Drug Reactions Affecting Hair: Diagnosis

doi:10.1016/j.det.2007.01.005

Dermatologic Clinics

Volume 25, Issue 2, April 2007, Pages 223-231

https://doi.org/10.1016/j.det.2007.01.005 Get rights and content

Drugs may cause hair loss, stimulate hair growth, or induce changes in the hair shape and color. Drug-induced hair loss is, in most cases, a consequence of a toxic effect of the drug on the hair matrix. Although a large number of drugs have been occasionally reported to produce hair loss, the relationship between drug intake and hair loss has been proven only for a few agents. Type of hair loss (telogen effluvium, anagen effluvium, or both) depends on the drug, its dosage, and patient's susceptibility. Drug-induced hair loss is usually reversible.

Section snippets

Telogen effluvium

Telogen effluvium is the most common form of hair loss induced by drugs and is characterized by excessive shedding of telogen hairs. Drugs can induce telogen effluvium through three different mechanisms:

1.
In most cases, drugs induce telogen effluvium by precipitating the follicle into premature rest.
2.
Telogen effluvium may be a consequence of discontinuation of drugs that prolong the duration of anagen such as topical minoxidil and oral contraceptives.
3.
Some drugs may cause premature detachment of

Anticoagulants

Telogen effluvium is a common side effect of treatment with anticoagulants. It occurs in up to 50% of patients treated with high dosages of heparin, heparinoids, or coumarin derivatives.

Antineoplastic agents

Hair loss is the most common cutaneous side effect of antineoplastic drugs. Hair loss is more frequent and severe in patients receiving combination chemotherapy than in those treated with monotherapy (Table 2). Severity of hair loss varies among patients submitted to the same therapeutic regimen.

In most

Busulphan

Busulphan conditioning for allogeneic or autologous bone marrow transplantation produces permanent alopecia in up to 50% of patients (Fig. 4) [20].

Radiation

Radiotherapy of brain tumors often produces cicatricial alopecia. X-ray dosages higher than 700 Gy in fact permanently destroy the hair follicle. The irradiated area is not completely bald as the follicles that were in telogen at the time of radiation can survive the toxic damage (Fig. 5).

Lichen planopilaris

Lichen planopilaris can be precipitated by antihypertensive

Excessive hair growth

Hirsutism may be a consequence of drugs with androgenic effect and is associated with other signs of hyperandrogenism such as acne, seborrhea, and androgenetic alopecia. Hypertrichosis is a possible side effect of several drugs that stimulate hair growth (Table 3).

Diagnosis

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Consider all drugs taken until 4 months before the onset of hair loss.
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The causative role of the drug is often difficult to prove; normalization of hair loss may, in fact, require 2 to 3 months after drug discontinuation.
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Perform a pull test and examine the hair under the microscope to determine type of alopecia.

Telogen effluvium

Although telogen effluvium usually resolves spontaneously, it may precipitate or aggravate androgenetic alopecia in predisposed individuals. Discontinuing the causative drug may not

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Changing human hair fibre colour and shape from the follicle
2024, Journal of Advanced Research
Natural hair curvature and colour are genetically determined human traits, that we intentionally change by applying thermal and chemical treatments to the fibre. Presently, those cosmetic methodologies act externally and their recurrent use is quite detrimental to hair fibre quality and even to our health.
This work represents a disruptive concept to modify natural hair colour and curvature. We aim to model the fibre phenotype as it is actively produced in the follicle through the topical delivery of specific bioactive molecules to the scalp.
Transcriptome differences between curly and straight hairs were identified by microarray. In scalp samples, the most variable transcripts were mapped by in situ hybridization. Then, by using appropriate cellular models, we screened a chemical library of 1200 generic drugs, searching for molecules that could lead to changes in either fibre colour or curvature. A pilot-scale, single-centre, investigator-initiated, prospective, blind, bilateral (split-scalp) placebo-controlled clinical study with the intervention of cosmetics was conducted to obtain a proof of concept (RNEC n.92938).
We found 85 genes transcribed significantly different between curly and straight hair, not previously associated with this human trait. Next, we mapped some of the most variable genes to the inner root sheath of follicles, reinforcing the role of this cell layer in fibre shape moulding. From the drug library screening, we selected 3 and 4 hits as modulators of melanin synthesis and gene transcription, respectively, to be further tested in 33 volunteers. The intentional specific hair change occurred: 8 of 14 volunteers exhibited colour changes, and 16 of 19 volunteers presented curvature modifications, by the end of the study.
The promising results obtained are the first step towards future cosmetics, complementary or alternative to current methodologies, taking hair styling to a new level: changing hair from the inside out.
Medication-induced hair loss: An update
2023, Journal of the American Academy of Dermatology
Commonly prescribed medications associated with alopecia
2023, Journal of the American Academy of Dermatology
The diagnosis and treatment of medication-associated alopecia often challenges patients and physicians. While numerous studies on the topic exist, limited information on the strength and magnitude of these studies exists.
We investigated the most commonly prescribed medications with high levels of evidence to support associations with alopecia.
A list of most commonly prescribed medications was compiled using the “Top 100 Prescriptions, Sales” (Intercontinental Marketing Services) and “Top 200 Names Searched” (RxList.com). PubMed, Embase, and Web of Science were searched for “generic drug name” AND “alopecia” and “generic drug name” AND “hair loss.” Two reviewers independently reviewed articles for drug, study type and level of evidence, and number of alopecia cases.
A total of 192 unique drugs were investigated, with 110 yielding positive search results. Of these, 13 were associated with alopecia in studies with strong levels of evidence (adalimumab, infliximab, budesonide, interferon β-1α, tacrolimus, enoxaparin, zoster vaccine, lamotrigine, docetaxel, capecitabine, erlotinib, imatinib, and bortezomib).
Only full-length articles available in the English language were included. The methodology used relied on lists of drugs based on their sales rather than number of prescriptions, which likely overrepresented expensive drugs.
Few studies with high levels of evidence have been conducted on the topic of medication-associated alopecia. The mechanisms of hair loss must be further identified to provide effective management.
Comparing the frequency of isotretinoin-induced hair loss at <0.5-mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review
2022, JAAD International
Citation Excerpt :
Drug-induced telogen hair loss has previously been reported to start after 12 weeks of therapy.63 The drug prematurely transitions the follicles from the anagen phase to the telogen phase, which has a duration of 3 months prior to shedding.64,65 Data on hair loss with isotretinoin dose escalation are lacking and have only been documented in a small cohort of patients, with a median time of onset at 4 weeks.60
Over 1 million isotretinoin prescriptions are authorized in the United States per year. An insight into the frequency, dose dependency, timing, and reversibility of hair loss associated with isotretinoin treatment for acne vulgaris could help guide dosing regimens and patient counseling. The objective of this systematic review was to assess the frequency of hair loss in patients with acne vulgaris on <0.5 mg/kg/d daily doses of isotretinoin versus the frequency of hair loss in patients with acne vulgaris on ≥0.5 mg/kg/d daily doses of isotretinoin.
An Embase and MEDLINE search was conducted on July 15, 2020, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review focused on acne vulgaris patients. The treatment of acne vulgaris is the most common use of isotretinoin, and the population is typically younger and with fewer comorbidities.
Twenty-two studies reported hair loss with oral isotretinoin treatment. A frequency analysis suggested that patients with acne vulgaris on <0.5 mg/kg/d of isotretinoin experienced hair loss at a frequency of 3.2% (n = 18/565) compared with those on ≥0.5 mg/kg/d, who experienced hair loss at a frequency of 5.7% (n = 192/3375). Inferential statistics were not possible.
Physicians should consider counseling patients about the risk of telogen effluvium prior to drug initiation, as is commonly done for other side effects. The potential trend of increased hair loss frequency at a higher daily dosing warrants further investigation using higher-quality research.
Characteristics of telogen effluvium in COVID-19 in western Iran (2020)
2021, Anais Brasileiros de Dermatologia
Although COVID-19 pandemic significantly induces mortality, many of the patients who recovered present other medical problems such as alopecias. Telogen effluvium is a common alopecia that is usually related to previous events such as acute febrile diseases, including COVID-19.
To evaluate the characteristics of telogen effluvium in COVID-19.
This cross-sectional study was carried out on 526 patients with documented telogen effluvium that recovered from COVID-19. Demographic data, concurrent alopecia, associated diseases, and COVID-19 severity were recorded. Data were analyzed by appropriate statistical methods.
The mean age of the 526 patients (410 females, 116 males) was 30.97 ± 9.592 years, with 7.65 ± 1.739 weeks of mean time of alopecia onset. Vitamin D deficiency (24.3%), androgenetic alopecia (78.2%), and grade III COVID-19 severity were the most common findings. Alopecia onset was significantly earlier in the younger age group, females, in hypothyroidism, and more severe coronavirus infection. Higher grade coronavirus infection was significantly seen in males, higher ages, earlier onset, and androgenic alopecia.
Performing a single-center study and considering limited variables.
Although Coronavirus 2 infection can be an important factor in telogen effluvium induction, other factors such as associated diseases, drug intake and emotional stress may also be involved. In the cases of early onset of alopecia, concomitant diseases such as hypothyroidism and severe coronavirus infection can occur, thus, the presence of various factors in telogen effluvium induction should be considered.
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Drug Reactions Affecting Hair: Diagnosis

Section snippets

Telogen effluvium

Anticoagulants

Antineoplastic agents

Busulphan

Radiation

Lichen planopilaris

Excessive hair growth

Diagnosis

Telogen effluvium

Contraception

Clin Ther

Ann Oncol

J Am Acad Dermatol

Drug-induced hair-loss and hair growth

Drug Saf

Atrophic telogen effluvium from cytotoxic drugs and a randomized controlled trial to investigate the possible protective effect of pretreatment with a topical vitamin D analogue in humans

Br J Dermatol

Generalized hair loss induced by indinavir plus ritonavir therapy

AIDS

Hair loss in an HIV-1 infected woman receiving lopinavir plus ritonavir therapy as first line HAART

Dermatol Online J

Hair loss and contraceptives

Br Med J

Hair loss in children on long-acting gonadotropin-releasing hormone agonist triptorelin treatment

Acta Derm Venereol

Alopecia and breast disease

BMJ

Letrozole: a review of its use in postmenopausal women with breast cancer

Drugs