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Drug-induced alopecia - Hair and Scalp
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Drug-induced alopecia - Hair and Scalp

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Contributors: Vivian Wong MD, PhD, Claire Marie Reyes-Habito MD, Susan Burgin MD
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Synopsis

Drug-induced alopecia : Widespread non-scarring alopecia
Many drugs have been reported to cause hair loss. This loss is usually diffuse, temporary, nonscarring, and limited to the scalp. Women are more commonly affected. The mechanism varies depending upon the causal drug. In most cases, drugs induce the telogen (resting) stage of the hair and may lead to a chronic telogen effluvium. In addition, cytotoxic drugs can cause anagen effluvium, while certain medications (such as anti-tumor necrosis factor-α therapy) can cause alopecia areata. Several medications such as contraceptives containing androgenic progestational agents and topical diclofenac 3% gel could worsen or precipitate androgenetic alopecia.

The degree of anagen effluvium from cytotoxic drugs is dependent upon the dosage, schedule, and route of administration. The risk for alopecia is higher with high-dose, intermittent, intravenous, and/or combination therapies. Topical therapies such as topical timolol solution and topical diclofenac 3% gel can induce hair loss as well. Although drug-induced alopecia is usually reversible upon discontinuation of the culprit medication, permanent alopecia from chemotherapy (taxane and adjuvant hormonal therapy) has been reported. Changes in the hair color, quality, or texture are also possible from chemotherapy.

Localized alopecia has been reported as an adverse effect in men at the site of deoxycholic acid injections for submental adiposity.

See articles on telogen effluvium and anagen effluvium for more information on implicated medications.

Codes

ICD10CM:
L65.8 – Other specified nonscarring hair loss

SNOMEDCT:
73383004 – Drug-related alopecia

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Other causes of diffuse, nonscarring hair loss:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:05/20/2018
Last Updated:09/22/2019
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Drug-induced alopecia - Hair and Scalp
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A medical illustration showing key findings of Drug-induced alopecia : Widespread non-scarring alopecia
Clinical image of Drug-induced alopecia - imageId=255411. Click to open in gallery. caption: 'Decreased hair density on the frontal scalp.'
Decreased hair density on the frontal scalp.

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