Can medications trigger alopecia areata?

Question

Hello, hair loss Doctors. Can medications trigger alopecia areata if an individual has the genetic predisposition to it? If so what kind of medications? Can antihistamines cause it since they can affect the immune system? Or oral retinoids? Is it rare for medications to cause alopecia areata? Thank you

Anna Chacon, MD, FAAD · Answer

Alopecia areata is an autoimmune condition characterized by non-scarring hair loss, typically in patches. The exact cause of alopecia areata is not fully understood, but it is believed to be a combination of genetic predisposition and environmental triggers, including possibly medications.

Here are some key points regarding medications and their potential to trigger alopecia areata:

1. **Genetic Predisposition and Medications**:
   - Individuals with a genetic predisposition to alopecia areata may be more susceptible to triggers that can initiate or exacerbate the condition. These triggers can include infections, stress, and potentially certain medications.

2. **Types of Medications**:
   - While it is less common for medications to directly cause alopecia areata, some drugs can potentially trigger it in genetically predisposed individuals. These medications may include:
     - **Immunomodulatory drugs**: Medications that affect the immune system could theoretically trigger autoimmune responses. Examples include biologics and certain immunosuppressants.
     - **Interferons**: Used in the treatment of diseases like multiple sclerosis and hepatitis, interferons can sometimes trigger autoimmune conditions, including alopecia areata.
     - **Antihypertensives**: Certain blood pressure medications, such as beta-blockers and ACE inhibitors, have been reported in rare cases to be associated with hair loss, though not specifically alopecia areata.
   
3. **Antihistamines and Alopecia Areata**:
   - Antihistamines are generally used to treat allergic reactions and are not commonly associated with triggering autoimmune conditions like alopecia areata. They primarily work by blocking histamine receptors and do not typically have a direct immunosuppressive effect that would trigger alopecia areata.

4. **Oral Retinoids and Alopecia Areata**:
   - Oral retinoids, such as isotretinoin (commonly used for severe acne), can cause hair thinning and hair loss as a side effect, but this is usually diffuse hair loss (telogen effluvium) rather than patchy hair loss characteristic of alopecia areata. However, in susceptible individuals, any significant alteration in the immune or hormonal environment could theoretically act as a trigger.

5. **Rarity of Medication-Induced Alopecia Areata**:
   - It is relatively rare for medications to directly cause alopecia areata. Most cases of alopecia areata are idiopathic, meaning they arise without a clear external cause. When medications are implicated, it is often in the context of an individual with a pre-existing predisposition to autoimmune conditions.

While it is uncommon for medications to directly cause alopecia areata, they can potentially act as triggers in individuals who are genetically predisposed to the condition. Medications that modulate the immune system, such as certain biologics or interferons, are more likely to be implicated in such cases. Antihistamines and oral retinoids are less commonly associated with triggering alopecia areata, though they can cause other types of hair loss.

Jeff Donovan, MD, PhD · Answer

Sure it’s possible but most of the time it’s just coincidence. in other words, most of the time alopecia areata is not due to a drug.

According to a recent study by Ezemma and colleagues, here is the list of top culprits in drug-induced AA:

Adalimumab (18.6% of all published cases) - TNF inhibitor

Infliximab  (14.7% of all published cases) - TNF inhibitor

Dupilumab  (12.7% of all published cases)  - anti-IL-4/13

Etanercept  (11.7% of all published cases) - TNF inhibitor

Alemtuzumab  (5.8% of all published cases) - monoclonal anti-CD52 antibody

Hepatitis C therapy (ribavirin, interferon-alpha)  (3.9% of all published cases)

Cyclosporine  (2.9% of all published cases)  - calcineurin immunosuppressive agent

Belimumab  (2.9% of all published cases) - monoclonal AB; inhibitor of B-lymphocyte stimulator (BLyS)

Cladribine  (1.9% of all published cases) - antimetabolic chemotherapeutic

Golimumab  (1.9% of all published cases) - TNF inhibitor

Haloperidol  (1.9% of all published cases)  - antipsychotic

Pembrolizumab  (1.9% of all published cases)  - checkpoint inhibitor, anti-PD1

Rifampicin  (1.9% of all published cases) - antimicrobial

Oral retinoid  (1.9% of all published cases)  - vitamin A derivative

Be sure to see an expert!

Can medications trigger alopecia areata?

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Can medications trigger alopecia areata?

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