Compared to life-threatening complications, changes to your hair might not be the most serious symptom of chronic graft-versus-host disease (GVHD). However, for many people, healthy hair feels like a sign of well-being. Even small changes, like thinning or discoloration, can change how you look and affect how you feel about yourself. If you’re noticing hair loss or changes in color, you might feel self-conscious or worry about how others see you.

Learning about hair changes from GVHD may help you understand what to expect and even make it easier to accept this aspect of life after a bone marrow transplant. Read on to find out more.

What To Know About Chronic GVHD

GVHD is a common complication after a bone marrow transplant using donor cells. GVHD develops when the transplanted cells from a donor trigger an attack on the body’s cells. GVHD can take two main forms: acute GVHD, which usually develops within the first few months after transplant, and chronic GVHD, which tends to show up later and can last much longer. The symptoms of both types can range from mild to severe.

Chronic GVHD happens when the donor cells attack the host’s cells after the transplant, typically starting 100 days or more after transplantation. It can last for years or even be lifelong. It affects around 40 percent to 50 percent of people after a bone marrow transplant using cells from a donor.

Chronic GVHD can affect several of the body’s organs, causing symptoms that range from jaundice (yellowing of the skin and eyes) and shortness of breath to dry eyes, dry mouth, and skin rashes and ulcers.

Hair-Related GVHD Symptoms

One of the early symptoms of chronic GVHD is alopecia, or hair loss. Alopecia caused by GVHD can affect hair on the scalp and other parts of the body. Other common changes to the hair include premature graying, thinning, and brittleness.

For some people, GVHD hair symptoms may serve as a visible reminder of the long-term nature of GVHD, which can, in turn, lead to anxiety or distress.

Keep reading to find out three ways GVHD may affect hair.

1. Hair Loss

Researchers believe chronic GVHD may target hair follicles as it first develops, which is why hair loss and other hair-related symptoms can also be an early sign of chronic GVHD.

When donor immune system cells attack the host’s healthy hair follicles, they can change hair growth cycles — not just on the scalp but all over the body. The loss of hair can range from partial to complete. Some people may experience complete baldness, for example, while others may only notice mild thinning.

Hair loss can also vary depending on which of the two types of alopecia you develop:

• Scarring alopecia — Damage to the hair follicles causes fibrous scar tissue, leading to permanent hair loss.
• Nonscarring alopecia — The hair follicles are still there, so there’s a chance for the hair to grow back.

Scarring alopecia can affect both adults and children. According to one study, nearly 1 in 7 children who survive cancer have alopecia after completing their treatment.

2. Thinning or Brittleness

Thinning hair can show up in patches or feel coarse. It might also look dull or lose its shine. This damage is also caused by the donor cells attacking the host tissues. The damage just isn’t severe enough to cause scarring that results in the complete loss of the hair follicle.

In this case, treating GVHD on the scalp with topical therapies (applied directly to the skin) may help stop scarring before it leads to permanent hair loss. Topical steroid creams and oral medications like minoxidil can help reduce inflammation from GVHD flare-ups. Minoxidil helps keep hair in its growth phase longer and can make hair grow back thicker.

3. Premature Graying

Because the skin is usually the first part of the body affected by GVHD, changes in hair color are common in people with chronic GVHD. You might notice your hair turning gray earlier than expected.

For most people, hair starts to turn gray in their 30s or 40s. For some, though, it can begin to gray earlier. Your hair turns gray when your hair follicles stop producing melanin, the pigment responsible for hair, eye, and skin color.

Hair Care Tips for GVHD

You can’t prevent or reverse hair changes caused by GVHD, but there are ways to care for your hair and scalp. Start by being gentle with your hair. Your scalp may feel sensitive, sore, or even itchy if you have GVHD. So when you comb or brush your hair, start at the ends and use something with soft bristles or just your fingers. If you wear hats or head coverings, look for soft fabrics like cotton or bamboo lining.

Here are some tips for people with hair loss due to GVHD:

• Shampoo your hair less frequently.
• Try dry shampoo instead of washing your hair.
• Avoid blow dryers and curling irons, as well as coloring your hair.
• Ask your dermatologist about soothing treatments such as warm coconut oil.
• Wear a hat outside, or apply sunscreen of at least SPF 50 on your scalp.
• Try pigmented powders or sprays to help mask hair loss.

Talking to a dermatologist with expertise in GVHD can also help. If you’re interested, they can tell you whether scalp micropigmentation — a type of hair tattoo that creates the look of hair follicles — might be a good option for you.

Finally, don’t overlook mental health. Chronic GVHD can last a long time, and you or your child may struggle with body image issues along the way. If you notice these changes in yourself or your child, consider talking with a therapist, joining a support group, or finding another type of counseling. Taking care of mental health is just as important as caring for physical health.

Find Your Team

On myGVHDteam, the site for people living with graft-versus-host disease and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with GVHD.

Have you noticed changes to your hair since you were diagnosed with GVHD? Share your experience in the comments below.