Methotrexate (sold as Otrexup, Rasuvo, Reditrex, Rheumatrex, and Trexall) is one of the most commonly prescribed — and most effective — disease-modifying antirheumatic drugs for treating rheumatoid arthritis (RA). Occasionally, side effects such as tiredness, rash, or loss of appetite can occur from taking methotrexate for RA. One additional possible side effect is hair loss (also known as alopecia).

The good news is that hair loss from methotrexate is relatively uncommon. It occurs in 1 percent to 3 percent of people taking the drug, according to the Arthritis Foundation. If you do experience hair loss, however, you may wonder how to take care of your hair — and whether you can continue to style or dye it as usual.

Your rheumatologist is the best resource for managing the side effects of your RA treatments. They can provide medical advice based on your RA symptoms and your other medical conditions. However, you can take steps to help care for your hair and prevent or manage hair loss while taking methotrexate.

Why Can Methotrexate Cause Hair Loss?

Methotrexate is a type of immunosuppressant known as a disease-modifying antirheumatic drug. Although it is frequently prescribed for inflammatory conditions like RA, methotrexate was originally developed to treat cancer. It works by blocking cells’ access to folate (a kind of vitamin B), targeting fast-growing cells, including those that cause inflammation. However, it can also affect other cells that grow rapidly, such as hair follicles, leading to hair loss.

High-dose methotrexate is reserved for cancer treatment. Hair loss is a relatively uncommon side effect of methotrexate treatment for RA because of the low dose that’s typically prescribed. When methotrexate-related hair loss does occur in people with RA, it typically isn’t significant and usually stops when treatment using this drug ends. But for people with inherited male- or female-pattern hair loss, methotrexate can speed hair loss and, in some cases, may be permanent.

Hair Loss and Methotrexate: Talk With Your Doctor

If you are losing hair or are concerned about hair care while taking methotrexate, talk with your rheumatologist or health care professional. They can determine 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 advised to take folic acid supplements. Although supplementation hasn’t been found to promote hair growth, it may help reduce some of methotrexate’s side effects.

As the Arthritis Foundation notes, you should talk with your health care 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.

Take Care When Brushing and Combing

In some cases, harsh brushing or combing can contribute to temporary hair loss. 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 damaged by brushing or combing too vigorously usually will 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

Coloring Your Hair While on Methotrexate

Some people wonder whether coloring or bleaching their hair while taking methotrexate is a good idea. As one myRAteam member asked, “I was wondering if anyone has had any experience with bleaching your hair while on methotrexate?”

Members 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!”

One member shared that they “haven’t had any problems, and I dye my hair wild colors (I’m retired, so I can get away with it). The fun colors like purple, teal green, royal blue, magenta, etc. don’t seem to damage my hair, though my stylist has to bleach the hair first. No loss of hair so far.”

Other members, however, have been wary of coloring their hair. As one shared, their hairdresser “refused point-blank to put any color on my hair. I was losing quite a lot, and bleaching and colors damage your hair further. Going gray disgracefully now.”

If you plan on coloring or bleaching your hair while on methotrexate, talk with your rheumatology specialist first. They are the best resource for determining the potential impacts of these harsh chemicals on your hair and scalp while taking the drug. Once you have your doctor’s approval, be sure to 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

Before trying any new hair dyes, treatments, or styling products, perform an allergy test known as a patch test. A patch test involves dabbing a small amount of the product on less visible areas of skin, such as behind the ear or on the inner elbow, and allowing it to dry. If you experience any irritation or skin reaction, do not use the product further.

Find Your Team

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 193,000 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 myRAteam.