Before your hair falls out, your scalp often starts to tingle and in some cases it can feel tender, tight, prickly or sore, a bit like you've worn a tight ponytail for three days straight. It usually starts a week or two into treatment, and it's your follicles reacting. It passes, and it's completely normal, though it's an unsettling thing to experience when nobody's mentioned it might happen.
Once the hair goes, you're left with skin that's never been exposed before. It might become dry, sensitive, and will need protecting from direct sunlight too. Looking after it properly will make a real difference to how comfortable you feel.
Wash gently, and less often than you think
Your scalp doesn't need a lot of fuss or fancy products while you're in treatment.
- Use lukewarm water rather than hot, because heat can make the tenderness worse
- Choose a mild, fragrance-free shampoo or ph neutral shampoo
- Use your fingertips, not your nails when washing, and don't scrub the skin
- Rinse properly, since leftover product is a common cause of itching
- Pat dry with a soft towel rather than rubbing
Washing every two or three days is plenty for most people. If your scalp is bare, you may find you dont need much shampoo at all and a rinse does the job.
Coping with hair loss while your hair is coming out
The shedding stage is messy and can be upsetting, but there are a few things that make it easier.
Use a soft baby brush or a wide-tooth comb and be gentle when brushing your hair - it is important to brush it to remove any hair that has shed and prevent matting.
A satin or silk pillowcase creates less friction than cotton and can be more comfortable. Some people sleep in a soft cap simply to contain hair as it falls out overnight, which sounds like a small thing, but it can make it easier and less traumatic to clean up the following morning.
Put away the dye, bleach, perms and anything harsh for now. Same goes for tight ponytails, clips and grips.
Should you cut your hair before chemo treatment?
Lots of people decide to cut their hair short early, or shave it, rather than watch it come out. There's no right answer here. Some find it puts them back in control. Others want to keep their hair as long as possible.
If you do decide to take it off, clippers are a must - do not use a wet razor. A grade two or three leaves a soft covering, and there's no risk of nicks and cuts. That matters, because your immune system is lower during treatment and any break in the skin is a way in for infection.
How to keep a bare scalp comfortable
Once your hair has gone, treat your scalp like the delicate skin it is.
Moisturising. A light, fragrance-free moisturiser helps with dryness and flaking. Check with your team before you start anything new, and never put moisturiser on broken or weeping skin.
Sun. This one catches everybody out. Bare scalp burns extraordinarily fast, and some chemotherapy drugs make your skin more sensitive to sunlight anyway. A hat is far better protection than sun cream, and you'll want one even on a cloudy British afternoon. If you're using sun cream too, ask your team which is suitable.
Cold. You lose a surprising amount of heat through your head. People are often astonished by how cold they feel that first winter. A soft hat indoors is not a sign you're being dramatic.
Itching and flaking. This is common, but try not to scratch. If it's severe, or your scalp is red, weeping, spotty or painful, tell your team rather than treating it yourself.
If you're using a cold cap
Scalp cooling means you may keep some or all of your hair, and it also means your scalp needs extra care.
Wash your hair less often, use lukewarm water and a very mild shampoo, and skip heat styling completely. Be gentle when you brush your hair too so you dont inadvertently pull fragile hair out. Your radiographers or chemo nurses will give you specific advice for the cap you're using, so make sure you are familiar with the instructions.
How to choose chemo headwear that supports you
A woolly hat, a scratchy label or a rough seam sitting against a tender scalp will drive you mad within an hour. What you want is:
- Seam-free construction, so there's nothing rubbing against the skin
- Soft natural fabric, with bamboo and cotton jersey both breathable and gentle
- A full or partial lining if you have a sensitive scalp
- No labels, or labels printed/easily removable
- Something that pulls straight on, because fiddling with ties is the last thing you want on a bad day
Our chemo hats and head scarves are all made this way, and several of the hats double as a sleep cap for cold nights.
Have more than one. Whatever you're wearing sits against your scalp all day, so you'll want to wash them regularly, which means having something else to put on.
Keeping warm at night
Night-time is when people notice the cold most. A soft sleep cap keeps your head warm without the weight of a hat.
If night sweats are a problem, and they often are, bamboo is a good choice because it breathes well and doesn't hold heat.
Ring your chemo helpline or speak to your nurse if:
- Your scalp is red, hot, swollen or weeping
- You've got spots, sores or crusting
- The skin has broken anywhere
- You have a temperature
- The tenderness is severe or getting worse rather than better
After treatment finishes
Your scalp needs a little while to settle. Keep the gentle shampoo and the sun protection going, because new skin and new hair are both fragile.
When regrowth starts, resist the urge to attack it with product and heat. There's more on what to expect in our guide to when to get your hair cut after chemo.
Frequently asked questions
Why does my scalp hurt before my hair falls out? Tenderness in the days before shedding starts is very common and comes from the follicles reacting to treatment. It usually eases once the hair has gone.
What shampoo should I use during chemotherapy? Something mild and fragrance-free and PH neutral. Avoid medicated or strongly scented products unless your team has recommended them.
Should I shave my head during chemo? It's a personal choice and there's no medical need to. Many people find clipping it short feels better than watching it come out. Clippers are safer than a wet razor because they don't nick the skin.
Can I put sun cream on my bald head? Ask your team which product is suitable, as some chemotherapy drugs increase sun sensitivity. A hat gives better protection than cream alone, and a bare scalp burns very quickly.
How do I stop my scalp itching during chemo? Usually it's dryness. Gentle washing, a fragrance-free moisturiser and avoiding scratching all help. If the skin is red, sore, spotty or broken, speak to your team.
