•Where the skull has been irradiated, there is partial to total hair loss, depending on radiation dose and individual factors. Hair does not always grow back, depending on the radiation dose

19.2.2.3Treatment

•The patient needs to be informed prior to commencement of therapy about hair loss

•The absence of hair and especially the bare skin of the scalp can psychologically be traumatic for many children and adolescents

•Promise acceptable hair substitution

•Assure the patient that hair loss as a result of chemotherapy is not permanent

19.2.2.4Nursing Tips Concerning Hair Loss

•Suggest an easy-to-maintain hairstyle prior to treatment

•Wash hair with a mild shampoo (e.g., baby shampoo) and dry carefully with a towel

•Comb hair carefully

•Should hair substitution be required, a hairdresser or wig specialist ought to be contacted early on, so that they get to see the original hair growth

•Apart from the wearing of wigs, there are other possibilities such as stylish scarves, hats, caps

•The head should be covered outdoors so as not to burn the skin of the scalp in summer and to minimize heat loss in winter

•A cloth roller removes shed hair from clothes

Coverage of Costs for Hair Substitution

Hair substitution is a medically prescribed hair prosthesis, which may be partially covered by health insurance.

19.2.3Stomatitis and Mucitis

Sometimes chemotherapy and radiotherapy heavily reduce regeneration of mucosa, which can lead to ulceration or inflammation of mucous membranes in mouth, throat, and intestines, resulting in a dry and sore mucous membrane of the mouth. This can serve as an entry path for pathogens such as bacteria, viruses, or fungi. Before and during treatment, daily checks on oral hygiene need to be performed.

19.2.3.1Cause

The natural balance of flora and mucous membranes is disturbed by direct damage to cells of mucous membranes through chemotherapy and/or radiation, as well as indirect damage due to neutropenia.