Hair loss and body image

Alopecia

Alopecia or hair loss is almost inevitable with most of the treatments for cancer in children and young people (CYP) and this can be one of the most challenging aspects of the cancer diagnosis for the patients and their parents/carers. Hair loss with chemotherapy is usually total (all body hair), although scalp hair is more severely affected as the hair follicles of the scalp are the most rapidly growing – up to 90% of them can be in a phase of rapid growth at any time (NHS Inform, 2024). 

It is important to reiterate that the hair will grow back, however it may re-grow a different colour and texture. Hair loss with radiotherapy (for brain tumours) is local to the beam site and dose and may not grow back. All patients are offered wigs from the NHS or high quality real hair wigs through charities such as the Little Princess Trust. CYP are encouraged to go for a wig-fitting before they lose their hair, enabling the hairdresser to see what they look like naturally, thus allowing time for the wig to be made. Some children may prefer to wear a hat or bandana instead or may not wish to cover their head at all. It is important that professionals do not underestimate the impact that hair loss, and anticipation of it, can have on a child or young person and their family. 

Usually, the hair starts to fall out three to five weeks after their first chemotherapy treatment, although the rate and extent to which this occurs is very individual, with some drugs causing worse alopecia than others. For some, alopecia is almost total in the space of 24-36 hours, while for others the hair just thins. At the first sign of hair loss (or before) it could be advisable to cut it short, or brush it out, to avoid the distress of getting hair everywhere. The Play Specialists will support children with hair loss and create age-appropriate activities to discuss these changes. 

There is some, less noticeable, hair loss after every cycle, so the alopecia effects accumulate. Hair re-growth starts to show within four weeks of drugs (that cause alopecia) ceasing.

Nail changes 

Nail changes with chemotherapy can include infection, discolouration, banding, transverse ridges, oncholysis (detachment of nail bed) (Morrison et al., 2022).  Of these, the most frequently seen in the child and young person age group is ridges. These are temporary side-effects and will resolve slowly after treatment.  

Body image  

Many children and young people with cancer will experience changes in their body image as well as hair loss. Almost all will have a central venous access device in their chest and some will have a naso-gastric tube. There can be weight loss due to lack of appetite, weight gain due to steroids, and scars following biopsy and surgery.  Some patients with bone tumours may require amputation of a limb.  

Body changes and medical devices may affect the picture the child or young person has in their mind about how they look and therefore have a knock-on effect on how they feel. All ages can be deeply affected by this. Acknowledging with them (and their family, as appropriate) that they may be experiencing difficult emotions is important.  

The above issues are particularly acute in young people, where it has a huge impact on self-esteem, social acceptance and development of personal identity, when the effects of puberty on changing body shape is already so closely scrutinised by self and others. 

It is advisable to discuss physical changes in the child or young person with siblings, extended family and friends before they visit, especially if they have not seen them in a while, so that they know what to expect. If siblings can visit frequently, changes will not be so apparent.  

It is also a good idea to ensure that the possible changes to the child or young person’s physical appearance are discussed with their class at school, before they return to school, as in some cases the child or young person will have changed beyond recognition. The class should be given the opportunity to ask an adult the questions they may have. This allows them the opportunity to address their concerns in a safe and supportive environment before their classmate’s return.

CCLG offer an information guide ‘Supporting a pupil with cancer: a school’s guide’ to assist teachers in talking to the class. Paediatric Oncology Outreach Nurse Specialists (POONS) can also help families and young people liaise with school. Schools are always asked to allow the child or young person with cancer to wear a bandana or hat, whatever they prefer. Schools must ensure that this permission is communicated to all members of staff in a school, especially if it is a large school.  

References 

Morrison, A., Marshall‑McKenna, R., McFadyen, A.K., Hutchison, C., Rice, A‑M., Stirling, L., McIlroy, P. and MacPherson, I.R., (2022). A randomised controlled trial of interventions for taxane‑induced nail toxicity in women with early breast cancer. Scientific Reports, 12(1). doi:https://doi.org/10.1038/s41598-022-13327-6. 

NHS Inform (2024). Hair loss and cancer treatment. Available at: https://www.nhsinform.scot (Accessed: 20th Jan 2026). 

Last reviewed February 2026