Ulcerative Colitis and Hair Loss: Why It Happens and How to Manage It

For people with ulcerative colitis (UC), managing symptoms such as abdominal pain, fatigue, and diarrhea can feel like a full-time job. But there’s another lesser-known symptom of UC that can catch those with the condition off guard: hair loss.

Research suggests that as many as 33 percent of patients with an inflammatory bowel disease (IBD) such as UC or Crohn’s disease grapple with hair loss.

One study that assessed sex-related differences in hair loss suggested that it affects 28 percent of men and 40 percent of women with UC.

While hair loss isn’t a main symptom of UC, it can happen, and for a variety of reasons, including nutritional deficiencies, medication side effects, and the stress of living with UC.

It’s another added stressor in what is often a difficult diagnosis, but with the right treatment and lifestyle changes, hair loss related to UC can be temporary and manageable.

“There are many reasons why someone with IBD could experience hair loss — some are unique to having IBD, while other reasons are the same as in the general population,” says Alexandra Gutierrez, MD, medical director of the IBD Center in Medicine at NewYork-Presbyterian/Columbia University Irving Medical Center.

Sometimes it’s a combination of causes, says Supriya Rao, MD, a gastroenterology, internal medicine, obesity medicine, and lifestyle medicine physician and professor of gastroenterology at Tufts University in Massachusetts, who focuses on digestive disorders and women’s health. “There’s usually more than one factor involved,” she says.

It’s important to pinpoint the cause, because that could help determine any treatment you need for the hair loss. Possible causes include:

Stress

Telogen effluvium is a temporary form of hair loss that’s triggered by intense stress or changes to your body.

It’s a particularly common trigger for UC-related hair loss, says Jessica Philpott, MD, PhD, a gastroenterologist who specializes in IBD at the Cleveland Clinic in Ohio.

There are three stages of hair growth — anagen (growth), catagen (resting), and telogen (shedding) — but during a UC flare, hair follicles go into the telogen phase, Dr. Philpott says. People with the condition may notice their hair shedding, including what appears to be significant hair loss.

“This may result in the patient fearing that the medicine they were started on to treat the UC caused the hair loss, but in fact the hair loss is a delayed reaction to being so sick with the active disease in the first place,” says Philpott.

This kind of hair loss is delayed and typically happens weeks after someone has been in the hospital for their UC, says Sunanda Kane, MD, a professor of medicine in the department of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota. It can also happen after a period of intense stress.

Medication

Certain medications used to treat UC, including mesalamine and methotrexate, may have hair loss as a side effect.

Other drugs such as azathioprine, steroids, and thiopurines can also cause hair loss as a side effect, says Dr. Gutierrez.

Nutritional Deficiencies

UC can affect your body’s ability to properly digest food and absorb nutrients, which over time can lead to serious vitamin and mineral deficiencies and malnutrition. Up to 62 percent of people with UC deal with malnutrition and weight loss, which in turn can lead to hair loss.

In particular, deficiencies in riboflavin (vitamin B2), biotin, folate, and B12 can lead to hair loss in people with UC, says Gutierrez. Deficiencies in protein, iron, zinc, and selenium can cause it as well, says Dr. Kane. “When someone has been really ill, they lose protein, and when it is being restored hair and nails are the last to be replenished,” she says.

Having Another Condition That Causes Hair Loss

Having another health condition, such as alopecia areata, can cause hair loss in people with UC, says Kane. Alopecia areata is an autoimmune disease that causes hair loss particularly on the scalp, and research shows it’s common among people with UC.

If you have UC and you’re experiencing hair loss, tell your doctor, says Dr. Rao. “You’re not imagining it, and you’re not alone,” she says. “The good news is that hair loss is often temporary, and it might be your body’s way of asking for support. The best thing you can do is treat the root cause.” Some ways to manage UC-related hair loss include:

1. Talk to Your Gastroenterologist

First things first, if you’re worried about hair loss, talk to your gastroenterologist, says Gutierrez. Not only can your gastroenterologist help you manage UC symptoms and flares — they can also help pinpoint what may be triggering your hair loss. “A good evaluation will lead you toward the path of treatment faster than the ‘trial and error’ approach alone,” she says.

Your gastroenterologist can work with you to look at your holistic (whole body) health. They may even refer you to a dermatologist, who might request a biopsy of your scalp, so that they can further assess your hair loss by looking at a small sample of your hair follicles under a microscope, Gutierrez says.

2. See a Registered Dietitian if You Have Nutritional Deficiencies

Working with a registered dietitian who counsels people with IBD can help ensure you’re getting the nutrients needed to support hair growth, even during flares.

To identify specific areas of need, your gastroenterologist may first request blood tests to screen for nutritional deficiencies you may have, says Rao. “We can check for ferritin, vitamin D, thyroid levels, and B12/folate,” she says. “Lab work can tell us a lot, and we can treat underlying deficiencies if needed.” You’re better off understanding what your deficiencies are before adding supplements to your diet, Rao says.

3. Review Your Medications With Your Doctor

If you suspect your medication may be contributing to hair loss, talk to your gastroenterologist about it. Doctors know that certain medications used to treat UC can cause hair loss, Kane says. Your gastroenterologist may look into other treatments that suit your needs.

Don’t stop any medication without speaking to your doctor first. “It is important not to stop medicines out of fear that they are causing the hair loss without talking to your provider, because not uncommonly it was the disease and not the medicine that caused the chain of events,” Philpott says.

4. Do Your Best to Curb Stress

As mentioned, stress can worsen UC and contribute to hair loss. Doing what you can to lower your stress levels can make a big difference. “It’s important to remember stress can be a big player here, so I’ll often ask about stress levels and sleep quality,” Rao says.

Some examples of effective stress-busting techniques include mindfulness, yoga, and gentle exercise. It could also help to see a mental health professional, such as a therapist, to talk about the stressors in your life and figure out ways to manage them.

5. Assess Your Diet and Lifestyle

Rao says that she works with her patients to take a step back and look at how they’re tending to their overall health, as this can contribute to hair loss. It can help to ask yourself whether you’re eating nourishing foods, avoiding smoking, and taking care of your physical health. Researchers have linked smoking to hair loss, due to the constriction of the blood vessels to the scalp and free radical damage to hair follicles, for example.

Rao also recommends the Mediterranean diet, which is anti-inflammatory and beneficial for UC (which is an inflammatory condition). Researchers have also found that the phytochemicals (plant chemicals) in this antioxidant-rich diet can help promote hair-growth hormones that may help reverse hair loss.

It’s important to get enough sleep each night too, Rao says. One study noted that sleep quality is often impaired in people with alopecia areata, especially if they’re also experiencing depression or anxiety. (As mentioned, alopecia areata is a hair loss condition that’s common among people with UC.)

Most adults should aim for at least seven hours of sleep each night.

6. Have a Gentle Hair Care Routine

If you’re concerned about hair loss, it’s important to make sure you have a gentle hair care routine that limits damage and helps boost follicle health:

Be gentle when combing, drying, and styling your hair, because tugging on it too harshly can lead to hair loss.
Limit the amount of heat you use to style your hair, including curling irons, hair straighteners, and blow-dryers, which can weaken your hair. Try to let your hair air-dry when possible and use these tools only on special occasions, such as job interviews or weddings.
Avoid chemical treatments, such as dyeing, perming, or relaxing your hair.
Use gentle shampoos, conditioners, and hair products.
Avoid hairstyles that tug on your hair follicles, such as tight ponytails, buns, pigtails, braids, or cornrows.

7. See a Dermatologist for Hair Loss Treatment

As mentioned, your gastroenterologist can refer you to a dermatologist for further hair loss treatment, if needed. There are several medications and interventions available to help treat hair loss:

Minoxidil, which is available as an over-the-counter solution or foam, increases new hair growth with repeated use over two to four months.
Finasteride, which is a medication that’s taken by mouth, is used to treat certain types of hair loss by increasing hair growth on the scalp.
Red light therapy, worn via a mask on the scalp, can help promote hair growth, research shows.

It’s worth noting, however, that only limited research exists on how these treatments can help people with UC-related hair loss in particular. Consult with your gastroenterologist or a dermatologist before trying them.

Hair loss affects up to one-third of people with an inflammatory bowel disease such as ulcerative colitis.
Hair loss in people with ulcerative colitis can be caused by a number of factors, including medication side effects, nutrient deficiencies, stress, or other health conditions that trigger hair loss.
With proper care and medical support, hair loss can be reversed through a combination of strategies, including medical treatment and lifestyle changes.

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