Crohn's disease and hair loss: does the use of the drug infliximab cause hair loss?

Question

Hi, Would Crohn's disease associated with the use of the drug infliximab cause hair loss? Telogen effluvia? I started using infliximab in 2016, every 2 months (8/8 weeks), a year ago I started using it every month (4/4 weeks) and after that my hair started to fall out. I have been using Finasteride for 10 months and the crown remains thin and unsuccessful. Would my guess be androgenetic alopecia with chronic telogen effluvium?

Jason Emer, MD · Answer

You need a formal evaluation to see what type of hair loss you may have. When you have hairless it's best to do a full hormonal workup for internal optimization plus scalp biopsies or scrapings to rule out any stress related, inflammatory, autoimmune or infectious causes of hair loss. In general most people with early hair loss have telogen (stress related) and/or androgenetic (normal aging) and both can be treated with in office treatments like steroid injections, PRP/acell, Exosomes and at home treatments like oral medications, oral vitamins like Viviscal, topical exfoliating sprays like Restorsea, and weekly growth factors like anteagemd.  See an expert for an evaluation. If hair loss is significant it may requires hair transplant (follicular unit translation).

Jeff Donovan, MD, PhD · Answer

That approach may be correct but it might not. It’s actually not so simple. Having cared for many patients with Crohn’s disease related hair loss, I can say at the outset that often it is not always so simple. Your hair loss could be due to many things you have not considered so be sure to review with a dermatologist who specializes in hair disorders and understands the complexities behind use of infliximab and the many systemic issues that can happen with inflammatory bowel disease. Your hair loss might have nothing to do with infliximab. First, let’s state that infliximab can cause hair loss. But fortunately it does not in most. Usually in most it actually reduces hair loss in a patient with active IBD. But it can cause many more hair loss conditions than telogen effiuvium alone so you’ll need to include lichen planopilaris and alopecia areata in your list. You’ll also want to include a psorasiform type dermatitis on your list which can cause scaling and hair loss in some. Second, one should not forget that “active” inflammatory bowel disease is a cause of hair loss. If a patient has gone up from injections every 2 months to injections monthly it is an indication the disease is active. So the chances of this being a reason for hair loss is ... high!  Active disease can cause hair loss completely separate from any drug effect. With active IBD, I often want to know the status of iron and zinc absorption so these blood tests may be important. Blood tests B12 and vitamin D are to be considered as is a basic CBC. General nutrition and weight loss must be considered. A full medical history of course is critical here. Other tests could be helpful as well. Be sure to carefully review with the dermatologist. Finally, if you have some degree of androgenetic hair loss, this needs to also be addressed.

William Rassman, MD (retired) · Answer

The Stress of Chron's Disease and its activity can cause hair loss. When drugs like infliximab are added to the treatment routine, hair loss is reported to be more common.

Crohn's disease and hair loss: does the use of the drug infliximab cause hair loss?

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Crohn's disease and hair loss: does the use of the drug infliximab cause hair loss?

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Everything you need to know about Hair Loss Treatment

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