Crohn’s Disease & Hair Loss

Crohn’s – a type of inflammatory bowel disease (IBD) causing intestinal inflammation – can cause patchy or diffuse alopecia on the scalp and body. 

It is believed to be caused by an autoimmune reaction to gut bacteria. Inflammation and abnormal immune response not only affect the small intestine and the beginning of the large intestine but also other parts of the body, such as the eyes, joints, and skin. 

And because of the changes it induces in the body, your hair follicles can also be affected, which can affect their growth. Many people have also reported experiencing hair loss with Crohn’s disease. 

Since it’s a lifelong condition that can come and go in episodes, hair loss can occur more than once. Fortunately, there are different treatments to manage Crohn’s disease hair loss. 

Does Crohn’s Disease Cause Hair Loss?

Case reports and anecdotal evidence show that people with Crohn’s experience hair loss. And there are different reasons why this type of hair loss can happen.

Since Crohn’s is an inflammatory condition that affects the gut, it can affect the absorption of different nutrients in food. Also, being an autoimmune disease, it’s likely to occur with other autoimmune diseases that cause hair loss. 

The shock of flare-ups and the general stress of the condition can also push the hair follicles into a resting phase. Moreover, the medicines used to treat Crohn’s can also cause alopecia as a side effect. 

Paradoxically, some of the drugs that cause hair loss are also the ones that are used to treat it in the first place. 

Depending on the underlying cause, Crohn’s can cause different types of alopecia. It could be diffused or localised. It could also be non-scarring or scarring. 

Keep in mind that hair loss isn’t the only symptom of Crohn’s. It can also cause: 

• Diarrhoea
• Blood in stool 
• Abdominal pain 
• Fatigue 
• Fever
• Weight loss 
• Anaemia
• Ulcers 
• Fistula (an abnormal connection between two body parts) 
• Reduced appetite
• Nutritional deficiency 

The exact cause of this condition is still unknown, but genetics are implicated. Also, contrary to popular belief, stress and diet don’t cause this condition.  

What Causes Crohn’s Disease Hair Loss? 

Crohn’s disease hair loss can occur due to any one or more of the following: 

Nutritional Deficiency 

Crohn’s can cause nutritional deficiencies due to malabsorption, poor gut motility, reduced food intake due to appetite loss, nausea and diarrhoea. 

Some of the drugs used to treat this condition can also affect your nutritional status (like prednisone). 

According to a study published in Current Opinion in Clinical Nutrition & Metabolic Care, an inflammatory bowel disease can cause the following micronutrient deficiencies: 

• Iron 
• Vitamin B12, D, K, B1 and B6 
• Folic acid 
• Selenium 
• Zinc 

Additionally, the researchers concluded that Crohn’s disease patients have these deficiencies more often than other types of inflammatory bowel diseases, such as ulcerative colitis.

Due to the fact that your hair needs these nutrients to grow normally, your hair will suffer in their absence.

Blood loss in Crohn’s also leads to the development of anaemia. Iron deficiency can also trigger a type of “shock” hair loss known as telogen effluvium. 

Additionally, Crohn’s has also been associated with protein-energy malnutrition (PEM). Insufficient protein in the body also deprives hair of its building blocks, which can also cause hair loss. 

Other Autoimmune Illnesses 

As mentioned above, autoimmune conditions tend to occur with other autoimmune conditions. Since Crohn’s is one as well, it can also be associated with: 

• Multiple sclerosis
• Rheumatoid arthritis
• Lupus 
• Psoriasis 
• Ankylosing spondylitis 
• Alopecia areata 

There are different ways in which these conditions can further cause hair loss. For instance, lesions in lupus can cause permanent hair loss. 

Or if it’s alopecia areata, you might have circular patches of hair loss on the scalp.

Less commonly, you can also experience alopecia universalis, which causes hair loss on the entire scalp and body.  

Shock and Stress 

Crohn’s disease can cause hair loss due to the shock your body experiences. It can happen due to: 

• Nutritional deficiencies (weight loss)
• Crohn’s flare-ups
• Stress of the condition 

In particular, these instances induce telogen effluvium, which results in diffuse shedding 2-3 months after the stressful event. 

Side Effect Of Medication

Some of the following medications for Crohn’s might also cause hair loss as a side effect: 

• Prednisone – An anti-inflammatory steroid that may cause hair thinning. 
• Methotrexate – Reduces the activity of the immune system. According to the Arthritis Foundation, it’s responsible for hair loss in 1-3% of people. 
• Azathioprine (Imuran) – Also reduces immune activity. It can cause both telogen and anagen effluvium. 
• Vedolizumab (Entyvio) – Reduces inflammation in the gut. A few case studies report hair loss. 
• Infliximab (Remicade) – A tumour necrosis factor-alpha (TNF-alpha) inhibitor that helps with inflammation. It can also cause hair loss. 
• Adalimumab (Humira) – Another TNF-alpha inhibitor that also causes hair loss in rare cases. 

As far as the TNF-alpha inhibitors are concerned, according to a study published in Dermatology and Therapy, they can also cause scalp psoriasis. This is especially in those patients who have Crohn’s. 

More alarmingly, this scalp psoriasis can progress to scarring alopecia. This drug can also lead to the development of alopecia areata.

How Do You Stop Hair Loss From Crohn’s Disease?

The treatment for Crohn’s disease hair loss will depend on what’s causing your hair loss. For this, you need to seek the help of a medical professional.

If it’s a nutritional deficiency, your doctor may advise dietary changes to you (to avoid foods that worsen symptoms and eat foods that are easily digestible). For this, they may also advise some supplements. 

For alopecia areata, you might be prescribed immunosuppressive medication. Fortunately, alopecia areata can be reversed. 

In the case of telogen effluvium, your doctor will probably try to reassure you that your hair will grow back. While it doesn’t require any treatment, you may still be prescribed minoxidil to promote hair growth. 

Lastly, if it’s the side effect of a medicine, talk to your doctor about it, and they may consider making changes to your treatment plan. 

In the meantime, you should look for ways to manage your stress and try to practise gentle hair care. 

Is Hair Loss Due To Crohn’s Disease Reversible? 

Whether or not Crohn’s disease hair loss is reversible depends on the type of hair loss you’re experiencing. 

Hair loss due to nutritional deficiencies, shock, or stress is likely to grow back. Alopecia areata and drug-induced alopecia can also be reversed.

However, if you develop scars (as can happen from a TNF-alpha inhibitor), it can cause permanent hair loss. 

Keep in mind that your hair loss can also come and go with the flare-ups of this condition. It can be diffuse or patchy. 

Conclusion 

Crohn’s disease is chronic, and it cannot be cured. On its own, this condition can be quite stressful and cause many physical side effects – one of which is hair loss. 

Now, there are many different reasons why and how Crohn’s can end up causing hair loss. For this reason, it’s important to seek the consultation of a medical professional. 

There are many different types of hair loss. So, before you start any treatment, make sure to get an accurate diagnosis from a board-certified medical professional.