Hair loss in IBD patients is quite common, with one-third of patients reporting some kind of hair loss. Although this isn’t a dangerous medical condition, hair has an important role in our social interactions, and sudden hair loss can negatively impact quality of life, confidence, and the way we express our identity.
Depending on the cause, hair loss is likely to be temporary in UC and there is a range of treatment options to consider.
What Causes Hair Loss in Ulcerative Colitis?
Hair loss is caused by very different factors, and it can be very individual but there are a few specific types of hair loss that are immune-related and are more common in IBD patients.
Alopecia Areata (AA)
Alopecia is a blanket term for hair loss, with several subtypes. Most commonly found in ulcerative colitis is alopecia areata, which may share a molecular pathway in the development of IBD.
Alopecia areata causes hair to fall off in patches due to an autoimmune inflammatory attack on the follicle in the first phase of the hair growth cycle. The immune attack disrupts the normal hair cycle, leading to patches of baldness, or complete scalp loss. It can also lead to body hair loss. Men and women appear equally affected.
Telogen Effluvium & The Stress of Flare-Ups
The physiological strain of an IBD flare-up can lead to a condition called telogen effluvium (TE). When this happens, physical stressors or changes cause the body to push more hair into the telogen phase of the hair growth cycle – the ‘resting’ or inactive phase.
TE in IBD patients is most commonly caused by a high fever, surgical trauma, or hemorrhaging. Between 30-50% of one’s hair may fall out, but complete hair loss is very rare. Still, if not treated, chronically active IBD can result in ongoing TE.
Many drugs for IBD report alopecia as a rare side effect. And although there are anecdotal reports of hair loss when taking common medications for IBD, there is little concrete information.
Some medications cite or report hair loss as a rare adverse effect, such as mesalazine (Asacol, Mezavant, Octasa, Pentasa, Salofalk, Zintasa), olsalazine (Dipentum), and sulfasalazine (Azulfidine). A recent meta-review of 5-ASA and sulfasalazine in IBD did not note an association with hair loss, but there have been a few case reports of hair loss from mesalazine. In these cases, the hair loss resolved after discontinuation of the drug.
Hair loss is sometimes reported as a side effect of methotrexate in IBD patients but appears more common in those with psoriasis or rheumatoid arthritis. TNF-a blocker agents such as infliximab (Remicade) and adalimumab (Humira) report hair loss as a possible rare side effect, but this is not reported in larger trials with IBD patients.
Nutritional deficiencies have been associated with IBD-related hair loss, in particular zinc and iron. Zinc tends to be lower in those suffering hair loss and is important for regrowth. A B12 deficiency should also be ruled out, as low B12 levels can cause hair thinning and hair loss.
Treating Hair Loss in Ulcerative Colitis
Treating hair loss can be tricky, as the treatment depends largely on the cause and this can be difficult to pinpoint in cases of IBD. Your doctor may recommend tofacitinib, which has successfully treated AA in patients with Crohn’s disease. Other options are anthralin cream, which is used for psoriasis, or topical corticosteroids which soothe the inflammation around the hair follicles.
Stress management and nutritional support are always beneficial, as well as avoiding dying your hair, pulling it back in tight buns and ponytails, and excessive brushing.
Hair loss can be difficult to cope with and should be addressed, even though it is not considered a serious medical condition. If you’ve noticed a thinning out, speak to your doctor about options such as changing your medication.
Remember, hair loss from IBD is usually temporary and should resolve with some changes so rest assured, your freak flag shall fly once again.