Alopecia from chemotherapy: the importance of donating


Alopecia due to chemotherapy: the importance of donating.

Author: Dr Daniele Dusi, specialist in dermatology, venereology and trichology

for Dr Kaan Pekiner


Noemi Aquilanti, Marche region contact person for hair donation for cancer patients

Bruno Giusti, biomedical scientific communication specialist in aesthetic oncology

Chemo-therapy-induced alopecia in cancer patients

It is estimated that in the course of a lifetime one in two men and one in three women will fall ill with cancer. Despite this apocalyptic scenario, today, thanks to new therapies, 60% of cancer patients survive the disease and become chronically ill. Cancer is no longer a terminal illness: patients learn to live with the disease and the difficult and unpredictable consequences it has on their perception of sensations and their body image.

The cancer patient is a fragile person, full of fears, anxieties, negativity and uncertainty about the future, who not only suffers the trauma of a serious diagnosis, but also sees his physical appearance change abruptly, both because of the consequences of the disease and because of the effects of cancer therapies, radiotherapy and surgery.

One of the adverse effects of chemotherapy and radiotherapy is alopecia, the loss of hair.

The importance of hair

The hair is not only a banal appendage of our body but also a symbol: there has never been a century in which this natural ornament of the body, the anatomical frame of the face, has not been given special consideration.

There has never been a century in which this natural body ornament, the anatomical frame of the face, has not been given special consideration. Women and men have always taken special care of their hair, regardless of their age, because they consider it to be a means of enhancing their image.

Throughout time, hair has represented strength, immortality and beauty, and its loss implied purification, punishment and shame. From Ancient Egypt, where hair was considered a symbol of a person’s social status, to the Middle Ages, where beliefs considered hair a material extension of the soul of the person who owned it, led to its use in rituals and magic potions. The care of the hair and of the person in general was also exalted during the Renaissance, a period of courts and pageantry in which the hair became a true work of art, with extravagant and exaggerated hairstyles, up to the 20th century and the present day, where hair care is no longer linked only to a wealthy social class but becomes an aspect that everyone shares, revealing itself as an expression of self and of one’s identity and individuality.

Hair, therefore, can really represent the strong, feminine part of women and the main part of themselves, the part to hold on to, to hide behind or to shine with.

The importance of hair

Chemo alopecia

Unfortunately the old chemotherapy drugs, still used today, are not intelligent drugs, they affect both normal and diseased cells, particularly at the level of the hair follicle they negatively affect the mitotic and metabolic activity of the matrix cells during the anagen phase. Alopecia from chemotherapy is therefore an anagen effluvium: hair is lost as a result of hair shaft fracture and interruption of the hair growth phase. It is an effluvium: hair starts to fall out after 7-14 days from the start of chemotherapy in a massive and diffuse way, in strands, from the whole scalp until complete alopecia.

This is psychologically devastating, especially for female patients. This is a reversible alopecia, the cells of the follicle matrix resume their interrupted mitotic and metabolic activities a few weeks after the end of chemotherapy and the hair will grow back within 3-6 months.

The chemotherapy drugs that can cause alopecia are the following:

Cyclophosphamide, Dactinomycin, Irinotecan, Doxorubicin, Paclitaxel, Topotecan, Docetaxel,

Bleomycin, Etoposide, Epirubicin, Gemcitabine, Methotrexate, Mitomycin, Oxaliplatin and Fluoruracil.

Hair usually begins to fall out within a few weeks of starting therapy. They fall out in strands when combing or simply running the hand through the hair; this event represents a trauma for the patient, a stress load that goes beyond the disease.

1 by activating the neuroendocrine system to produce a state of chronic stress that is highly immunosuppressive and therefore very harmful

2 by reducing the person’s adherence to the therapy and in some cases even suspending it.

All this is to make it clear how superficial it is to underestimate alopecia caused by chemotherapy as a merely aesthetic aspect of cancer patients: as health workers and others, we have an ethical and moral duty to help the sick person in all his or her aspects; health is not merely the absence of disease but complete mental, physical and social well-being, as the World Health Organisation says. Much can be done about alopecia caused by chemotherapy: there are both preventive and curative therapies, but something much simpler can be done: giving one’s own hair to those who are experiencing hair loss.

How and why to become a hair donor for cancer patients: The natural trichoprosthesis (“the wig”)

It is now possible to make trichoprostheses (so-called “wigs”), to be used during chemotherapy alopecia, out of natural hair from healthy donors. Natural trichoprostheses are assembled by carefully selecting the hair, which must be of high quality standards, combable and shiny. Thanks to increasingly innovative production technologies, the artificial hair faithfully reproduces the natural hair. Natural trichoprosthesis hair is easy to dry, and can be styled and styled just like normal hair, with the possibility of colouring and perming.

Donated hair is collected through non-profit associations and the requirements that the locks must meet vary from association to association, but generally it is necessary for the hair to be natural or treated as long as it has a uniform colour, there must be no streaks, chatuches or other procedures that alter the colour; it must be healthy, washed, and without split ends.

Fundamental for the trichoprosthesis to be well accepted by the patient’s scalp is the cap on which the hair is mounted. The scalp of a cancer patient is compared to that of a child: delicate, easily irritated and inflammable. The cap must therefore be as hypoallergenic as possible. It is made of natural fibres, cotton and a small percentage of elastane so as not to create discomfort when in contact with hairless skin, even if residual hair is present, it does not sting or pinch, it does not overheat and is highly breathable; in the upper area the hair is grafted by hand to achieve the most natural effect possible; This small detail is fundamental to give the whole the naturalness that characterises the prosthesis, as it is also possible to reproduce the natural perimeter hair that makes it possible to create tails and tufts without a fringe; the measurements are personalised to one’s own cranial conformation, so there is no abundance or traction or feeling that “escapes”; in the case of particular needs they can be made to measure, in this case the wait will be 4/5 months instead of the customised 7 days.

The use of the hydrobend applied in a few points allows the total and safe anchorage of the prosthesis to the skin, increasing the safety performance in everyday life; you can do any movement and activity without fear of any surprise, after 24-36 hours from the application you can go swimming in the pool or at the sea in total tranquility, you can go to your hairdresser for a washing and styling in the normal open salon, obviously you can sleep without ever removing it (only once a month for the maintenance of the cohesive).

The hydrobend is a Medical Device, used for years in hospitals to treat bedsores, applied by the adhesive side it helps the healing of the skin absorbing organic liquids if necessary and leaving the skin clean from germs and bacteria, it is the same used in ostomy; the one for trichological use is in double-sided adhesive format. The hydrobend does not release substances, is solvent-free, is not a glue even though it has the effect of one, is hypoallergenic and safe; it has been used for years in people undergoing immunosuppressive treatment without ever having had any cases of discomfort or irritation.

It can be worn continuously, and should be changed once every 4/5 weeks; if a semi-fixed anchorage is desired, it can be applied in smaller quantities, putting the prosthesis in the morning, for example, and removing it easily in the evening; in this case, the hydrobend itself remains active for a few days without the need to change it every time.


Costs and contributions for the provision of trichoprosthesis

The cost of purchasing a wig can be deducted for tax purposes when submitting the tax return by attaching appropriate documentation. The Italian Revenue Agency, in its resolution 19/E of 16 February 2010, has clarified that a wig can be included among the deductible health expenses (19 per cent IRPEF deduction, pursuant to Article 15, paragraph 1, letter c) of the TUIR) if it serves to remedy the aesthetic damage caused by a disease and to alleviate a condition of serious psychological distress in everyday life relationships. In this case, in fact, the wig performs a health function to all intents and purposes and can be considered in its own right as any medical device intended by the manufacturer to be used to alleviate illness or injury and marketed for these purposes. In particular, the wig is included among the deductible health care costs in cases where it is used by cancer patients to overcome psychological difficulties related to hair loss caused by chemotherapy treatments.

In order to be eligible for the deduction, the following documents must be presented when submitting the tax return: a tax document certifying the purchase of the wig, indicating the tax code of the person undergoing chemotherapy treatment, and medical documentation certifying the anti-cancer treatments undergone.


How to donate hair

To donate hair, simply tie the hair already cut into a tail or braid of approximately 25cm-30cm (minimum length for donation). They should be tied on both ends with two elastic bands, as they all need to be in the same direction. They should then be placed in an airtight envelope and sent to the relevant association. If you decide to perform this beautiful gesture of solidarity by sharing it with another person, make sure that the hair is placed in two separate bags so that it does not get mixed up.

Leaving aside aesthetics, or rather recognising its links with psychology, saying that it is also through this biological adornment that we give ourselves an identity and pursue our interests in the world, let’s highlight the importance of these gestures, from the donation of hair to specific projects that take care of it to make wigs for cancer patients or simply those suffering from baldness.

We highlight the good side of people and the power of social unity, which is why it is essential to always keep imagining and working for a better world. It’s not the donation itself that makes you happy, but the thought of another girl, maybe your own age, with a smile on her face again when she looks in the mirror, thanks to a wig that I contributed to.


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