Medication and hair loss in women

The hair loss caused by medical treatments have become increasingly common over the last 50 years. Chemical substances arrive directly via the bloodstream at the level of the hair follicle, where the hair's keratin is manufactured.

When these substances have a negative effect on normal hair renewal, the extent of the damage caused depends on the duration of the treatment and the doses prescribed, as well as the patient's sensitivity to hair problems. In women, certain contraceptives are the most common cause of medicated hair loss.

THREE TYPES OF DRUG-INDUCED ALOPECIA

1. Telogen effluvium, the most common type

In medical terms, telogen effluvium means that a larger quantity of hair than usual enters the renewal phase. In other words, the lifespan of this hair will be shortened under the harmful effect of the drug. Hair will begin to fall out within 2 to 4 months of starting to take the drug. Hair loss will be diffuse, covering the entire scalp, and will be reversible when treatment is stopped, but will recur if treatment is resumed.

2. The anagen effluvium

It generally leads to faster and more severe alopecia. In this case, the drug abruptly stops the development of the hair at a time when it is in its growth phase. Anagen effluvium mainly concerns products prescribed for cancer chemotherapy. As in the previous case, hair loss is reversible when treatment is stopped, but recurs if treatment is resumed.

3. Androgenetic hair loss

A third category concerns 'androgenising' substances, contained in certain corticosteroid or hormonal treatments (such as 1st or 2nd generation contraceptives). In predisposed individuals, these substances can trigger or aggravate a androgenetic alopecia.
This type of alopecia is characterised by a shrinking of the hair follicles sensitive to androgens, a thinning and a localised and very gradual loss of hair.

THE IMPORTANCE OF DIAGNOSIS

Before accusing a medicinal product, it is important to ensure that :

• That the hair loss coincides in time with that of the medication.
• That it is not the disease itself, or the stress it causes, that is the cause of hair loss, but the treatment itself. In this case, you should ask your doctor if it is possible to replace this treatment (it sometimes is) with another molecule that has no effect on hair loss.
• That the substance in question is duly listed as harmful to hair health. Some molecules have an undeniable and almost systematic negative effect, while others have a definite but less systematic effect, in terms of the number of cases reported. Others are controversial, having only been the subject of isolated cases. A in-depth diagnosis of your hair is recommended when in doubt.
  

TREATMENT FAMILIES INVOLVED

The table below lists the main drug families, some of which are likely to trigger drug-induced alopecia.

THERAPEUTIC FAMILIES	TYPE OF ALOPECIA
Anticoagulants: to make blood more fluid	telogen effluvium
Antidepressants	telogen effluvium
Antiepileptics/anticonvulsants: reduce the activity of the central nervous system	telogen effluvium
Anti-estrogens: blocking the action of estrogens on the breasts and uterus	telogen effluvium
Antihypertensives Hypertension and androgenetic hair loss	telogen effluvium
Colchicine anti-inflammatories: to combat gout attacks	telogen effluvium
Anti-inflammatory steroids (AIS): synthetic corticosteroids	androgenetic
Non-steroidal anti-inflammatory drugs (NSAIDs): for pain and rheumatism	telogen effluvium
Antimitotics: cancer chemotherapy Chemotherapy and hair loss	anagen effluvium
Antithyroid drugs: regulating the thyroid gland Hair loss and thyroid problems	telogen effluvium
Beta-blockers: blocking the action of adrenaline	telogen effluvium
Hormonal contraceptives Hair and homonal contraception	androgenetic
Hypocholesterolemics-Hypolipidemics Cholesterol and hair loss	telogen effluvium
Alpha interferons: regulating the immune system	telogen effluvium
Lithium: mood regulator	telogen effluvium
Retinoids: treating severe forms of acne, seborrhoea and psoriasis	telogen effluvium
Gold salts: anti-rheumastimal: treating polyarthritis	telogen effluvium
Hormone replacement therapy (HRT) Menopause and hair loss	androgenetic

Other families in which molecules that promote alopecia (hair loss) may be found: certain antiarrhythmics, antibiotics, antifungals, antigonadotropics, antihelminthics, antimigraine drugs, antineoplastics, antimalarials, antiparkinsonian drugs, antirheumatic drugs, antiulcer drugs, antivirals, thyroid hormones, immunomodulators, immunosupressants, ACE inhibitors, neuroleptics, etc.

RED LIST OF MEDICINES

To find out whether the specific medication you are taking can cause hair loss, refer to the alphabetical list. This list is not exhaustive, but includes most medicines sold in pharmacies that are likely to cause hair loss. cause alopecia (it does not include treatments reserved for hospital use).

DRUGS	HAIR LOSS	ALOPECISING SUBSTANCE
Activelle®	often, if androgenetic predisposition	norethisterone
Adépal®	often, if androgenetic predisposition	levonorgestrel
Adrexan®	rarely	propranolol
Advil®	very rarely	ibuprofen
Aldomet®	rarely	methyldopa
Alève®	very rarely	naproxen
Allochrysine®	rarely	gold salts
Amlor®	sometimes	calcic inhibitor
Amlodipine Gé	sometimes	calcic inhibitor
Anafranil®	sometimes	clomipramine
Apegmone®	sometimes	tioclomarol
Apranax®	rarely	naproxen
Arava®	sometimes	leflunomide
Arimidex®	often	anastrozole
Arthrocine®	very rarely	sulindac
Atenolol Gé	rarely	atenolol
Avlocardyl®	rarely	propranolol
Azantac®	very rarely	ranitidine
Azathioprine Gé	rarely	azathioprine
Basdène®	sometimes, if overdosed	benzylthiouracil
Béfisal®	rarely	bezafibrate
Betnésol	sometimes	betamethasone
Bisoprolol Gé	sometimes	bisoprolol
Brufen®	very rarely	ibuprofen
Calciparin®	often, especially in high doses	heparin
Captea®	very rarely	captopril
Captirex®	very rarely	captopril
Captolane®	very rarely	captopril
Captopril Gé	very rarely	captopril
Carbamazepine	sometimes	carbamazepine
Catapressan®	sometimes	clonidine
Celestamine®	sometimes	betamethasone
Célestène®	sometimes	betamethasone
Cellcept®	rarely	mycophenolate mofetil
Cérazette® (and its generics)	often, if androgenetic predisposition	desogestrel
Chrono-Indocid®	very rarely	indometacin
Cimetidine Gé	very rarely	cimetidine
Clomid	very rarely	clomiphene
Colchicine H. ®	often, especially in high doses	colchicine
Colchimax®	often, especially in high doses	colchicine
Contracné Gé	quite often	isotretinoin
Cordarone®	rarely	amiodarone
Corgard®	rarely	nadolol
Co-Renitec®	rarely	enalapril
Cortancyl®	sometimes, in such large doses, for a long time	prednisolone
Coumadin	sometimes	warfarin
Crestor®	sometimes	rosuvastatin
Crixivan®	very rarely	indinavir
Curacné Gé	quite often	isotretinoin
Cynomel®	sometimes, if the dosage is incorrectly balanced	Liothyronine sodium
Daily Gé®	often, if androgenetic predisposition	levonorgestrel
Danatrol®	often	danazol
Dectancyl®	sometimes, in such large doses, for a long time	dexamethasone
Defanyl®	sometimes	amoxapine
Depakine®	often	valproic acid
Depakote®	often	valproic acid
Depamide	often	valpromide
Depo-Medrol	sometimes, in such large doses, for a long time	methylprednisolone
Depo-Provera®	often, if androgenetic predisposition	medroxyprogestone
Deroxat®	rarely	paroxetine
Désernil®	rarely	methysergide
Detentiel®	sometimes sometimes	bisoprolol
Dexambutol®	rarely	ethambutol
Di-Hydan®	sometimes	phenytoin
Diprostene®	sometimes in such high doses for so long	betamethasone
Divarius®	rarely	paroxetine
Divina®	often, if androgenetic predisposition	medroxyprogestone
Dolcidium®	very rarely	indometacin
Duova®	often, if androgenetic predisposition	medroxyprogestone
Ecazide®	very rarely	captopril
Effexor®	very rarely	venlafaxine
Elavil®	sometimes	amitriptyline
Epivir®	sometimes	lamivudine
Euthyral®	often, if the dosage is incorrectly balanced	Levothyroxine
Exluton®	often, if androgenetic predisposition	lynestrenol
Feldène®	very rarely	piroxicam
Fémara®	often	letrozole
Fenofibrate Gé	rarely	fenofibrate
Fivasa®	rarely	mesalazine
Floxyfral®	rarely	fluvoxamine
Fluoxetine Gé	sometimes	fluoxetine
Fluvoxamine Gé	rarely	fluvoxamine
Furadantine®	sometimes	nitrofurantoin
Furadoin	sometimes	nitrofurantoin
Gentalline®	rarely	gentamicin
Glucophage®	rarely	metformin
Haldol®	very rarely	haloperidol
Hemiprlalon®	rarely	propranolol
Heparin C.®	often, in such large doses, for a long time	heparin
Hydrocortancyl®	sometimes, in such large doses, for a long time	prednisolone
Hydrocortisone®	sometimes, in such large doses, for a long time	Hydrocortisone
Ibuprofen Ge	very rarely	ibuprofen
Implanon®	often, if androgenetic predisposition	etonogestrel
Imurel®	rarely	azathioprine
Indocid®	very rarely	indometacin
Intrinsa®	often	testosterone 8.4 mg
Introna®	often	interferon a 2b
Isoptine®	very rarely	verapamil
Keratyl®	quite often	nandrolone
Kessar Gé	often	tamoxifen
Kliogest®	often, if androgenetic predisposition	norethisterone
Laroxyl®	sometimes	amitriptyline
Ledertrexate®	often	methotrexate
Levothyrox®	often, if the dosage is incorrectly balanced	Levothyroxine
Lipanor®	rarely	ciprofibrate
Lipanthyl®	rarely	fenofibrate
Lipur®	rarely	gemfibrozil
Livial®	often, if androgenetic predisposition	tibolone
Lodalès®	sometimes	simvastatin
Lodoz®	sometimes	bisoprolol
Lopressor®	rarely	metoprolol
Lopril®	very rarely	captopril
L-Thyroxine®	often if the dosage is incorrectly balanced	Levothyroxine
Ludéal Gé®	often, if androgenetic predisposition	levonorgestrel
Ludiomil®	sometimes	maprotiline
Lutenyl®	often, if androgenetic predisposition	nomgestrol
Malarone®	very rarely	proguanil
Mediator	rarely	benfluorex
Médrol®	sometimes in such high doses for so long	methylprednisolone
Metformin Gé	rarely	metformin
Methotrexate	often	methotrexate
Microdoin®	sometimes	nitrofurantoin
Microval®	often, if androgenetic predisposition	levonorgestrel
Minidril®	often, if androgenetic predisposition	levonorgestrel
Miniphase®	often, if androgenetic predisposition	norethisterone
Mini-Sintron®	sometimes	acenocoumarol
Miréna®	often, if androgenetic predisposition	levonorgestrel
Modopar®	rarely	levodopa,benserazide
Myanbutol®	rarely	ethambutol
Naémis®	often, if androgenetic predisposition	nomgestrol
Naprosyne®	rarely	naproxen
Neo-Mercazole	sometimes, if overdosed	carbimazole
Neoral®	extremely rare	cyclosporine
Nilevar®	often	norethandrolone
Nolvadex®	often	tamoxifen
Noristerat®	sometimes, if there is an androgenetic predisposition	norethisterone
Norplant®	sometimes, if there is an androgenetic predisposition	levonorgestrel
Novafemme®	sometimes, if there is an androgenetic predisposition	norethisterone
Novatrex®	often	methotrexate
Nureflex®	very rarely	ibuprofen
Ocadrik®	very rarely	verapamil
Oncotam Gé	often	tamoxifen
Orencia®	sometimes	abatacept
Orgametril®	often, if androgenetic predisposition	lynestrenol
Pacilia Gé	often, if androgenetic predisposition	levonorgestrel
Paludrine	very rarely	proguanil
Parlodel®	very rarely	Bromocriptine
Paroxetine Gé	rarely	paroxetine
Pentasa®	rarely	mesalazine
Pepcidac®	very rarely	famotidine
Pergotime®	very rarely	clomiphene
Pertofran®	sometimes	desipramine
Pindione®	rarely	phenindione
Piroxicam Gé	very rarely	piroxicam
Prednisolone Gé	sometimes in such high doses for so long	prednisolone
Préviscan®	rarely	fluindione
Procuta Gé	quite often	isotretinoin
Propranolol®	rarely	propranolol
Propylex®	sometimes, if overdosed	propylthiouracil
Prozac®	sometimes	fluoxetine
Quitaxon®	sometimes	doxepin
Renitec®	rarely	enalapril
Ridauran®	rarely	gold salts
Roaccutane®	quite often	isotretinoin
Roferon®	often	interferon a 2a
Rowasa®	rarely	mesalazine
Salazopyrin®	very rarely	sulfasalazine
Savarine®	very rarely	proguanil
Seloken®	rarely	metoprolol
Sinemet®	rarely	carbidopa, levodopa
Sintrom®	sometimes	acenocoumarol
Solumédrol®	sometimes in such high doses for so long	methylprednisolone
Solupred®	sometimes in such high doses for so long	prednisolone
Soriatane®	often	acitretin
Sotalex®	rarely	sotalol
Sotalol Gé	rarely	sotalol
Stédiril®	often, if androgenetic predisposition	norgestrel
Stalevo®	rarely	carbidopa, levodopa
Surmontil®	sometimes	trimipramine
Surgestone®	often, if androgenetic predisposition	promégestone
Tagamet®	very rarely	cimetidine
Tamofen Gé	often	tamoxifen
Tamoxifen Gé	often	tamoxifen
Tegretol®	sometimes	carbamazepine
Tenormin®	rarely	atenolol
Téralithe®	often	lithium
Thiophenicol®	very rarely	thiamphenicol
Thyrozol®	sometimes so badly dosed	thiamazole
Timacor®	rarely	timolol
Timolol Gé	rarely	timolol
Timoptol®	rarely	timolol
Tofranil®	sometimes	imipramine
Triella®	often, if androgenetic predisposition	norethisterone
Triflucan®	often in such high doses for so long	fluconazole
Trinordiol®	often, if androgenetic predisposition	levonorgestrel
Trisequens®	often, if androgenetic predisposition	norethisterone
Trolovol®	sometimes	penicillamine
Viraferon®	often	interferon a 2a
Vitamin A	very often, if overdosed	retinol
Zeffix®	very rarely	lamivudine
Zentel®	very rarely	albendazole
Zocor®	sometimes	simvastatin
Zoloft	rarely	sertraline
Zyloric®	very rarely	allopurinol