Methotrexate for Hair Loss:

A closer look at MTX for Autoimmune Hair Loss

Methotrexate (MTX) is an immunosuppressive medication that can both be used to treat some forms of hair loss as well as cause hair loss. Methotrexate is a medication the has been used for over 60 years. It was initially developed as a cancer treatment (and continues to be used in oncology) but is also used to treat a variety of autoimmune conditions including lupus, rheumatoid arthritis, psoriasis and vasculitis.

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When treating hair loss, MTX has a role in treating both scarring and non scarring conditions. Evidence supports a role of weekly oral methotrexate in treatment of lichen planopilaris, frontal fibrosing alopecia, discoid lupus and alopecia areata. In the treatment of alopecia areata, methotrexate has been used in both children and adults, often in combination with systemic corticosteroids (like dexamethasone and prednisone).

Hair Loss as a side effect of MTX

In addition to its use in treating hair loss, methotrexate can sometimes also cause hair loss. About 2-4 % of users experience hair loss and the type of hair loss includes both increased hair breakage as well as increased shedding.  Hair color changes can also occur.

MTX side effects

Anyone considering MTX needs to speak to their physician about the risks and benefits. Side effects from methotrexate include reduced blood counts, liver damage, ulcers, cough, lung irritation (rarely fibrosis or scarring in the lung), nausea and abdominal pain, fatigue, kidney damage and memory problems. Methotrexate can not be used by women trying to become pregnant or who are pregnant. 

Because methotrexate interferes with how folic acid is metabolized, the drug needs to be taken with folic acid supplements. Generally methotrexate is given only one day per week and folic acid is given the other 6 days of the week (on the days methotrexate is not taken).

Download MTX Handout for Patients. 

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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