Hydroxychloroquine (Plaquenil) for Cicatricial Alopecia:

How long does it take for hydroxychloroquine to start to take effect?

Hydroxychloroquine (Plaquenil) is a slow acting drug. It can take up to 8 weeks or more before the medication really starts to have an effect and actually help an individual using the drug. Because hydroxychloroquine is so delayed in its onset, I usually give it 4-6 months before really deciding if it is working ... and sometimes even longer. Clinical symptoms (like itching and burning) tend to go away (or at least be reduced) first in those who respond to the drug followed by clinical signs on the scalp (perifollicular erythema, perifollicular scale, scalp erythema). The actual stopping or slowing of hair loss is last.

Hydroxychloroquine is among the slowest acting of all the typical oral immunomodulators such as doxycycline, methotrexate, mycophenolate and cyclosporine (cyclosporine tends to be the most rapid).

For my patients I often tell them that the “timer” does not start until 8 weeks into treatment.  So if I see them in September, I tell them we will actually set the 'real' starting point of treatment in November. I tell the individual on the medication that for the next two months they can 'consider/imagine/pretend' that they are not really even on treatment from the perspective of their scalp disease. (Of course blood tests need to be done because the body certainly knows from day 1 that the drug was started).


Hyrdoxychoroquine (Plaquenil) use requires patience from patients and physicians.