Non-Hodgkin’s lymphoma (NHL) is a cancer that originates in the lymphatic system. The condition develops when white blood cells, called lymphocytes, begin to grow and divide uncontrollably. While NHL itself can cause a variety of systemic symptoms, the hair loss often associated with a cancer diagnosis is overwhelmingly a side effect of treatment. Understanding the difference between hair changes caused by the disease and those caused by treatment is helpful.
The Disease and Hair Loss: Systemic Effects
NHL does not typically cause complete, widespread hair loss. However, in cases of severe or advanced disease, generalized hair thinning can occur due to systemic factors. This shedding is generally a form of telogen effluvium, triggered by major physical stress on the body.
The body prioritizes energy for fighting the disease, diverting resources away from non-essential functions like hair production. This systemic stress, combined with chronic inflammation and nutritional deficiencies, negatively impacts the hair growth cycle. In rare instances of cutaneous (skin) lymphoma, the disease itself causes patchy or localized hair loss, distinct from widespread thinning.
Chemotherapy and Radiation: Primary Causes of Hair Loss
The most common cause of hair loss in people with NHL is the use of cytotoxic chemotherapy drugs. Hair follicles contain some of the fastest-dividing cells in the body, making them unintended targets. This rapid destruction of the hair matrix cells causes the hair shaft to narrow and break off, a condition known as anagen effluvium. Hair loss typically begins within a few weeks, often resulting in complete or near-complete baldness on the scalp and body.
The severity and timing of hair loss depend on the specific drug regimen and dosage administered. Common NHL protocols carry a high risk for significant hair loss. Higher doses and more frequent administration increase the likelihood of complete hair shedding.
Radiation therapy causes hair loss through a different mechanism, as its effect is highly localized to the treatment field. When radiation is directed at an area containing hair follicles, such as the head or neck, the hair in that specific region is damaged or destroyed. If the radiation dose is low, the hair loss is usually temporary, but higher doses can cause permanent damage to the follicle stem cells. Unlike chemotherapy, which causes systemic hair loss across the entire body, radiation-induced alopecia is sharply demarcated at the borders of the treatment area.
Newer targeted therapies and immunotherapies used for NHL carry a lower risk of severe hair loss than traditional chemotherapy. These agents work differently, focusing on specific molecular pathways rather than broadly attacking dividing cells. Side effects are usually limited to mild thinning or textural changes, affecting a small percentage of patients.
Strategies for Managing Hair Changes
Managing hair loss involves practical steps to reduce discomfort and emotional impact.
- Cut hair short before treatment to make shedding less traumatic.
- Use a soft hairbrush and gentle, mild shampoos to soothe a sensitive scalp.
- Protect the scalp from sun exposure and cold temperatures with hats, scarves, or sunscreen.
- Wigs can offer a temporary return to a pre-treatment appearance and may be covered by health insurance as a cranial prosthesis.
Scalp cooling systems, also known as cold caps, offer a potential mitigation strategy during chemotherapy. These devices cool the scalp to restrict blood flow and reduce drug uptake by the hair follicles.
Scalp cooling is not universally recommended for people with lymphoma. Because lymphoma is a systemic cancer, there is a theoretical concern that cooling the scalp could prevent chemotherapy from reaching microscopic cancer cells in that area. This risk must be discussed thoroughly with the oncology team.
Hair Regrowth: What to Expect After Treatment
For most people, hair loss caused by chemotherapy is a temporary side effect, and the hair cycle resumes once treatment ends. The first signs of regrowth, often a soft, fine fuzz, can typically be noticed within two to four weeks after the final chemotherapy dose. Within three to six months, the hair usually becomes thicker and longer, allowing for a short hairstyle.
A common experience is for the initial hair to grow back with a different texture or color than before, sometimes appearing curlier, which is often called “chemo curl.” These temporary changes usually normalize over the course of several months as the hair follicles fully recover and settle back into their regular growth pattern. If hair loss was caused by radiation therapy, the prognosis for regrowth is different, as the damage can be permanent if a high dose was administered to the area.