Beautiful hair makes us look good, and most of us are concerned about taking proper hair care and pamper it in all possible ways. Having beautiful and perfect hair is a boon that is admired by everyone around. Proper hair care routine and diet play a significant role in having healthy-looking hair. Despite putting all our efforts into taking care of our hair, we tend to lose some hair strands every day.
Hair loss is a distressing condition that affects a person’s self-esteem, especially when it comes to baldness. Both men and women are at equal risk of hair loss and experience psychological distress. According to a research study and the American Academy of Dermatologists, it is quite normal to lose 100 strands of hair per day.
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It is a concern when we see plenty of hair tangled in our hairbrush and when we get to see many strands lying on the floor. If it lasts longer, it is essential to identify the potential cause of hair loss. Some of the patients suffer from hair loss as a traumatic side effect resulting from certain medications. Hair loss disorders vary according to the type of illness that a person undergoes.
What is Alopecia?
Hair loss or alopecia is the loss of hair that affects the scalp or any part of the body. It is a common problem seen in both men and women. Hair loss is one of the most distressing conditions that impact the physical appearance of a person. The symptoms of alopecia may vary depending upon the underlying cause of the condition.
Causes for Hair Fall
Depending on the reason behind the hair loss, it can happen suddenly or gradually. Hair loss can result from any one or more of the following reasons:
- Heredity is one of the most common causes of hair loss that usually happens with aging.
- Excessive use of hairdryers and straighteners, hot-oil treatments result in hair loss.
- Hormonal changes during pregnancy, childbirth, and menopause can cause temporary hair loss.
- Medications used to treat cancer, depression, heart problems, and high blood pressure can cause hair loss.
- An extended period of physical or emotional stress can cause thinning of hair and temporary hair loss.
- Lack of sufficient intake of nutritious food can increase the risk of hair loss.
Drug-induced Alopecia Types
Drug-induced alopecia is a side effect of certain medications that are used in the treatment of various illnesses. The severity of the condition depends on the dosage and type of drugs used for the treatment. It usually occurs within three months of starting a particular medication. Drug-induced alopecia causes two types of hair loss, namely anagen effluvium and telogen effluvium.
Anagen effluvium
Anagen effluvium is alopecia that affects the anagen hairs. Anagen is a growth phase, i.e., the period of epithelial proliferation. Anagen effluvium is specified as chemotherapy-induced alopecia. Anagen effluvium is triggered by alkylating agents, antimetabolites, and mitotic inhibitors that are used in chemotherapeutic treatment. With the administration of these drugs, the hair shaft gets damaged and causes hair loss. The hair shedding begins within two weeks of administration of the offending agents that damage the hair follicles. Anagen effluvium is equally prevalent in men and women.
Once the chemotherapy is stopped, the hair begins to regrow but with a slightly different texture and color of the hair. According to research conducted on breast cancer patients, hair loss begins anywhere from 18 days of starting the chemo treatment and begins to regrow three months after completing the chemotherapy treatment (1).
Hair loss is a common side effect in cancer treatments like chemotherapy, radiation, and targeted therapy. According to the American Society of Clinical Oncology (ASCO), cisplatin, altretamine, docetaxel, carboplatin, gemcitabine, paclitaxel, vinorelbine, epirubicin, and ifosfamide are some of the common chemotherapy drugs that result in hair loss (2).
Telogen effluvium
Telogen effluvium is the temporary shedding of the hair in the resting phase of the hair growth cycle. It can affect people of all age groups and irrespective of gender. This type of hair loss is a side effect of medications and supplements. Although hair loss might not be an important indication on the warning labels, some people might develop hair loss as a typical side effect.
A study says that many hairs in the growing phase (anagen) will enter the resting phase (telogen) when a person undergoes psychological stress. Telogen effluvium can result from psychological stress that makes the hair growth halted for a certain period of time. The chances of hair loss are more when the hair follicles enter the resting state (3).
There are a considerable number of causes that lead to telogen effluvium. High fever, severe infection, chronic illness, childbirth, under or overactive thyroid, lack of protein intake, crash diets, and various medications can cause hair loss. Cholesterol-lowering drugs, anticoagulants, anticonvulsants, antihypertensives, antidepressants, high doses of vitamin A, and non-steroidal anti-inflammatory (NSAIDs) are some of the common medications that induce hair loss.
Medications That Cause Hair Loss
1. Antihypertensives
These are the class of drugs that are prescribed for high blood pressure (HBP) or hypertension. Beta-blockers that are often prescribed for hypertension result in hair loss. Research says that discontinuation of nadolol (beta-blocker) resulted in regrowth of scalp hair within three months. Some of the common beta-blockers that induce hair loss are timolol, atenolol, and propranolol (4).
Another class of drugs called angiotensin-converting enzyme (ACE) works by relaxing the blood vessels. They reduce the volume of blood flow, thus lower the blood pressure. ACE inhibitor drugs cause thinning of the hair. According to a study, the patients who were given lisinopril to manage heart problems developed medication-induced alopecia, which was the adverse reaction of lisinopril drug. Some of the commonly used ACE inhibitors that induce hair loss are enalapril and captopril (5).
2. Anticoagulants
Anticoagulants are also known as blood thinners that help prevent blood coagulation and effectively prolong the blood clotting time. Although anticoagulants prevent heart attack and stroke, they do carry specific side effects like hair loss. World Health Organisation (WHO) has received reports from the pharmacovigilance database that shows direct oral anticoagulants (DOACs)-induced alopecia. Heparin and warfarin are the commonly used anticoagulants that have reported hair loss as an adverse effect (6).
3. Cholesterol-Lowering Drugs
‘Statins’ are a class of cholesterol-lowering drugs that are prescribed to lower the low-density lipoprotein (LDL) cholesterol, which clogs the arteries. Cholesterol is a percussor for hormones, such as cortisone, estrogen, progesterone, aldosterone, and testosterone. It is also essential for the growth of the hair. Lowering the blood cholesterol levels by using ‘statin’ drugs can result in hair loss. Research published in The American Journal of Medicine says that patients who received statin drugs have reported hair loss as a side effect. Simvastatin and atorvastatin are the commonly prescribed cholesterol-lowering medications (7).
4. Anticonvulsants
Anticonvulsants are a class of drugs that are used in the treatment of epilepsy and seizures. A research study published in The New England Journal of Medicine mentions that patients developed alopecia during the treatment of epilepsy with trimethadione, which is an anticonvulsant medication (8). It was observed that the discontinuation of the drug resulted in regrowth of the scalp hair. Another research says that sodium valproate or valproic acid used as an anti-epileptic drug resulted in drug-induced alopecia in some patients (9).
5. Antidepressants
Antidepressants are the drugs prescribed to relieve the symptoms of anxiety disorders and depression. Antidepressants cause telogen effluvium type of hair loss. Although the risk of hair loss varies with the type of medication and dose, a study claims that antidepressant medications, such as fluoxetine, paroxetine, sertraline, and certain other antidepressants, result in drug-induced alopecia (10).
6. Vitamin A
Isotretinoin belongs to a class of Vitamin A medications called retinoids. It is used to treat acne and several other vitamin A deficiency conditions. Isotretinoin suppresses the sebum production that plays a significant role in developing acne. According to research, the use of isotretinoin in patients with moderate to severe acne vulgaris resulted in hair loss, which was observed by altered drug dose (11).
Final Words
Drug-induced alopecia usually improves when the medication is stopped after a few weeks of treatment. However, in severe cases like chemotherapy for cancer treatment requires special care and treatment to regrow the hair. Eating a balanced diet that supports hair growth and taking supplements to overcome nutritional deficiencies can help to regrow the hair within 3 to 6 months.