Managing Hair LossA guide to managing hair loss during and after cancer treatment

Produced through generous support from Philip Kingsley

If you are under medical supervision, it is important that you discuss any side effects of your treatment and possible adverse reactions to cosmetic and toiletry products with your doctor. Your doctor must resolve any questions you have about which products are appropriate for use during your therapy. Look Good Feel Better and Philip Kingsley make no representations, express or implied warranties or endorsements regarding the products or procedures mentioned in this booklet and can accept no liability or responsibility for any injury, loss or damage, whether consequential or otherwise, suffered as a result of the advice given herein.

contents

Message from Look Good Feel Better

The experts at Philip Kingsley

What is Trichology?

Why do Chemotherapy and Radiotherapy cause hair loss?

Dealing with the emotional aspects

Case studies

Making decisions

Caring for your hair and scalp

Being bold and bald

Choosing and styling wigs

Creative head coverings

Advice for men

Nutrition

Directory

Acknowledgements

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Look Good Feel Better UK offered its first free skincare and make-up workshop at the Royal Free Hospital in London in 1994 and since then has increased its reach to nearly 100 hospitals and cancer care centres around the UK. The Programme also offers Masterclasses in less accessible areas and a self-help Confidence Kit for cancer patients to view in the comfort of their own homes. Look Good Feel Better’s unique Programme is operational in 26 countries and we are proud that we have reached nearly 2 million women face to face and many thousands more through our online services.

Message from Look Good Feel Better

Research studies clearly demonstrate the strong link between feeling confident in your appearance and personal self-esteem and this is endorsed by medical professionals. LGFB Workshop beneficiaries constantly tell us that learning new make-up and skincare skills and tips and, as importantly, sharing a positive experience with other women undergoing cancer treatment can give a real boost to confidence. For family and friends, seeing someone they love looking better and feeling more confident is also very beneficial.

Whilst the focus of the LGFB Programme is on skincare and make-up, we know that hair loss is a side-effect of cancer treatment that many people find very difficult to cope with.

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This booklet on Managing Hair Loss has been produced with the expertise and generous support of leading trichology and specialist hair care company, Philip Kingsley. Internationally renowned trichologists, Anabel Kingsley and Glenn Lyons from Philip Kingsley share their extensive knowledge, explaining why cancer treatment may cause hair loss and how you can best care for your hair and scalp before, during and after treatment. There’s also plenty of practical advice on being ‘bold and bald’, expert tips on choosing and styling wigs and being creative with a variety of head coverings.

Our grateful thanks to the Philip Kingsley team, to Maureen Royston-Lee, Lead Consultant Counselling Psychologist for Cancer Services at HCA, to wig suppliers’ Trendco, to our LGFB beneficiary ‘models’ and very special thanks to Emma, Latifa and Neil for sharing their stories on how they coped with and managed their hair loss. We hope that their stories will inspire and help you.

Sarahjane Robertson

Executive Director, Look Good Feel Better UK

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Glenn Lyons is Clinical Director at Philip Kingsley, having first qualified from the Institute of Trichologists in 1968, where he served as a governor for 10 years. He has been a practising consultant at the Philip Kingsley Clinic since qualifying and has had clinical research papers published in Medical and Scientific Journals, culminating in being awarded a Fellowship of the Institute of Trichologists in 2004. A member of the Royal Society of Medicine and the Society of Cosmetic Scientists, as well as being a Fellow of the Royal Society of Public Health, Glenn is recognised both nationally and internationally as a key authority on hair and scalp health, particularly for his specialist area of hormone-related female hair loss.

We dedicate this Hair Loss booklet to Philip Kingsley, the world’s most renowned trichologist - known as the ‘hair doctor to the stars’ - who sadly passed away during its production. Aged 86, he was still actively involved with the Trichological Clinic he founded in 1957 and his company.

The Experts at Philip KingsleyWe are indebted to Philip Kingsley, the leading authority in hair and scalp health, for sponsoring this LGFB Hair Loss booklet and in particular appreciate the extensive knowledge and expertise that Anabel Kingsley and Glenn Lyons have provided.

Anabel, a qualified trichologist and Director of Communications, started her career at her father’s eponymous Hair Clinic in 2006, moving to New York to manage the New York Trichological Clinic for three years. With a First Class Degree with Honours in History, specialising in the History of Medicine, she is an Associate Member of The Institute of Trichologists, having graduated with a distinction, as well as receiving ‘The Award of Excellence’.

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What is Trichology and what causes hair loss?

Hair loss resulting from chemotherapy can be the most distressing of all. Not only is an individual having to cope with their diagnosis, but they also have the worry of losing their hair. Women may feel their femininity has been taken away, and experience an unsettling shift in self-image. Men may feel a loss of masculinity and worry about how others will perceive them.

Whether someone will lose their hair during chemotherapy is unpredictable. Some people may experience total loss of body hair, total or partial loss of scalp hair and/or facial hair, or may not experience hair loss at all. What we know for certain is that hair loss from chemotherapy is almost always temporary – and psychological support alongside access to reliable information is very important. Equally essential is a comprehensive guideline for taking care of your hair and scalp during and after chemotherapy and radiotherapy treatments.

Trichology is the scientific study of the hair and scalp. As trichologists, we treat all types of hair and scalp disorders ranging from purely cosmetic hair concerns to serious scalp conditions. The main problem we address, however, is alopecia – which describes ANY type of hair loss. Regardless of the cause, alopecia is often extremely upsetting. Hair has greater psychological importance than any other part of our body. It influences confidence, sense of self, quality of life and morale.

Anabel Kingsley explains

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Why do Chemotherapy and Radiotherapy cause hair loss?

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Chemotherapy uses anti-cancer drugs to destroy rapidly growing cancer cells. Unfortunately, as these drugs are delivered systemically, they can also affect normal, healthy cells that divide quickly. Hair cells are the second fastest growing cells the body makes, so hair is often affected during treatment and may fall out.

Before you start chemotherapy, your doctor or chemotherapy nurse will discuss the possibility of hair loss and other side effects with you. Not all chemotherapy drugs cause hair loss, and sometimes the loss is so slight it’s hardly noticeable. If you do lose your hair due to chemotherapy, it will almost always grow back when your treatment is over.

Chemotherapy

The hair growth cycle consists of four distinct stages; Anagen (growing), Catagen (transitional), Telogen (resting) and Exogen (shedding).

Certain anti-cancer drugs can cause hairs to fall out during the Anagen phase, when they are usually growing. This is known as ‘Anagen Effluvium’.

As the hair does not complete its normal growth cycle, and bypasses the other phases, hair loss can occur quite soon after starting treatment.

Chemotherapy and the hair growth cycle

The hair growth cycle

ANAGEN (growing)

CATAGEN (transitional)

TELOGEN (resting)

EXOGEN (shedding)

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If your hair is going to fall out, it usually does so within 2-3 weeks of starting chemotherapy, although very occasionally it can start within a few days.

Chemotherapy may also cause loss of body hair, such as loss of eyebrow, eyelash, armpit, arm, leg and pubic hairs. Unlike cancer cells, however, the normal cells quickly recover, so if you lose your hair due to chemotherapy, it is almost always temporary.

The amount of hair that falls out depends on the drug or combination of drugs used, the duration of the treatment, the doses given and the ways your body reacts to the drug.

The first thing you may notice is that your hair starts to come out more when you brush, comb or wash it. For some, hair may fall out in this way over several weeks until they become completely bald. Sometimes, the hair comes out quickly in handfuls over 1-2 days, which can be very upsetting. You may also find more hair on your pillow in the morning or that your hair gets thinner and becomes dry, fragile and breaks easily. Some people find their scalp feels tender.

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Radiotherapy treats cancer by using high-energy rays that destroy the cancer cells, while doing as little harm as possible to normal cells.

Unlike chemotherapy, radiotherapy is localized and only causes hair loss in the area being treated. For example, if you are having treatment for breast cancer and the radiotherapy includes your armpit, the hair under your arm is likely to fall out. You can ask the radiotherapy staff to show you exactly how you might be affected.

radiotherapy

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Dealing with the emotional aspects

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Are patients generally willing or reluctant to discuss their concerns about the visual and emotional effects of cancer treatment?

After the initial shock of a cancer diagnosis and discussion on the most appropriate form of treatment, it is often the potential side-effects of that treatment that will concern many women. They may be uncomfortable about discussing this initially, as they feel it may come across as vain or that I may be judgemental. When they are given the space to articulate their concerns about their appearance, they talk openly about hair loss, weight gain, changes to their skin and lack of eyebrows and lashes.

Is hair loss the appearance-related side effect of cancer treatment that most concerns patients?

I would say that for most cancers, with the exception of head and neck tumours, hair loss is the most visible effect of the cancer. I often remind my patients that it is the outward manifestation of their cancer treatment and often the first time that it ‘brings it home’ to them that they are receiving treatment for a very serious illness. It can have a profound effect on some patients and can affect the way in which they process the diagnosis and they can feel traumatised by it. For others, it has a much lesser impact and they feel that ‘it is the least of my concerns as I know that it will grow back’. Every patient is different and it is therefore very important to address it with them. We cannot make assumptions.

Talking with family and friends following a cancer diagnosis is vital, but there are also trained professionals, especially cancer nurse specialists, who can help you and your family with the many questions you will have and the different emotions you will experience. Maureen Royston-Lee is Lead Consultant Counselling Psychologist for Cancer Services at HCA (Health Corporation of America) in the UK. She set up the Psychological Counselling, Complementary Therapy and Patient Information services at the Harley Street Clinic over 16 years ago. Here she answers our questions on how patients may feel and react.

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“For every hair I lost, it felt like losing a

part of myself, as if my personality was disappearing away.”

Sonia Goldring-Banachowicz, LGFB Beneficiary

Her husband, Dylan, wasn’t bothered about the hair loss,

he was more worried about how Sonia would cope.

Is hair loss more of a concern for younger or older patients?

One might assume that the younger the patient is, the more difficult it might be for them due to peer pressure, for example. But this is not the case and often one will find an elderly patient will be more concerned about hair loss than younger patients.

How does hair loss impact on different people?

It depends on how important their hair was to them and what it meant to them – for some people, as in Emma’s case (see page 17), it was their ‘identity or trademark’. The meaning their hair has had for a patient will determine their coping mechanisms. Patients who are able to embrace the process and make a decision to use this as an opportunity to try out different hair colour (on a wig) and hair styles will have an easier adaptation to the hair loss.

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Is there a difference between how men and women react?

There is a difference in the way in which men and women react to losing their hair, and their eyebrows/eyelashes. Men on the whole do not seem to be unduly worried or upset by this. They see it as an opportunity to shave their head. There are many high profile men in the world of sport and entertainment who deliberately shave off their hair, so it can be a style statement. However, there are men who may have had a good head of hair and perhaps a beard and moustache, who may feel unhappy that this has now gone (see Neil’s story on page 20).

Does talking to friends and family help?

Nowadays, patients have several outlets in which to discuss any issues to do with their cancer. As well as talking to family and friends, there are excellent cancer charities, support groups, internet chat rooms and often patients will write a blog about their experience. They are more likely, however, to discuss their hair loss issues with friends or other cancer patients rather than with family members as this may be too much of an emotional burden for close family members.

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Is there any advice you give about action to take before treatment begins?

Prior to starting chemotherapy, I would have a conversation with the patient about the likelihood of them losing their hair and what thoughts they might have about preparation in advance on how to manage this hair loss. For patients with long hair, a two-step approach would be advisable. They should consider having a short hairstyle initially to get used to not having long hair and then as soon as their hair starts falling out, to have it shaved off completely. This will avoid the shock of seeing their hair covering their pillow or blocking their shower plug hole, which can be very traumatic.

I also encourage them to look at and try on different wigs in advance and to take a close friend or family member with them, maybe making it into a positive occasion by having a drink or a meal afterwards! Some patients prefer not to have a wig and are more than happy to wear colourful hats or scarves.

How much do the feelings of a patient’s family or partner about hair loss impact on the patient’s decision on how to manage it?

Patients are very mindful of the impact that their hair loss will have on their family. In terms of their partners, patients tend to have these discussions in advance as they are normally well prepared by the medical and nursing staff when they have their pre-chemotherapy talks. With children, the impact will vary according to their ages. Very young children, provided they are involved early in the process, will be quite accepting of their parent’s hair loss (see Emma’s story on page 17). With teenage children, it may be more difficult.

For them, it is very important that their parent looks like other parents and does not stand out as ‘different’. They may be strongly affected by the reactions of their peers. Patients often tell me that they have been ‘instructed’ by their teenage children to wear their wig ‘as soon as the doorbell goes’!

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What about after treatment when hair starts to grow back – often very differently in terms of texture, colour and type? How does this affect people?

Some patients find it very upsetting when they see that their hair is growing back in a very different texture to their ‘normal’ hair. This is particularly true of women who have been dying their hair for many years. They are therefore very shocked to see that they have turned completely grey. Usually it is not advisable to have hair dyed using commercial dyes for some time following chemotherapy. Their nurse or consultant can usually advise them on a suitable alternative (see advice on page 28 & 29).

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Case studies

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LGFB interviewed three of our ‘models’ during our

photographic shoot.

They all really enjoyed the day, trying different wig styles, colours and head coverings and were all

incredibly open and willing to share their experiences of hair loss to

help others going through cancer treatment.

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A month before her wedding, Emma went to her doctor as she had felt a swelling on her face. After an initial diagnosis of glandular fever and some blood tests, she was then referred to a Consultant Haemotologist, who gave Emma the shocking news that she had Non-Hodgkins Lymphoma.

Once the wedding and rather subdued honeymoon were over, Emma went to her own Consultant who advised her that she actually had very rare Mantle Cell Lymphoma and she went through intensive treatment, as well as a stem cell transplant in May 2015.

Emma had always had very long, thick hair which she loved wearing in different ways – it was very much her identity and ‘trademark’. “I had such a lot to deal with, not only with the diagnosis and treatment, that it was very important to me to have a ‘hair plan’, so the first thing I did was cut my hair short and donate it to the Little Princess Trust, a charity that provides real hair wigs, free of charge, for boys and girls who have lost their hair through cancer treatment. This was very cathartic for me. I then went to a wig expert and bought a wig that my hairdresser cut and styled similar to my normal look. My wig was like a ‘comfort blanket’ and part of my armoury against the cancer.”

Once Emma’s treatment had started, she found it very annoying that her hair just fell out in clumps – “It was dreadful – I couldn’t even make my son’s breakfast because my hair kept falling onto the toast! So, one day I decided the time was right and I was ready to shave my head! I put on my make-up, complete with false eyelashes and bright lipstick and told my husband Liam and my 5 year old son, Milo, that I’d like them both to help me shave my head – I wanted it to be a positive experience for us all. Afterwards, Milo said me, ‘Mummy, you look so beautiful’ and in fact I did feel wonderful, so liberated and sexy!”

Emma McHugh’s Story

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“When I was out, I wore my wig, because it was in my normal style and no-one would know what I was going through - ‘put a smile on, put my wig on’ – although Liam did encourage me to open the door

without it and not worry about what delivery men might think! And every night, Milo would kiss my head goodnight.”

Emma recently received the wonderful news that she is now in remission and although it took her a while to get used to her new hair growing through, she now loves her new short crop. “When I first lost my hair, I felt I had lost my femininity and I never would have thought I would love my new short style – but I do!”

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Sixteen-year-old Latifa was diagnosed in March 2014 and came to London for treatment from her home in Dubai. “When I started the treatment, I didn’t really focus on the possible side-effects, but the day my hair started falling out, I felt very confused, angry and frustrated. Before I was diagnosed, I had really long hair almost down to my hips! Once it started falling out, I had it cut to shoulder length. My eyebrows also fell out, but I just left them.”

Latifa’s mother tried to explain that the hair loss was temporary,“Latifa was very brave about it. It was very difficult for her as she was away from home and all her friends.”

Latifa started wearing ‘sheilas’, rectangular headscarves used to cover the head, then experimented with a whole collection of beanies and bandanas. “I knew I had to face the hair loss, but I didn’t want people to see me bald.”

By the time she went back home, her hair had grown back, but sadly, in January 2016, Latifa had to come back to London for more treatment. “I felt very depressed this time, especially when my hair fell out again.” With help and support from her parents and the hospital team, Latifa overcame her feelings and, with her artistic flair and love of fashion, she now creates her own style of turbans and other head coverings, sometimes wearing these together with one of her two beautiful wigs. One of these is sleek black and almost as long as her own hair was.

Latifa has helped to encourage some young patients at the hospital who are going through treatment and hair loss. “I talk to them about the treatment and how I’ve coped and that it’s nothing to worry about. The hair loss is temporary. One girl I spoke to really wasn’t sure about starting treatment, but after I spoke to her and helped her, I heard that she had gone ahead with it. So I felt very happy about that.”

Latifa Saleh’s Story

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“I now have a small tuft of hair on the top of my head and I’m not ashamed of how I look – it almost feels like a ‘badge of honour’ after what I have been through. My wife Hannah has been amazing all the way through this experience and loves my new look. She just said, ‘let’s rock that look for a while!’ My boss thought I might need a new job in Media or that I should consider joining a boy band! Now I am comfortable with my new look; my main concern is that I don’t want to look like ‘sick Daddy’ just ‘different Daddy’ to my boys.”

Neil believes it is much easier for men to cope with hair loss than women. “Many of my friends lost their hair in their twenties and these days, younger guys can have shaved heads and there is no stigma attached. Nevertheless, I was shocked at my reaction to my hair loss. I thought I would be OK, but because it happened so quickly and made me look ill, I couldn’t wait to get it cut and sorted out.”

Neil is a 42 year old husband and father of two young sons who, in May 2016, was diagnosed with a Glioblastoma, a type of brain tumour. He has subsequently undergone surgery, followed by chemo- and radiotherapy. Before surgery, Neil’s head was shaved in patches to prepare for the incisions and he was left with stitches and a large scar, post-operation. “My head was a real mess after the operation but it healed quickly and my hair grew back within weeks. By covering up with a hat, I was comfortable to go out and not be stared at.”

“It was during radiotherapy that my hair loss was more extensive. The nurses explained to me that after three or four weeks, my skin would begin to itch and my hair would start to fall out. And that’s exactly what happened but I was still surprised at how quickly it happened. My head started feeling itchy and within a few days, my hair was coming out in clumps where I had been zapped. About two-thirds came out in one go while I was shampooing! I was a bit shocked as I went from looking normal to looking ill within the space of 10 minutes. It had a visible impact on my wife and kids and I was immediately conscious of people looking at me.”

Neil’s first reaction was to go to the hairdresser and have his hair cut, which made him feel better. He was wearing his hats again to cover up and protect his head from the summer sun and he decided to buy a Trilby for each of his sons, so they could look like Daddy too.

Neil Appleby’s Story

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Making decisions

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There are three main ways to manage hair loss:• Opting for the natural route and being bold

and bald

• Being clever with wigs and styling – and maybe having a whole array of different looks

• Getting creative with different headwear, coverings and accessories

Or, there’s no reason why you couldn’t try a combination of all three – perhaps a wig for when you’re at work or out and about; wearing scarves or other head coverings at the weekends and being bald when you’re relaxing at home. Trying to make a positive out of something that you cannot change will help you cope better and, in turn, seeing you confident and in charge of your looks will help your family deal with the ‘new’ you, while you are going through your treatment.

Whatever route you decide on, caring for your hair and in particular your scalp is all important and the following pages provide expert advice from Anabel Kingsley, qualified trichologist and Director of Communications and Glenn Lyons, Senior Consultant Trichologist and Clinical Director at the Philip Kingsley Trichological Clinic.

As our case studies illustrate, there is no right or wrong choice when it comes to deciding how you are going to manage hair loss. Ultimately, it should be your own decision, made after careful discussion with your family and friends and with help and advice from your cancer support team.

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Caring for your hair and scalp

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Preparing for hair loss

Whether you wear a wig, hairpiece or scarf to cover your scalp during treatment or choose to be bold and bald is a personal preference. Choose what you feel most comfortable with; there is no right or wrong decision.

Your cancer nurse specialist will be able to advise you if you are likely to lose your hair once your specific treatment is confirmed. If you are told you will have hair loss, you may wish to have your hair cut short before your treatment starts. If your hair is shorter, it will feel like you are losing less hair. If you’re used to having long hair, you may find it easier to have it cut in stages. Some people prefer to shave their head before treatment, which they say gives a sense of control over what is going to happen. If you do not want to cut your hair for cultural or religious reasons, you may find alternative headwear helpful. Again, it’s important to emphasise that hair loss does not happen to everyone and the degree of loss can also vary depending on the treatment you are having.

“ I was devastated about hair loss. I had long, dark red, curly gypsy hair and I

thought that losing it would be like losing part of me. I had 2 wigs, but haven’t worn them. At home I leave my head bare, but

wear various scarves when I go out.

Day 16 of treatment I went and had my head shaved, but I had to wash and

condition it one more time beforehand. I had to say ‘goodbye hair’.”

Jo Seager, LGFB beneficiary

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Cold caps and scalp cooling

By cooling the scalp during chemotherapy it is sometimes possible to reduce the amount of chemotherapy drug that reaches the hair follicles on your scalp. This often minimizes hair loss and can, in some cases, prevent it altogether.

Scalp cooling is only effective when used with certain chemotherapy drugs and it’s not always possible to know how effective the treatment will be. Scalp cooling is not advisable when treating some types of cancer and some hospitals don’t have the necessary facilities. Your doctor or chemotherapy nurse can tell you if it’s available and whether it’s appropriate for you.

Scalp cooling can be done in two ways:

One is with a ‘cold cap’ that is fitted with Velcro, filled with cold gel and placed on the head. The other is with a refrigerated cooling system which pumps a liquid coolant continuously through the cap.

Both methods of scalp cooling need to be worn for up to 30-40 minutes before your chemotherapy drugs are given and for some time afterwards. You may have the cap on for a few hours in total. You might feel very cold during the treatment, but the chemotherapy staff will do all they can to make you as comfortable as possible.

Preventing hair loss during chemotherapy

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You may not lose your hair during treatment, but sometimes the texture and condition may change temporarily.

If your hair is dry or brittle during or after cancer treatment, there are steps you can take that will help benefit its condition:

• Your skin may be more sensitive, so only use gentle hair products and non-medicated shampoo

• Avoid massaging your head. Hair growth after chemotherapy will be shorter and often much finer, so massaging could cause damage

• If you’re having radiotherapy to your head, check with the radiotherapy staff whether you can use shampoo and if so, which type

• Be gentle when you brush and comb your hair. Use a brush with wide, rounded prongs, or a wide-tooth comb. Avoid brushes with sharp or metal prongs

• At night, consider wearing a turban or soft cap to stop your hair becoming tangled and to collect any loose hair. It will also help to keep your head warm

• Try to eat a well-balanced diet with plenty of fruit, vegetables, protein, carbohydrate and iron-rich foods

• Avoid using excessive heat from hairdryers, hair straighteners or heated rollers. This can dehydrate and weaken the hair and make it brittle and break

• If you put your hair up, wear it loosely and secure it with a soft, fabric covered hair tie or plastic clip. Don’t wear your hair in a tight style or tight plaits, or use rubber bands. These can be damaging

• DO NOT perm or colour your hair during treatment

Looking after your hair during treatment

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Your skin could be more sensitive on areas where you have lost hair, so it’s important you take extra care of it.

• If you lose your underarm hair, avoid perfumed deodorants. Instead, opt for baby powder or deodorants made from natural mineral crystals

• If your scalp gets dry, flaky or itchy, use a gentle unperfumed moisturiser, such as E45 or aqueous cream. Do not apply oils. If you are having radiotherapy, always check with the radiotherapy staff before using anything on your skin

• Use pillowcases made of 100% natural fibres, such as cotton, silk or linen. Man-made fibres like nylon and polyester can irritate the scalp

• On sunny days, cover your head with a hat to protect your skin from burning. If you don’t want to cover your head, use a sun cream with a sun protection factor (SPF) of at least 30. Re-apply as per the instructions on the bottle or tube

• If you swim, avoid chlorinated pools. Chlorine can irritate the skin. Always consult your specialist before doing any exercise

Protecting your scalp when wearing a wig

The linings of wigs can irritate the scalp, so it may be helpful to wear a thin, cotton wig liner underneath. These are usually available from wig suppliers. However, liners can make it more likely that a wig will move around, so you may need to experiment to find out what works best for you. Be aware that your scalp may sweat more when you wear a wig, so you’ll need to wash the wig regularly. Try to gently cleanse your scalp daily if possible.

Looking after your scalp and skin

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How long will it take my hair to grow back?

Any hair loss from chemotherapy treatment will almost certainly grow back. At first, hair will often be very fine, but it is extremely unlikely for hair not to ultimately return to what it was like before chemotherapy treatment. Hair grows approximately 1-1.5cm a month, so it is likely you will have a full head of short hair within 3-6 months.

Will the texture of my hair change?

When your hair first grows back you may find it is curlier, straighter or finer than it was before and it may also be a different colour. However, depending on your treatment schedule, hair should grow back and revert close to normal within 12 months.

Gradually your hair will become thicker and as soon as it’s long enough to style, you may no longer want to wear a wig or head covering. Having your hair styled by a hairdresser who knows you and understands your situation can be very helpful. Often people who were used to long hair find that a shorter style suits them. Your hairdresser can help you choose a style.

Hair products

As your hair grows back, and provided your scalp is healthy, you can use a shampoo, conditioner and styling products that are suitable for your hair and scalp’s condition and texture. These can be used on a regular basis without any problems. But, if you notice that your scalp becomes irritated or the condition of your hair changes, seek advice from a professional trichologist or nurse specialist.

Taking care of your hair post-treatment

Hair should grow back and revert close

to normal within 12 months

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Perming, colouring or chemical straightening

You should NEVER have your hair chemically processed during chemotherapy, as it may be weak and react differently to the chemicals. Your scalp may also be very sensitive. However, once your hair is about 3 inches (7.5cm) long, which should take roughly 6 months, and your scalp is in healthy condition, you can do so – but take the following steps.

Firstly, let your hairdresser know that you have had cancer treatment - and check with a professional about ingredients in dyes, processes etc.; many products, even those labelled ‘natural’, can contain chemicals that may cause an allergic reaction. Ask your hairdresser to be particularly attentive and to test for a reaction before your first treatment.

If you apply permanent colour, you must do a ‘patch test’ beforehand to check for sensitivity - even if you have used the same product before. This involves applying the colour on a small, hidden area of skin behind your ear or on your forearm 48 hours before applying it to your hair. If a patch test doesn’t cause irritation, it’s safe to apply the colour. If you’d like to bleach or highlight your hair, ask your hairdresser to do a strand test. Colour may produce a different shade or texture than it did before chemotherapy. This also applies to henna, where the colour may be more intense after chemotherapy treatment.

If you experience one of the following issues, it is especially important to seek advice from a professional trichologist, your hairdresser or doctor, before treatment:

• Your scalp is scaly, sore or irritated

• Your hair is very rough to the touch

• Your hair is drier than usual

• Your hair appears to be breaking or not growing normally

• Your hair is lighter in colour than it was before treatment

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Being bold and bald

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Deciding to be bald can be the simplest – some people describe it as very liberating - and there are obvious advantages. It’s easy and comfortable and you don’t have to worry about cleaning your wigs or making decisions each day on what head covering to wear.

Some women take the focus away from their head and hair loss by wearing colourful tops, bright scarves or unusual necklaces. You can also use make-up to give a new definition to your face – perhaps wearing more eye make-up or a brighter shade of lipstick and recreating eyebrows.

Visit www.lgfb.co.uk/confidence-kit for online tutorial support

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Before you start, remove any excess oil from the eyebrows with a cotton wool pad. If you use a pencil make sure it is sharp so that you can create really fine strokes. Warm the pencil tip by rolling it on the back of your hand so it becomes softer to apply and won’t drag your skin.

Hold a pencil vertically along the outside of your nostril and inner corner of your eye. Make a dot above your eye at this line, right on the brow bone. This is the inner edge of your brow.

Hold the pencil vertically across your iris (the coloured part of your eye) and again make a dot above the eye, just above the brow bone. This is where your natural arch occurs.

Hold your pencil at an angle beginning at the outside edge of your nostril, lined up with the outside edge of the eye. This is where your brow should end. Draw another dot.

Connect these dots with a series of gentle arching, feathery strokes to mimic the look of hair. Concentrate on fullness closer to the inner edge, thinning as you go outwards.

For a really natural look, use two colours of eyebrow pencil - one light and one darker - alternating the light and dark shades. If this sounds a bit daunting, try drawing the shape with a light brown eyeshadow first – apply with a small fine brush and paint little hair-like strokes until a shape starts to emerge. Then you can add your brow pencil for extra depth. Keep it light; don’t go too heavy or hard.

Here we show you this clever way of creating eyebrows

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Useful Tip:

Most faces are not symmetrical, so don’t be too concerned about making your eyebrows match each other

precisely. If new brow hairs grow back at odd angles, a little hairspray or Vaseline on a brow brush can help to

keep them smooth and counteract brittleness.

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Choosing and styling women’s wigs

35

Wigs allow you to experiment with hair colours as well, but it’s important to choose a colour that will complement your skin tone rather than drain colour from your face. A wig specialist or your hairdresser will help you with this, but it’s a good idea to invite a friend or family member, who you know will give you an honest opinion and help you choose. It’s also useful to take along a photo of the ‘before’ you, as well as photos from magazines of the kind of styles you would like to try.

You can choose between synthetic and human hair wigs and both have advantages and disadvantages which your wig specialist will advise on. There are specialist wig suppliers for Afro Caribbean, Indian and Asian hair and some suppliers also have a small range of children’s wigs. Human hair wigs are not normally available on the NHS.

If you decide to wear a wig, you will then need to make some choices. First of all, you need to decide what style you would like. Some women may want to recreate their ‘normal’ style, while others think it’s a good time for a whole new look. On a practical note, you may consider having two wigs so that you can wear one while the other is being cleaned and dried and this also gives you the opportunity to have two distinct looks for different occasions.

Tip:

Allow plenty of time, try to relax and make it as fun an occasion

as you can.

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Trendco, one of the UK’s leading specialists in hair replacement for more than 50 years, offer their expert advice on all aspects of wig selection:

Choosing your wig:

You will have a choice of synthetic and human hair wigs, both available in a range of colours, styles and lengths. Synthetic wigs are easier to look after and maintain as they are pre-styled and after washing they will revert back to the original style. You cannot apply heat to the majority of synthetic wigs as they must be left to dry naturally. However, a new synthetic hair is now available called Flexi-Fibre, which can be heat styled using temperature controlled straighteners, rollers or curling irons, offering a new level of personalisation in fibre wigs (styling max 140°).

Human hair wigs will require styling after washing to achieve the desired look and heat appliances can be used to style the wig. If you are wearing a wig full time, it is advisable to have a spare, either to alternate or as a backup.

Fitting your wig:

Once you know the type of style and colour you prefer, the stylist will show you a selection to try. A wig cap is normally put on the head before fitting the wig, for hygiene reasons and to stop any movement on any remaining hair. It also provides a thin layer between the scalp and the wig, as the scalp can feel sensitive during treatment.

To establish the front hairline position correctly, a good tip is to place 4 fingers flat from your eyebrow across your forehead. This should provide you with a good idea of the start of your hairline. Hold the front of the wig in position and pull it over the head right down to the nape of the neck, place the ear piece on to the temple points and press flat to the side of the head. This will ensure the wig is sitting firmly and correctly.

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Cutting and Styling:

Most wigs will require some cutting to personalise and enhance your natural features. With synthetic wigs, because they are pre-styled, there will be limitations as to how much can be cut. So choose something as close to the style you require – it can be trimmed and thinned by an experienced stylist.

Human hair wigs will usually need cutting into the desired style as most come un-styled. It’s important to take into account the time needed to style after washing, which can either be done with the wig on a wig block or once it is on your head. Always use the recommended aftercare products and follow the aftercare instructions of the wig supplier.

Size:

Once the stylist has tried a few different styles they will advise on those that are sitting correctly and also that allow room for hair growth underneath the wig. Always make sure you feel comfortable and secure with the size. If you have not yet lost any hair, then the wig should be quite snug so that it fits well later on. Most wigs have nape adjusters to loosen or tighten as required. Wigs are normally a standard cap size of 54cm, but some are available in petite and large sizes. Any alteration needs to be done by an expert wigmaker.

Colour:

When choosing the colour, try something that will complement your skin tone. Darker shades can sometimes look a little dense, so choosing a shade lighter will look more natural. Synthetic wigs cannot be colour-treated, but they will not lose colour.

Human hair wigs can sometimes be coloured but only to add tone or to darken. Lightening is not recommended as the hair has been processed and to take colour out would damage it.

It’s best to choose the colour as close to your preference as possible and always get professional advice from your wig supplier, regarding any colouring treatment.

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“Being older, I thought I wouldn’t mind hair loss so much. But it didn’t feel like me. When you’re older, you’ve got wrinkles and

then without hair, I felt I looked hideous.

With a wig, I felt fine, it was in a similar style to my natural hair. I have four wigs altogether.”

Marilyn Perilli, LGFB beneficiary

39

Creative head coverings

40

Hats, caps, headbands, head squares, long scarves and bandanas can provide a wide variety of stylish looks, whilst also being very practical in protecting your scalp and camouflaging your lack of hair or when it’s just beginning to grow back. A hat or scarf is also essential in hotter weather to protect the skin from exposure to the sun and also to keep your head warm in winter.

You can choose different fabrics for summer and winter and you can also combine your headwear with added hairlines, such as ‘fringing’ front and back, to give the impression of natural hair.

41

Hats

The simplest choice and most department stores will have a good selection for both men and women. You can also wear a scarf underneath, so if you want to remove the hat, your head won’t be exposed. A scarf worn underneath will also cover the areas around your ears and neck.

‘Buffs’

These multi-function stretchy tubes come in different types of fabric and are lovely and comfortable to wear as well as being very easy to put on.

Scarves

There are so many different styles of scarves available, in terms of shape, length and colour as well as fabric and texture, so get together a good selection to go with different outfits. You can also twist one or two long scarves together and ‘crinkly’ fabrics also give extra ‘body’ when twisted and tied. It’s best to avoid satiny finish fabrics as these may slip.

Headbands

Once your hair starts to grow back, headbands can be useful and they’re also good for keeping your head warm.

Turbans

Easy to wear, they are available in different fabrics and soft ones can be a simple way of covering your head when you’re at home.

Top three tips:

1. Mix and match colourful and patterned head coverings with plain

outfits or vice versa to create a co-ordinated look.

2. Use a mirror so that you can see how the hat or scarf looks at the back. If you turn your back to

a wall mirror and hold a small hand mirror in front of you, you’ll be able

to see the rear view.

3. If you have a special event to go to, a ‘fascinator’ over a

colour-co-ordinated scarf can look amazing. Fascinators, available

from most department stores, can be attached with headbands or clip.

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Advice for men

43

Hair loss for men can be as distressing as it is for women, especially for men who have always had a full head of hair. Although, it is currently a style statement for some men to have shaved heads, this may not be your personal preference. As with women, hair loss may or may not happen depending on your specific cancer treatment, but it is good to be prepared and here we describe the three C’s approach for men to manage hair loss as a result of cancer treatment.

Cut

Always comb hair gently and use a mild shampoo. As hair starts to thin, consider cutting it short or even having it neatly clipped to the scalp by a professional stylist - this can offset concerns about patchy hair loss. However, medical professionals caution against shaving the scalp with a razor, which can cause hard-to-heal cuts that may result in infection when blood counts are low.

Cover

There are many hat and cap styles today for sports, sun, cold, rain, wind and pure style, so it’s easy to find something you like to cover and protect your head. If hair loss really bothers you, there are special hair pieces for hair loss caused by medical conditions that can conceal bald spots. As hair starts to grow back, these can be phased out. As with all wigs, those designed for men may require some styling and can be cut to give a natural look.

Counteract

When eyebrows are thinning, try a clear or coloured brow gel designed to help smooth, control and fill the brow line. A brow pencil also works for minor gaps, but drawing in the whole thing can look a little obvious on men. Instead, try wearing glasses with heavy frames, which can add definition to the area and of course, there’s no prescription required!

44

Shaving TipChemotherapy and radiation can

change your skin – making it dry, itchy, flaky or irritated. A few simple steps in

the morning and at night can help you look healthier.

During treatment, when you are at risk of bleeding and infection, your doctor may suggest that you switch to an electric

razor to prevent potential cuts.

Warm your skin first with water or a hot towel and rinse afterwards with cool water. Avoid alcohol, menthol or strong

fragrance. If you feel you must use a manual razor – and we advise that you

discuss this with your doctor first - keep it sharp, always rinse after use and shake off excess water without wiping. Soften

hair follicles with shaving gel, leaving it on your face for about one minute

before the first stroke.

45

Nutrition

46

• Hair is made of protein, so try to eat plenty of protein rich foods. The best are ‘complete proteins’, which contain all essential amino acids. These include eggs, fish, poultry, lean meats and low fat cottage cheese. Limit your intake of mercury rich fish, such as tuna and swordfish

• Try to eat iron dense foods at least twice a week. Iron and ferritin (stored iron) are very important for your hair. The best sources are red meats, such as steak and liver. Taking a daily iron supplement can be helpful and is also necessary if you have iron or ferritin deficiency

• Incorporate energy dense complex carbohydrates into each meal. As hair cells grow incredibly quickly, their energy needs are great. Good examples are whole grain bread, whole grains and brown rice and pasta

• Drink water or another low-sugar drink as often as possible. Hydration is important to scalp health. Ask your doctor for advice on your personal recommended daily fluid intake

• Have a healthy nutrient dense snack between meals. Energy to form hair cells drops four hours after eating

• To give your hair extra nutritional support, supplement a healthy diet with relevant nutritional supplements. Ask your pharmacist, healthcare advisor or hospital nutritionist for advice

You may find that you don’t have much of an appetite when undergoing chemotherapy. However, after treatment when your appetite increases, eating a well-balanced diet, rich in nutrients can help encourage and support the growth of new hair.

Diet is very important to hair growth. Hair is the second fastest growing tissue the body produces, so its energy needs are great. But, because hair is also non-essential tissue, your body does not prioritize it. As your body is likely to be depleted after chemotherapy, making sure your hair is receiving the nutrients it needs may be challenging and taking the following steps can be useful:

47

Breakfast

• 2 poached, boiled or scrambled eggs on whole-grain toast

• Grain cereals, such as porridge, with some fruit.

• Smoked salmon on a bagel with sliced tomatoes

• Bacon, turkey bacon or lean sausages with pancakes and blueberries

• Smoked trout with crème fraiche and new potatoes

The most important meal of the day for hair as its when energy levels are lowest.

Snack

Morning:

• Fresh fruit

• Crudité and hummus

• No-added sugar granola

Afternoon:

• Crackers with peanut butter

• Half an avocado on toast

• A handful of almonds

Energy to form hair cells drop four hours after eating, so have a healthy snack.

Healthy hair Meal Plan Examples

48For more specific nutritional advice, consult your cancer specialist or hospital nutritionist

Ideally include 120g (in weight) of protein with vegetables and carbohydrates.

Lunch

• Chicken, spinach and wild rice salad

• Prawn salad with couscous and chopped vegetables

• Ham sandwich with tomatoes and lettuce and an apple

• Bolognese and cheese in a baked potato with salad

The least important meal of the day for hair, so indulge in whatever you fancy!

Dinner

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Directory

On these pages, you will find details of organisations that our workshop participants have found useful. Your treatment team may also be able to direct you to other sources of help and advice.

Please note that inclusion in this directory does not represent an endorsement or recommendation by Look Good Feel Better or Philip Kingsley. Details were correct at the time of going to print.

BOWEL CANCER UKwww.bowelcanceruk.org.uk020 79401760

BRAIN TUMOUR ACTIONwww.braintumouraction.org.uk0131 446 3116

BREAKTHROUGH BREAST CANCERwww.breakthrough.org.uk0333 20 70 300

BREAST CANCER CAREwww.breastcancercare.org.uk0808 800 6000

THE HAVEN BREAST CANCER SUPPORTwww.thehaven.org.uk020 7384 0099

CANCER RESEARCH UKwww.cancerreseaerchuk.org0808 800 4040

MAGGIE’S AT CANCERKIN CENTREEmail: info@cancerkin.org.uk or royalfree@maggiescentres.org020 7830 2323

CLIC SARGENTwww.clicksargent.org.uk0300 330 0803

KIDNEY CANCER UKwww.kcuk.org0844 870 7054

LEUKAEMIA CAREwww.leukaemiacare.org.uk0808 8010 444

LYMPHOMA ASSOCIATIONwww.lymphomas.org.uk0808 808 5555

MACMILLAN CANCER SUPPORTwww.macmillan.org.uk0808 808 0000

MAGGIE’S CENTRESwww.maggiescentres.org0300 123 1801

MARIE CURIE CANCER CAREwww.mariecurie.org.uk0800 716146

OVACOMEwww.ovacome.org.uk0845 3710 554

OVARIAN CANCER ACTIONwww.ovarian.org.uk020 7380 1730

TEENAGE CANCER TRUSTwww.teenagecancertrust.org020 7612 0370

TEENS UNITEwww.teensunitefightingcancer.org01992 440091

General Information and Support

50

ALTERNATIVE LOOKwww.alternativelook.co.uk01253 624977

BOHEMIA FASHIONS HEADWEARHeadscarves, turbans, hats and bandanaswww.bohemia-fashions.co.uk01582 750083

CANCER HAIR CAREWigs, information, advice and support for women going through cancer and hair loss.www.cancerhaircare.org.uk0300 330 0803

HAIRWARE UKWigs, hairpieces, extensions and wig accessorieswww.hairware.com01793 831363

HATS4HEADSHats and other headwear for women experiencing hair losswww.hats4heads.co.uk0845 576 4287

MY NEW HAIRAdvice, support and wig cutting through Trevor Sorbie’s national network of hair salonswww.mynewhair.org

SUBURBAN TURBANContemporary headwear for women experiencing hair losswww.suburbanturban.co.uk01306 640123

TONI & GUYStrengthen in Style expert haircare and advice servicewww.toniandguy.com01273 774977

TRENDCOOne of the UK’s leading specialists in hair replacement for over 50 years, offering ready-to-wear wigs and other hair loss solutions.www.trendco.co.uk01273 774977

If you decide, like Emma McHugh did (see page 17) to cut off your long hair prior to treatment and wish to donate it, the following is a charity who then make wigs for boys and girls who have sadly lost their own hair due to cancer:

THE LITTLE PRINCESS TRUSTwww.littleprincesses.org.uk01432 352359

Donating Your HairWigs and Other Head Coverings

51

Philip Kingsley Team: Anabel Kingsley and Glenn Lyons for their expertise as leading authorities in trichology; Helen Tailby, Senior Brand Manager for her input and co-ordination; and Alice Weston for her design skills and flair.

Trendco: Louise Wright and Zeljka Subervie for their wig-styling skills and creativity and for making our ‘models’ feel comfortable and look so fantastic. Lana Mercer and Anele Wyatt for their expert tips on choosing, styling and caring for wigs.

Alicia Clarke for excellent photography

Elizabeth Arden for providing the location for our photographic shoot

Volunteer make-up artists, Dulcie Rowe and Kamanza Amihyia

Our ‘models’: Emma McHugh, Latifah Saleh, Neil Appleby, Marilyn Perilli, Nadine Miles, Jo Seager, Sonia Goldring-Banachowicz and Paulette McQueen. Thank you so much for your willingness to share your stories and thoughts and for looking so fabulous with different wigs and head coverings.

Acknowledgements and thanks

Copyright © 2017 Look Good Feel Better

Look Good Feel Better

West Hill House, 32 West Hill, Epsom, Surrey KT19 8JD

Charity Title:

Cosmetic, Toiletry and Perfumery Foundation

Registered in England 2850925

Registered Charity No. 1031728

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical,

photocopying, recording or otherwise, without the prior permission of the publishers (Look Good Feel Better and Philip Kingsley).

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