Alopecia medicamentosa L65.8

Mostly self-limiting hair loss caused by taking certain drugs, which occurs 2-6 months after the triggering event.

Medications that can cause hair loss:

• Cytostatics/immunosuppressants: e.g. cyclophosphamide, methotrexate, colchicine, azathioprine, prednisone. General alopecia incidence for chemotherapeutics is about 65%.
• Targeted tumor therapeutics (especially inihbitoren of the Hedgehog, VEGF, MAP kinase signaling pathway; especially vismodegib, sorafenib, dabrafenib, incidences, sunitinib and others; average alopecia incidence >15%)
• Analgesics: Diclofenac, Indometacin, Ibuprofen, Naproxen.
• Antimycotics: Ketoconazole.
• Anticoagulants: systemic heparins, systemic coumarins.
• Antihypertensives: ACE inhibitors.
• Retinoids: vitamin A acid derivatives, e.g. acitretin, isotretinoin, tretinate.
• Lipid reducers: Fibrates such as clofibrate, fenofibrate, benzfibrate.
• Hormone preparations: Bromocriptine, androgens, anabolic steroids, clomiphene
• Antimalarials: chloroquine, hydroxychloroquine, mefloquine.
• Heavy metals: mercury, bismuth, gold, thallium.
• Neurological drugs: antiepileptic drugs (e.g. valproic acid), antidepressants, anticonvulsants, sedatives, Parkinson's drugs (e.g. levodopa).
• Others: Thyrostatic drugs (e.g. carbimazole), propranolol, butyrophenones, D-penicillamine, H2-blockers, amiodarone.

Diffuse effluvium.

Positive plucking test (assuming > 6 hairs if 40-50 hairs are pulled); anamnesis.

As far as possible, discontinuation or conversion of the triggering medication. Usually full reversibility of alopecia. See below alopecia.

1. Belum VR et al (2015) Alopecia in patients treated with molecularly targeted anticancer therapies. Ann Oncol 26: 2496-2502