DMARDs and Hair Loss: What You Need to Know

Noticing more hair in the shower or on your brush after starting a DMARD? You’re not imagining it. Some disease‑modifying antirheumatic drugs (DMARDs) can cause hair thinning or shedding. That doesn’t always mean permanent baldness, but it’s worth understanding why it happens and what you can do right now.

Hair shedding from medications usually shows up as diffuse thinning rather than patchy bald spots. The two main patterns are telogen effluvium (a shift of hairs into the resting phase) and less commonly anagen effluvium (direct damage to growing hairs). Timing matters: drug-related telogen effluvium often starts 6–12 weeks after a trigger and peaks around 2–3 months.

Which DMARDs are linked to hair loss?

Methotrexate is the DMARD most often talked about when it comes to hair. Low-to-moderate doses can cause mild shedding in some people. Sulfasalazine and leflunomide have also been reported to cause hair thinning for some patients. Biologic drugs (TNF inhibitors, IL‑6 blockers, etc.) are less commonly tied to hair loss but can be involved indirectly—sometimes by changing the immune balance or unmasking other causes.

If you want a deeper read on specific RA drugs and hair, our article RA Medications and Hair Loss: Methotrexate, Sulfasalazine, Biologics Explained goes into the science and what patients have experienced.

Practical steps if your hair is falling out

1) Check the basics first. Active disease, iron deficiency, low ferritin, thyroid problems, rapid weight loss, and recent infections can all cause shedding. Ask your doctor for simple blood tests (CBC, ferritin, TSH, vitamin D) before blaming the DMARD.

2) Timeframe and dose. If shedding began soon after a dose change, discuss dose adjustment or timing with your rheumatologist. Sometimes lowering the dose or switching agents fixes the problem without losing disease control.

3) Simple hair care helps. Use a gentle shampoo, avoid tight styles and heat tools, and skip harsh chemical treatments while your hair recovers. Cutting back on heavy styling can reduce breakage and make regrowth look better faster.

4) Treatments that might help. Topical minoxidil can speed regrowth for some people. Nutritional support—iron if ferritin is low, vitamin D if deficient—also matters. Talk with your doctor before starting supplements; some (like high‑dose biotin) can interfere with lab tests.

5) When to see a specialist. If shedding is sudden, patchy, or accompanied by scalp inflammation, see a dermatologist. They can confirm the type of hair loss and offer targeted treatments such as steroid injections, prescription topicals, or lab-guided therapy.

Keep the conversation open with your care team. Treating the underlying condition is the priority, but most drug-related hair loss improves once the trigger is removed or managed. If you want clear next steps, bring photos of your scalp and a timeline of when hair changes started to your appointment—that helps doctors figure out the cause fast.