What Lupus Medications Cause Hair Loss and How to Manage It

Hair loss, or alopecia, affects approximately 45% of people with lupus at some point [1.5.1, 1.5.5]. While the disease itself is a primary cause, it's also crucial to ask: what lupus medications cause hair loss? Several common treatments can contribute to this distressing side effect.

Quick Summary

Hair loss in lupus can be caused by the disease's inflammatory activity or as a side effect of medications like corticosteroids and immunosuppressants. Management involves medical treatment and gentle hair care.

Key Points

• Medication is a Key Cause: Immunosuppressants (like methotrexate and cyclophosphamide) and corticosteroids (like prednisone) are common lupus medications that can cause hair loss [1.2.1, 1.2.4].

• Disease vs. Drug: Hair loss in lupus can result from the disease's inflammatory activity (sometimes causing permanent scarring) or as a reversible side effect of medication [1.6.2].

• Consult Your Doctor First: Never alter or stop your medication without consulting your doctor, who can adjust your treatment plan to manage side effects [1.2.2, 1.4.3].

• Gentle Care is Crucial: Avoid harsh chemical treatments, tight hairstyles, and excessive heat to prevent further hair breakage and loss [1.2.2, 1.4.7].

• Sun Protection is Essential: Protecting your scalp from the sun is vital, as UV exposure can trigger lupus flares and worsen hair loss [1.4.2, 1.4.3].

• Nutritional Support Helps: Deficiencies in nutrients like iron, zinc, and vitamin D can contribute to hair loss; discuss supplementation with your doctor [1.2.5, 1.4.4].

• Hair Regrowth is Possible: Hair loss caused by medication is typically not permanent and the hair is likely to grow back after the medication is adjusted or stopped [1.2.3, 1.4.7].

Lupus is a chronic autoimmune disease where the body's immune system mistakenly attacks its own healthy tissues, causing widespread inflammation [1.6.1]. This can affect the skin, joints, and organs [1.6.1]. One of the most visible and common symptoms is hair loss, known as alopecia, which can be caused by the disease itself or by the very medications used to control it [1.2.1, 1.6.2].

Distinguishing Between Lupus-Induced and Medication-Induced Hair Loss

It's important to understand that hair loss in lupus patients can stem from two main sources:

• Disease Activity: Inflammation from lupus, particularly skin-related lupus like discoid lupus erythematosus (DLE), can damage hair follicles on the scalp [1.6.1]. This can lead to either non-scarring hair loss that may be reversible or scarring alopecia, where the hair loss is permanent because the follicles are destroyed [1.2.3, 1.4.7]. Non-scarring hair loss often appears as diffuse thinning or "lupus hair"—short, broken hairs along the hairline [1.6.1, 1.6.4].
• Medication Side Effects: Many powerful drugs used to suppress the overactive immune system in lupus can disrupt the normal hair growth cycle, leading to thinning and shedding [1.3.2, 1.3.3]. This type of hair loss is typically non-scarring and often reversible once the medication is adjusted or stopped [1.2.3, 1.4.7].

Common Lupus Medications That Can Cause Hair Loss

Several classes of drugs prescribed for lupus are associated with hair loss. The effect is often a type of hair loss called telogen effluvium, where a shock to the system pushes more hairs than usual into the resting (telogen) phase, leading to increased shedding a few months later [1.3.7, 1.8.3].

Immunosuppressants

These drugs work by taming the body's immune response to prevent it from attacking healthy tissues [1.2.7]. Unfortunately, in doing so, they can also affect rapidly dividing cells like those in hair follicles [1.7.5].

• Methotrexate (Rheumatrex): A commonly used disease-modifying antirheumatic drug (DMARD), methotrexate is known to cause hair loss in 1% to 3% of users [1.7.4, 1.7.5]. It works by stopping cell growth, which includes both the inflammatory cells causing lupus symptoms and the cells in hair follicles [1.7.5]. The hair loss is usually gradual thinning rather than large patches [1.7.5].
• Azathioprine (Imuran, Azasan): This is another immunosuppressant frequently used in lupus treatment where hair loss is a known side effect [1.2.1, 1.3.1].
• Mycophenolate Mofetil (CellCept): This medication is also linked to hair loss in lupus patients [1.2.1].
• Cyclophosphamide (Cytoxan): As a more potent immunosuppressant, often used in severe cases of lupus, cyclophosphamide has a higher likelihood of causing hair loss [1.2.5, 1.7.2]. Hair typically grows back after the treatment is stopped [1.7.2].

Corticosteroids

Corticosteroids, such as Prednisone, are powerful anti-inflammatory drugs frequently used to control lupus flare-ups [1.2.7, 1.3.3]. While essential for managing the disease, long-term use can contribute to hair thinning and a condition called telogen effluvium [1.3.7].

Other Medications

• Antimalarials: Drugs like Hydroxychloroquine (Plaquenil) are a cornerstone of lupus treatment. While generally well-tolerated, hair loss can be a side effect for some patients, though it is usually reversible [1.3.7].
• Biologics: Newer treatments like Belimumab (Benlysta), which are a type of monoclonal antibody, can also be associated with hair loss in some individuals [1.2.1].

Medication Class	Drug Examples	Likelihood/Type of Hair Loss
Immunosuppressants	Methotrexate, Azathioprine, Mycophenolate, Cyclophosphamide	Common side effect, typically diffuse thinning (telogen effluvium) [1.2.1, 1.7.5]. Cyclophosphamide has a higher incidence [1.7.2].
Corticosteroids	Prednisone	Can contribute to hair thinning, especially with long-term use [1.2.4, 1.3.7].
Antimalarials	Hydroxychloroquine (Plaquenil)	Less common, but possible; often reversible [1.3.7].
Biologics	Belimumab (Benlysta)	Can be a side effect for some patients [1.2.1].

Strategies for Managing Medication-Induced Hair Loss

If you suspect your lupus medication is causing hair loss, the first and most crucial step is to speak with your rheumatologist. Never stop or change your medication dosage without medical supervision [1.4.3].

Medical and Professional Guidance

• Medication Adjustment: Your doctor may be able to lower the dose, switch you to an alternative medication, or confirm if the hair loss is due to disease activity rather than the drug [1.2.2, 1.4.3]. Getting the underlying lupus under control is the best way to stop inflammation-related hair loss [1.2.4].
• Supplements: Deficiencies in iron, vitamin D, biotin, and zinc can worsen hair loss [1.2.5, 1.4.2]. Your doctor can test for these and recommend appropriate supplementation. However, you should not start supplements without medical advice as they can interfere with lupus medications [1.4.3, 1.4.4]. Folic acid is often prescribed with methotrexate to help alleviate side effects [1.7.4].
• Topical Treatments: A dermatologist may recommend topical treatments like corticosteroid creams or injections for scalp inflammation [1.4.4]. Over-the-counter products like minoxidil (Rogaine) might help in some cases of medication-induced telogen effluvium, but should only be used after consulting a doctor [1.4.3, 1.4.6].

Gentle Hair Care and Lifestyle Tips

• Avoid Harsh Treatments: Steer clear of chemical treatments like dyes, bleaches, and perms, as well as heat styling tools that can make hair more brittle [1.2.2, 1.4.2].
• Gentle Handling: Use a mild or baby shampoo and a wide-tooth comb [1.2.2, 1.4.7]. Avoid tight hairstyles like ponytails or braids that pull on the scalp [1.2.2, 1.4.7].
• Sun Protection: Sun exposure can trigger lupus flares and scalp lesions [1.4.2]. Always wear a wide-brimmed hat or use scalp sunscreen when outdoors [1.4.3].
• Stress Management: Stress is a known trigger for both lupus flares and hair loss [1.4.2, 1.4.6]. Practices like meditation, yoga, or gentle exercise can be beneficial [1.4.1].

Conclusion

Hair loss is a challenging aspect of living with lupus, stemming from both the disease itself and its treatments. Medications like immunosuppressants (methotrexate, cyclophosphamide) and corticosteroids (prednisone) are common culprits [1.2.1, 1.2.4]. The good news is that medication-induced hair loss is often temporary and can be managed [1.4.7]. Open communication with your healthcare team is essential to adjust your treatment plan effectively, while gentle hair care and lifestyle adjustments can help protect your hair and promote regrowth. For additional support, consider resources like the Lupus Foundation of America.

Lupus Foundation of America

Frequently Asked Questions

Can lupus itself cause hair loss, or is it always the medication?

Both can cause hair loss. The disease itself can cause inflammation that damages hair follicles, sometimes leading to permanent, scarring hair loss. Medications used to treat lupus are also a common cause of non-scarring hair loss that is often reversible [1.6.2, 1.6.4].

Is hair loss from lupus medications like methotrexate permanent?

No, hair loss from medications like methotrexate is usually temporary. The hair often begins to grow back once the dosage is reduced or the medication is stopped, as advised by a doctor [1.2.3, 1.7.5].

What kind of hair loss do lupus medications cause?

Lupus medications typically cause a type of hair loss called telogen effluvium, which is diffuse shedding and thinning all over the scalp rather than distinct bald patches. This happens when the medication pushes more hair into the 'resting' phase of the growth cycle [1.3.7].

Will I lose all my hair if I take cyclophosphamide (Cytoxan)?

While cyclophosphamide can cause significant hair loss, it doesn't always lead to complete baldness. The extent varies among individuals. The hair usually grows back after the medication is discontinued [1.7.2].

Can I use Rogaine (minoxidil) for medication-induced lupus hair loss?

Topical minoxidil may help in some cases of medication-related hair loss (telogen effluvium). However, it's crucial to consult a dermatologist before using it to ensure it's appropriate for your specific situation [1.4.3, 1.4.6].

What supplements can help with hair loss from lupus medications?

Your doctor might recommend supplements like biotin, iron, zinc, or vitamin D if you have a deficiency [1.2.5, 1.4.2]. Folic acid is also commonly prescribed with methotrexate to reduce side effects. Always talk to your doctor before starting any supplements as they can interact with your medications [1.7.4, 1.4.4].

How can I protect my hair while taking lupus medication?

To protect your hair, use gentle shampoos, avoid tight hairstyles and harsh chemical treatments, minimize sun exposure on your scalp, and manage stress. These steps can help reduce breakage and further hair loss [1.2.2, 1.4.2, 1.4.7].