Methotrexate is one of the most commonly prescribed disease-modifying antirheumatic drugs (DMARDs) for treating rheumatoid arthritis (RA). DMARDs are medicines that help slow down RA and protect the joints from damage. Sometimes, methotrexate can cause side effects, such as fatigue (extreme tiredness that doesn’t improve with rest), rash, or loss of appetite. Another possible side effect is alopecia (hair loss).

You may wonder, how common is hair loss with methotrexate? According to the Arthritis Foundation, 1 percent to 3 percent of people taking the drug experience hair loss, although more recent research has found higher rates. One study found that 9.2 percent of people with early RA had hair loss over one year of taking methotrexate.

If you’re noticing hair loss while taking methotrexate, you might be wondering how best to care for your hair — and whether it’s still safe to style or dye it as you normally would. A rheumatologist can help you navigate these changes. They can offer guidance based on your RA symptoms, treatment plan, and any other health conditions you may have.

However, there are some steps you can take to help care for your hair and prevent or manage hair loss while taking methotrexate.

Why Does Methotrexate Hair Loss Happen?

Methotrexate is a type of immunosuppressant, a medication that works by lowering the activity of the immune system. In RA, this can help reduce inflammation and prevent joint damage in rheumatoid arthritis. Although methotrexate is commonly used to treat inflammatory conditions like RA, it was originally developed to treat cancer.

Methotrexate works by blocking the body’s use of folate, a type of vitamin B that helps cells grow. This action targets fast-growing cells involved in inflammation — which is helpful for managing RA. However, methotrexate can also affect other fast-growing cells, like those in hair follicles. This is why some people may experience hair thinning or hair loss while taking the medication.

When hair loss happens with methotrexate, it’s usually mild and often improves after stopping the medication. Some people also notice changes in hair texture while taking methotrexate. But for people with inherited male- or female-pattern hair loss, the medication may speed up hair thinning — and in some cases, that hair loss may be long-lasting or permanent.

How To Stop Hair Loss When Taking Methotrexate

If you’re asking, “How can I stop my hair falling out from methotrexate?” you’re not alone.

If you are losing hair or are concerned about hair care while taking methotrexate, talk with your rheumatologist or another healthcare professional. They can figure out whether the drug is to blame and, if so, may recommend reducing your dosage or changing medications.

They may refer you to a specialist, such as a dermatologist, to rule out other potential causes of hair loss. You may also be told to take folic acid supplements. While these supplements may not reverse hair loss, they can help reduce other common side effects of methotrexate, such as nausea or mouth sores. Before starting any kind of supplement, it’s important to speak with your healthcare provider about the right dose and to make sure it won’t interfere with your treatment plan.

As the Arthritis Foundation notes, you should talk with your healthcare provider immediately if you start to see large clumps of hair fall out during washing or combing, or if you develop patchy or sudden hair loss.

Caring for Your Hair While on Methotrexate

You should keep a few things in mind during your hair care routine to help keep your scalp healthy and minimize or prevent hair loss.

Use a Light Touch When Brushing and Combing

Be gentle and avoid pulling too tightly when styling, combing, or brushing your hair. Brushing or combing less frequently may also help prevent hair loss. Hair that’s damaged by brushing or combing too hard will usually grow back — unless the follicles are damaged.

Avoid Tight Hairstyles

Constant tension from tightly pulled hairstyles may also cause hair strands or hair follicles to break or fall out, leading to a form of irreversible hair loss known as traction alopecia.

To prevent irritating the scalp and losing hair, avoid styles that constantly pull on the hair, including:

• Tight buns, ponytails, and other updos
• Tight braids or styles that require tight braiding, such as cornrows, box braids, and weaves
• Hair extensions
• Dreadlocks

Be Safe When Coloring Your Hair

Some people wonder whether coloring or bleaching their hair while taking methotrexate is a good idea. Members of myRAteam had varying responses. “I just did mine last month,” one replied. “No issues. Went the same as usual.”

“I have been on methotrexate since 2012,” replied another, “and have had no problems with having highlights in!”

Other members, however, have been wary of coloring their hair. One member shared that their hairdresser “refused point-blank” to put any color on their hair. “I was losing quite a lot, and bleaching and coloring can damage your hair further,” they said. “Going gray gracefully now.”

If you want to color or bleach your hair while taking methotrexate, talk to your healthcare provider first. Coloring your hair can cause more hair loss or hair thinning. Your healthcare provider can help you figure out how different hair products and chemicals might affect your hair and scalp while you take methotrexate.

Once you have your healthcare provider’s approval, let your hairstylist know about your condition beforehand. They may take precautions or use gentler products to help prevent irritation or hair loss during the coloring process.

Do a Patch Test for Hair Products

Before using any new hair dye, treatment, or styling product, it’s important to do a patch test to check for allergic reactions. Apply a small amount of the product to a discreet area of skin — such as behind your ear or on the inside of your elbow — and let it dry. If you notice any discoloration, itching, or irritation over the next 24 to 48 hours, it’s best to avoid using the product on your scalp or hair.

Talk With Your Doctor

Not everyone who takes methotrexate for RA will experience hair loss. When creating your treatment plan, your healthcare provider will consider the pros and cons of each option. There may be ways to reduce side effects or switch to a different medication if needed.

If you’re concerned about hair loss, bring it up — you can work together to find the treatment that’s right for you and helps you feel your best.

Find Your Team

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you experienced hair loss related to methotrexate? Do you have any hair care tips for others taking this drug? Share them in the comments below or by posting on your Activities page.