What changes do drugs cause?:
- excessive hair loss or alopecia
- hypertrichosis
- hirsutism
- change color and shape
We talk about excessive hair loss when we lose more of them than in the natural physiological process (up to a maximum of 100-150 hairs). The following factors are most often listed as the cause of this condition:
- Genetic
- Hormonal
- Environmental
We are not always aware that this hair loss may be a side effect of the medicines we are taking. There are many classes of drugs that affect the hair growth cycle.
What Kinds of Alopecia Cause Drugs?
The hair growth cycle consists of 3 main phases: anagen (growth phase), catagen (involution phase), and telogen (resting phase).
Telogen effluvium
- It begins 2 – 4 months after taking the drug and up to 3 months after the end of treatment.
- It is characterized by a shortening of the hair growth phase (anagen), premature onset of the hair follicle involution period, and thus an accelerated transition to the resting phase.
- Alternatively – termination of the use of anagen prolonging drugs or e.g., pregnancy.
- Telogen hair (club hair) predominates in the trichoscopy image
- The number of hair falling out exceeds 30 – 70% of the physiological norm
Which classes of drugs cause TE?
- Mood stabilizers e.g. sodium valproate, lithium, carbamazepine, topiramate
- Antimycotics e.g. fluconazole, intraconazole, terbinafine, anidulafungin
- Cholesterol-lowering drugs, e.g., fenofibrate, clofibrate, atorvastatin
- Drugs used in cardiology:
- β-blockers, e.g., metoprolol, propranolol, atenolol
- ACE inhibitors, e.g., enalapril, lisinopril, captopril
- Calcium channel blockers, e.g., verapamil
- anticoagulants:
- vitamin K antagonists, e.g., acenocoumarol, warfarin
- heparins e.g. enoxaparin, deltaparin, tinzaparin
- immunosuppressants, e.g. methotrexate, azathioprine, gold salts, sulfalazine
- non-steroidal anti-inflammatory drugs, e.g., ibuprofen, ketoprofen, naproxen
- antibiotics e.g. Gentamicin, Isoniazid
- retinoids
- antithyroid drugs, e.g., Propylthiquracil, carbimazole, metamizole
- synthetic thyroid hormones
- contraceptive drugs
- the predominance of estrogen -> 3 mths after the end of therapy clinically corresponds to postpartum alopecia
- advantage of gestagen -> androgenic action
- androgens, anabolic steroids e.g., testosterone, nandrolone
- antiestrogens – aromatase inhibitors e.g., tamoxifen, letrozole
Anagen Effluvium
- After a few days – weeks after taking medications, e.g., chemotherapy
- Mechanism
- Disruption of cell division – mitosis
- Disorder of matrix metabolism
- Hair structure disorder
- Anagenic, dystrophic, and broken hair predominates,
- Head hair, eyelashes, body
Which classes of drugs cause AE?
Cytotoxic drugs:
- Chemotherapy – causes temporary alopecia.
- Polychemotherapy, ablative chemotherapy (before bone marrow transplantation) -> permanent alopecia
Hypertrichosis after medicines?
There are certain groups of drugs that have the side effects of hypertrichosis (excessive hair growth). Below are examples of such drugs:
- Copper
- Cyclosporin A, Prednisone – an immunosuppressive drug
- Retinoic acid – tretinoin
- Minoksidil – antihypertensive drug
- Finasteride – an inhibitor of the enzyme 5-alpha-reductase type II testosterone, used in benign prostatic enlargement
- Interferon-alpha – HCV (hepatitis C) treatment
- Phenytoin – an anti-epileptic drug
- Prostaglandin analogs (drugs used to treat glaucoma), e.g., Bimatoprost, Latanoprost:
- Eyelash thickening
- Hair extension, darkening
Hirsutism
Certain medications can cause hirsutism, which is excessive women’s body hair in areas typical of men (face – mustache, chin, arms, abdomen, chest, back, inner thighs, nipples). Hirsutism is not the same as excessive scalp hair, on the contrary, it coexists with alopecia or acne. There can be many causes of hirsutism, e.g., Cushing’s syndrome, polycystic ovary syndrome, overweight, obesity, but also medicines.
What drugs can trigger hirsutism?
- ACTH adrenocorticotropic hormone, androgens (testosterone, nandrolone)
- Anabolic steroids, e.g. Danazol
- Metyrapone (medicine for Cushing’s disease)
- Implants releasing progesterone (progestin)
- Carbamazepine – an anti-epileptic drug
- Cyclosporine- immunosuppressants
- Tacrolimus – a modern version of Cyclosporine
- Prednisone (Encorton) – immunosuppressants
What other changes can drugs cause?
Hair curling
- Isotretinoin (Aknenormin, Curacne, Izotek)
- Acitretin (Neogasan) psoriasis – curling and color of the hair
- Alitretinoin (Toctino), a new drug for eczema
- Chemotherapy
- Valproic acid
Hair straightening – lithium, interferon
Hair roughness – vit. And retinol
Hair discoloration – chloroquine
Hair Color Restoration – cyclosporin A
Medicines are among the factors that may not affect our hair, but they can also profoundly affect it. When struggling with hair loss, let’s take into account all the factors that may affect the condition of our hair, including the medicines that we take for treating disease and which may cause alopecia. Due to our health, we cannot stop using prescribed drugs. However, knowledge about the side effects of excessive hair loss will save us unnecessary expenses and disappointments resulting from unsuccessful cosmetics treatments.
