Approximately 0,3% of the UK population (over 200,000 people) are living with Crohn’s disease [1]. This form of inflammatory bowel disease (IBD) mainly produces gastrointestinal symptoms, but it can sometimes affect other parts of your body as well. Between 6% and 36% of patients can experience extraintestinal symptoms [2] (e.g. affecting their joints, eyes, or skin). But can Crohn’s disease also cause hair loss?
There are many anecdotal accounts of Crohn’s disease-related hair thinning, but the body of research on this topic is still insufficient and sometimes contradictory [3]. However, the available data suggests there may be an association between this condition and diffuse hair loss (telogen effluvium). Keep reading this article to discover all you need to know about:
Crohn’s disease is one of the two major inflammatory bowel diseases, alongside ulcerative colitis. It is estimated to affect 0.3% of the UK population [1]. This condition involves inflammation of the intestinal walls, but it can affect any part of the digestive tract. Moreover, it can also cause arthritis, eye inflammation, or fat tissue inflammation [4]. The exact causes of this disorder are unknown, but it is believed to be determined by a combination of genetic, autoimmune and environmental factors [5].
Crohn’s disease is chronic and does not have a permanent cure at this time. It is characterised by flare-ups followed by periods of remission. Symptoms can be managed with medication (or, in severe cases, surgical intervention). Since diarrhoea is its most prevalent symptom, it is often accompanied by pronounced weight loss (10-20%) and sometimes nutritional deficiencies, due to nutrient malabsorption [4].
Patients living with Crohn’s disease can experience some or all of the following symptoms [5]:
Researchers believe hair loss to be a common occurrence in patients with IBD, especially those with Crohn’s disease. However, since the hair shedding associated with this disorder is often diffuse and mild to moderate, it is likely underreported. This is probably why only a few reports have been recorded and not many studies have investigated it. Thus, the prevalence of this Crohn’s-related hair loss remains uncertain [3].
One 2015 study [6] found that 33% of the 150 IBD patients included in the sample experienced hair loss. 66% of them reported diffuse hair thinning, while 34% reported patchy hair loss. However, it is difficult to connect their alopecia directly to their IBD, as it could also have been influenced by other factors. The study sample was small, the participants were of both genders, had different types and severity of disease and took various medications.
There is an ongoing debate in the scientific community regarding the chance of Crohn’s disease making your hair fall out. A 2013 literature review performed on the relationship between hair loss and IBD revealed several pathways that can connect Crohn’s disease with alopecia [3].
Four major pathways have been studied in relation to IBD-induced hair loss. While the scientific community agrees on some, others require further evidence.
Crohn’s disease flare-ups can be stressful on the body, as they can manifest with fever, pain, malnutrition and sudden weight loss. Moreover, it can be psychologically distressing, as it can take a significant toll on your quality of life and prevent you from performing your daily activities. This can be enough to trigger telogen effluvium, a temporary hair loss condition that develops at times of intense physical and/or mental stress, such as that caused by illness.
Telogen effluvium causes diffuse hair loss and can cause shedding of up to 50% of your hair within a few months [3], but it will not normally cause bald spots. It usually resolves itself 3-4 months after the Crohn’s disease flare-up has ended.
Certain medications can cause hair loss. Research shows that most drugs used to treat IBD can have this side effect, albeit rarely. Some of them, such as thiopurines [7] or methotrexate [3], can cause anagen effluvium, as they target rapidly dividing cells. While hair loss prevalence in patients taking this drug for IBD is unknown, research shows that 10% of people taking methotrexate for rheumatoid arthritis experience hair shedding [3].
The impact of other IBD medications on hair loss (such as sulfasalazine or mesalazine) is still debated. While some case studies suggest they caused diffuse alopecia, others found no association between these drugs and hair loss. Moreover, some studies have found that mesalazine can actually have a protective effect against IBD hair thinning [3][6].
Mineral and vitamin deficiencies can cause hair loss and nutritional deficiencies are well documented in relation to IBD. Research shows between 12% and 85% of patients with IBD are malnourished [8]. This is partly because of the malabsorption caused by diarrhoea and partly because some patients limit their food intake to avoid worsening their symptoms. This latter reason is especially true for Crohn’s disease patients [8].
It is known that iron deficiency anaemia causes hair loss and around 40% of people living with IBD experience this condition (especially if they pass blood in their stool). Zinc deficiency causes hair loss as well, affecting 15-65% of IBD patients [3]. However, one small study revealed that iron deficiency levels were similar between IBD patients who experienced alopecia and those who did not, so further research may be needed [6].
Alopecia areata is not a recognised symptom of Crohn’s disease. However, research into this matter is conflicting. Several studies revealed no association between these conditions [3]. However, a 2021 review of 79 studies [18] revealed a strong link between alopecia areata and IBD in general (alopecia is more common in ulcerative colitis than Crohn’s).
Some researchers still believe these conditions may be related, especially since several case reports show instances where they coexist, and even respond to some of the same JAK inhibitors [3][9][10].
Inherited genes may also be involved in the development of both alopecia areata and Crohn’s disease. These conditions also appear to share common forms of autoimmune system dysregulation [3]. This may suggest that while Crohn’s disease does not cause alopecia areata, if you are living with one of these conditions, you may have increased odds of developing the other as well.
The hair loss mechanisms associated with Crohn’s disease don’t normally cause permanent alopecia, so flare-ups are likely temporary. You should experience new hair growth approximately 3-4 months after your flare-up ends, or after stopping treatment (if your alopecia is medication-induced).
If you have been in remission for over 6 months and your hair loss has not started to improve, it is best to see a trichologist, to rule out a different type of alopecia, such as male pattern baldness (or female pattern baldness).
The appropriate treatment for Crohn’s-related hair loss depends on what may be causing the alopecia [3]:
In rare cases, telogen effluvium can become chronic, which means it can take years to resolve [11]. In this case, your hair may require some extra nourishment and stimulation to help it grow. Minoxidil is effective in treating this condition, as it increases blood flow to your hair roots, stimulating your hair follicles for growth [12].
Other solutions, such as PRP treatment for hair or red light therapy for hair growth have also been proven helpful. However, a hair doctor is the most qualified to recommend the best hair loss treatment for men (or the most effective hair loss treatment for women) with your specific condition.
Crohn’s disease is not the only systemic illness to be associated with hair loss. Here are some other diseases commonly associated with alopecia [13][14]:
Crohn’s disease hair loss can be difficult to diagnose. So if you are living with this condition and experiencing excessive hair shedding, book a consultation with our trichologists at your most convenient clinic locations. They will perform all necessary diagnostic tests to rule out different types of hair loss, such as androgenetic alopecia.
The first thing your hair doctor will do is get a detailed account of your medical history. Then, they may perform a hair pull test and order hair loss blood tests to pinpoint the source of your hair thinning. Once your diagnosis is determined, they will recommend the most effective, personalised treatment for your condition. They will also provide insight and advice regarding the best diet for healthy hair so your hair can thrive despite your IBD.
Are there things still left unclear regarding the link between Crohn’s disease and hair loss? Read the answers to the following frequently asked questions to learn more.
Vitamin and mineral deficiencies can cause hair loss among other health problems. So if you have Crohn’s disease, it is a good idea to monitor your nutrient levels. If you notice signs of nutritional inadequacy, supplementation may prevent this specific form of hair loss. However, there are no guarantees you will experience hair regrowth if you start taking vitamin or mineral supplements [3].
There is mixed evidence regarding the effect of the anti-inflammatory medication Mesalazine on the hair of patients with IBD [9]. Some researchers found it can cause significant telogen effluvium [16], while others found it can actually have a protective effect against alopecia [6].
One possible explanation is that individual patients may react differently to this medication, especially if they have a particular sensitivity to its components.
Some of the same medications used to treat Crohn’s disease can also be prescribed to treat alopecia areata. These are mostly JAK inhibitors, drugs that inhibit the signals sent to your immune system that provoke inflammation [17]. There are recorded cases of a single treatment (e.g. Tofacitinib [9], Upadacitinib [10]) reducing the symptoms of both conditions in patients who experienced them at the same time.
However, these medications are not as effective for all patients, and not all treatments prescribed for Crohn’s disease can also treat alopecia areata. Always get the recommendation of a healthcare professional before taking any medication to avoid interactions with other treatments.
While there is contradictory evidence regarding the relationship between alopecia areata and Crohn’s disease, recent studies show a strong association between these conditions. So if you are experiencing alopecia areata alongside gastrointestinal symptoms (such as abdominal cramps and/or diarrhoea), you may benefit from an IBD screening [18].
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