Sulfasalazine Telogen Effluvium: How to Spot It and What to Do

Noticed more hair in your brush after starting sulfasalazine? That's a common worry. Sulfasalazine — a DMARD used for arthritis and inflammatory bowel disease — can trigger telogen effluvium, a diffuse shedding that usually follows a physical or medication stress. The good news: it’s often reversible if handled right.

What telogen effluvium looks like and when it starts

Telogen effluvium causes uniform thinning across the scalp, not patchy bald spots. You’ll see more hair fall during washing, brushing, or on your pillow. Expect shedding to begin roughly 1–3 months after the trigger (like starting sulfasalazine). Peak shedding may last several weeks, then hair typically starts regrowing within 3–6 months once the trigger is removed or controlled.

Important: if you see sudden patchy loss, scarring, scalp pain, pus, or rapid progression, get urgent medical care — that could be a different problem.

Practical steps to take now

1) Don’t stop the drug on your own. Contact the prescriber. Sulfasalazine may be controlling a serious condition, and your doctor can weigh risks and look at alternatives.

2) Get simple tests. Ask for thyroid function, ferritin (iron stores), CBC, and basic metabolic labs. Low iron or thyroid issues can make hair loss worse and are easy to treat.

3) Consider medication changes only with guidance. Your rheumatologist or gastroenterologist may lower the dose, switch DMARD class, or recommend temporary measures. Changes usually require time and planning.

4) Try supportive measures that help hair recovery: topical 5% minoxidil (over-the-counter for many), gentle shampooing, avoid tight hairstyles and heat styling, and eat protein-rich meals plus iron-rich foods if your tests show low ferritin.

5) Be patient and track progress. Telogen effluvium often improves slowly — you might not notice regrowth for several months. Take photos monthly to see changes.

If shedding continues beyond 6 months despite these steps, or if it worsens suddenly, ask for a dermatology referral. A dermatologist can rule out other causes (alopecia areata, scarring alopecias) and discuss treatments like topical therapies, low‑level laser, or PRP if appropriate.

Final note: many people regain most or all hair after the medication trigger is managed. The best immediate move is a quick chat with your prescriber, basic blood tests, and simple hair care changes while you wait for regrowth. If you want, I can draft questions to ask your doctor or list nutrients and shampoos that support regrowth.