Stopping Hair Loss Medications in Pregnancy: Which ones do we need to stop?

Stopping Hair Loss Treatments During Pregnancy.

When I’m asked whether or not treatments for hair loss needs to be stopped during pregnancy, I generally respond with two questions: 1) What is the exact hair loss condition that the person has? and 2) what do we actually expect to happen to the hair and scalp during pregnancy.

Many hair loss related treatments can not be used during pregnancy.

For many hair issues, treatment is not recommended for women trying to conceive or during the pregnancy. The effect of the given treatment on the baby must always be given careful consideration. Some treatments have simply never been studied. Some have been studied and have been found to cause harm. Some appear to be safe.

For androgenetic alopecia, the hormonal changes that occur in pregnancy often help slow or stop hair loss. Many patients actually have an improvement in density. Most formal treatments for androgenetic alopecia can not be used with the exception of low level laser. Minoxidil, antiandrogens, PRP are all not an option.

For scarring alopecias, each patient situation is unique so there is no one guiding principle - with the exception of “less is better.” The occasional use of a mild topical steroid to control itching in patients with lichen planopilaris or other scarring alopecias may be possible and very helpful. For conditions like folliculitis decalvans, additional of a topical antibiotic like topical clindamycin may be helpful and I often prescribe in the second and third trimester. Oral immunosuppressive and immunomodulatory agents are not permitted. The rare exception is Hydroxychloroquine (Plaquenil) which is rarely used is serious and rapidly progressive scarring alopecias and those with systemic autoimmune diseases (lupus). Some studies have suggested an increase risk of fetal malformation in hydroxychloroquine users so the decision to use or not use this medication requires thorough discussion with the treating physician.

The use of doxycycline, methotrexate, mycophenolate are not permitted in pregnancy.

For treatment of seborrheic dermatitis, I often recommend a zinc pyrithione based shampoo or ciclopirox. I don’t advise use of ketoconazole.

There are few good options for treating alopecia areata in pregnancy. A low level laser can be considered but is often ineffective for alopecia areata. Repeated monthly steroid injections is not usually advised in pregnancy.

SEE ALSO

Article 1 - Hair Loss After Pregnancy

Article 2 - Treatment of AGA During Pregnancy

Article 3 - Hair Loss Drugs and Breastfeeding - Which are safe?