (alopecia) can happen with certain lung cancer treatments, but it’s not universal and depends on the specific therapy you receive. Some chemotherapy drugs commonly used for lung cancer can cause temporary hair loss because they affect fast‑growing cells like hair follicles. ^[1] Targeted therapies for lung cancer generally do not cause hair loss, and immunotherapy causes it rarely. ^{[2] [3]}

How Common Is Hair Loss by Treatment Type?

• Chemotherapy: Hair loss is a known side effect of several lung cancer chemo regimens. It usually begins about 2–3 weeks after the first cycle and is typically temporary, with regrowth a few months after finishing treatment. ^{[1] [4]} Examples of lung cancer regimens associated with hair loss include combinations like cyclophosphamide, doxorubicin, vincristine (CAV) and cisplatin with irinotecan in small cell lung cancer. ^{[5] [6]}

• Targeted therapy: These medicines are designed to act on specific cancer mutations and, in general, do not cause hair loss. ^{[2] [7]}

• Immunotherapy: Immune checkpoint inhibitors rarely cause hair loss; reported rates are around 1–2% across cancers. ^[3]

Timing and Recovery

• Onset: Hair thinning or loss often starts 2–4 weeks after starting chemotherapy. ^[4]
• During treatment: Hair loss can progress and may involve scalp and body hair. Scalp tenderness is possible during shedding. ^{[6] [5]}
• Regrowth: Hair typically grows back several months after the last chemo, sometimes with a different color or texture. ^[4]

Practical Management Strategies

Everyday Hair and Scalp Care

• Gentle care: Use mild, fragrance‑free shampoo and conditioner every 2–4 days; avoid harsh treatments like dyes, bleaches, and perms. ^{[4] [6] [5]}
• Protect the scalp: Shield your scalp from sun and cold with hats, scarves, or wigs; use UV‑protective hair products when outdoors. ^{[4] [6] [5]}
• Comfort measures: A soft brush and loose hairstyles can reduce tugging on fragile hair. ^{[6] [5]}
• Planning ahead: If you have long hair, cutting it shorter before chemo can make shedding feel less dramatic and easier to manage. ^[4]

Scalp Cooling (Cold Caps)

• What it is: Scalp cooling lowers scalp temperature before, during, and after chemo to reduce blood flow to hair follicles and may help preserve hair. ^[8]
• Effectiveness: Results vary by chemo type and dose; studies show many people lose less hair and use wigs less often with scalp cooling. ^[9] It tends to work better with shorter regimens, single‑agent, and non‑anthracycline therapies, and can be beneficial for lung cancer regimens with high alopecia risk. ^[10]
• How it’s done: A cooling cap or machine is used consistently throughout each infusion; multiple frozen caps may be needed to keep the scalp cold the entire session. ^[11]
• Evidence overview: Randomized and controlled trials across cancers support scalp cooling’s ability to reduce chemo‑induced alopecia, though success rates vary. [PM20] [PM21] [PM23] [PM24]

Wigs, Head Coverings, and Cosmetics

• Wigs and toppers: Exploring wig options early can ease the transition; many centers offer fittings and guidance. Head coverings (scarves, beanies) provide warmth and sun protection. ^{[6] [5]}
• Brows and lashes: Gentle cosmetic techniques or temporary solutions can help if thinning occurs.

Emotional Support

• Alopecia can feel distressing, and seeking support through counseling, peer groups, or oncodermatology services can help maintain quality of life during treatment. ^{[12] [13]}

When to Talk to Your Care Team

• Before treatment: Ask whether your planned regimen commonly causes hair loss and whether scalp cooling is suitable for you. Discuss timing, logistics, and expected success based on your specific drugs and doses. ^{[8] [10]}
• During treatment: Report rapid or painful hair loss, scalp irritation, or any skin changes so your team can suggest supportive care. If you are using scalp cooling, ensure correct fit and consistent temperature throughout sessions for best results. ^[11]

---

Quick Reference: Hair Loss Risk by Therapy Type

Therapy type	Hair loss risk	Notes
Chemotherapy	Moderate to high (regimen-dependent)	Often starts 2–4 weeks after first cycle; temporary; regrowth after completion. [1] [4]
Targeted therapy	Low	Generally does not cause hair loss in lung cancer treatments. [2] [7]
Immunotherapy	Very low (~1–2%)	Alopecia is uncommon with checkpoint inhibitors. [3]
Scalp cooling (supportive)	Reduces risk	More effective with certain regimens; requires proper timing and continuous cooling. [10] [8] [9] [11] [PM21]

---

Key Takeaways

• Hair loss is common with some lung cancer chemotherapy but not with all treatments. ^[1]
• Targeted therapy typically does not cause hair loss, and immunotherapy does so rarely. ^{[2] [3]}
• You can manage and often reduce hair loss with gentle care, scalp protection, and scalp cooling, and hair usually grows back after chemo ends. ^{[4] [8] [9]} [PM21]