From the Guidelines
Hydroxychloroquine can cause a type of alopecia known as drug-induced alopecia or specifically hydroxychloroquine-induced alopecia, which typically presents as diffuse thinning of the hair affecting the entire scalp. This condition is also referred to as anagen effluvium, which may mimic diffuse alopecia areata 1. The mechanism involves the medication's interference with melanin synthesis and its deposition in hair follicles, potentially disrupting the normal hair growth cycle.
Key Characteristics of Hydroxychloroquine-Induced Alopecia
- Diffuse thinning of hair
- Affects the entire scalp
- Dose-dependent
- Usually occurs after prolonged use, typically after several months of treatment
- Generally reversible upon discontinuation of the medication
- Regrowth typically begins within 2-3 months after stopping hydroxychloroquine If a patient experiences significant hair loss while on hydroxychloroquine, they should consult their healthcare provider who may consider reducing the dose or switching to an alternative medication depending on the underlying condition being treated 1. Supportive hair care measures and avoiding harsh chemical treatments may help minimize the appearance of thinning while waiting for regrowth.
Diagnostic Considerations
The diagnosis of hydroxychloroquine-induced alopecia can be challenging, as it may resemble other forms of hair loss, such as:
- Telogen effluvium
- Systemic lupus erythematosus
- Secondary syphilis
- Trichotillomania
- Tinea capitis
- Early scarring alopecia Dermoscopy can aid in the diagnosis of alopecia areata and distinguish it from other conditions, including hydroxychloroquine-induced alopecia 1.
From the Research
Hydroxychloroquine and Alopecia
Hydroxychloroquine has been studied as a potential treatment for various types of alopecia, including:
- Alopecia universalis: A study published in 2021 2 found that hydroxychloroquine was not an effective treatment for alopecia universalis, with only one out of six patients showing a response to treatment.
- Alopecia areata: A retrospective study published in 2018 3 found that hydroxychloroquine was effective in inducing significant hair regrowth in some pediatric patients with alopecia areata, with five out of nine patients showing improvement.
- Lichen planopilaris and frontal fibrosing alopecia: A review published in 2023 4 found that hydroxychloroquine showed variable efficacy in treating these conditions, with some patients showing halted hair loss or improvement.
- Folliculitis decalvans: A retrospective study published in 2025 5 suggested that hydroxychloroquine may be beneficial as an adjuvant therapy for folliculitis decalvans, a chronic and recurrent neutrophilic scarring alopecia.
Types of Alopecia Treated with Hydroxychloroquine
The types of alopecia that have been treated with hydroxychloroquine include:
- Alopecia universalis
- Alopecia areata
- Lichen planopilaris
- Frontal fibrosing alopecia
- Folliculitis decalvans
Efficacy of Hydroxychloroquine
The efficacy of hydroxychloroquine in treating alopecia varies depending on the type of alopecia and the individual patient, with some studies showing:
- Variable efficacy in treating lichen planopilaris and frontal fibrosing alopecia 4
- Limited efficacy in treating alopecia universalis 2
- Potential benefit as an adjuvant therapy for folliculitis decalvans 5
- Effectiveness in inducing significant hair regrowth in some pediatric patients with alopecia areata 3