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Your Hair After Chemo

By Heather Millar

Curly Hair

I need to get a new head shot. The picture that you see to the right of this blog post is about three years old. I’ve used that picture on my personal blog, my Gmail account, and my Facebook, Twitter, Linked In, and Pinterest accounts. My Internet persona is always wearing a black blazer and cocking her head just a bit to the side.

This may seem to show a lack of imagination, or some sort of digital laziness. How hard is it to take a picture and upload it these days? But the fact is: I hate having my picture taken. My standard joke is that I’m paying for a photogenic childhood with an adulthood in which I always seem to have my eyes closed or mouth open or head angled to make it look like I have double chins when the shutter clicks.

But, now, I think I really have to get serious about a new picture. Why? Because post chemo, my hair seems to be growing back wavy. This stuns me. I have always had hair that is so straight that it doesn’t even hold a perm. At first, I just thought that my hairdresser had cut the layers strangely, and that’s why the strands had begun to flip and twist. But, no, I finally realized: The hair, not the haircut, has changed.

What gives? I searched scholarly journals and magazine databases. I talked to several dermatologists. Here’s the amazing thing: Nobody really knows exactly how hair grows, or why it may regrow differently after chemotherapy.

We humans think we’re so smart, and yet we don’t know what goes into making our hair, or what’s going on in the center of a flame, or exactly what happens when we’re sleeping.

Scientists have a general idea of these processes, of course. But, as with many things, the devil is in the details. When it comes to hair growth, they haven’t nailed down exactly what genes and cell mechanisms are involved. I guess if they did, then men wouldn’t have to worry about male pattern baldness.

Here, in a general way, is how your hair grows: The hair comes from follicles, vase-shaped structures in the “basal” layer of your skin. This is the part of the skin that produces new cells and skin “products,” things like saliva, sweat, and hair. The follicle houses special cells called stem cells.

Some stem cells can turn into any kind of cell in the body. Others can turn into various kinds of one type, say different types of muscle cells, or nerve cells, or skin cells.

So the skin stem cells, which can turn into any kind of skin cell, migrate down into the follicle, and here’s where the mystery comes in: By some as-yet-undiscovered, cellular or genetic process, the stem cells help the follicle to create a hair bud. The bud starts to create “hair product,” a strand of proteins. As it does so, the protein—that is, your hair—grows.

All this hair growing involves cells dividing quickly, and that’s why about 70 percent of chemotherapy drugs will cause hair follicles to go haywire.

“Hair follicle stem cells are very fast-cycling cells, with significant numbers cycling all the time,” explains Dr. Amy McMichael, professor at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “Chemotherapy agents are knocking off all the cells with fast cycles.”

In other words, your locks end up as collateral damage in the war on your cancer. During normal life, about 90 percent of your hair is in a growth phase and 10 percent is in a resting phase or in the process of falling out. Chemo pushes all your hair cells into this resting phase: the hair stops growing; the strands narrow and then break off.

When chemo ends, experts say, it’s very common for the hair to grow back differently.

“We don’t know how chemo affects the cell cycle,” says Dr. Doris Day, an attending dermatologist at Lenox Hill Hospital in Manhattan and author of Forget the Facelift (Avery Penguin 2008). “But the thing is that chemo does seem to affect the hair cycle. After chemo, the hair may start cycling differently.”

Radical color changes—brown hair turning red, for instance—don’t seem to happen, doctors say. But straight hair may go curly, or curly hair straight. White hair may go dark again, or dark hair go white. Hair may grow back thicker. In rare cases, it may not grow back at all. Sometimes, the hair reverts to its original color and texture after a year or two. Sometimes, it doesn’t.

And often, as a recent New York Times article chronicled, patients choose to change their hair color after chemo.

But except for those artificial salon dyes, the whys and wherefores of these hair changes remain unexplained. Maybe it’s just one more way that cancer is like Forrest Gump’s box of chocolates: You never know what you’re going to get. Or why.

Photo: Pixland

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