Can lithium (lithium carbonate) cause hair loss?

Lithium-Induced Hair Loss: Diagnosis and Management

Yes, lithium can cause hair loss (alopecia) in approximately 10-19% of patients on long-term therapy. This is clearly documented in the FDA drug label as a dermatologic adverse effect 1.

Mechanism and Presentation

Lithium-induced alopecia typically presents as:

• Diffuse thinning of hair rather than patchy loss
• Non-scarring pattern of hair loss
• Reversible upon dose reduction or discontinuation in most cases
• Usually develops after weeks to months of treatment

The exact mechanism is not fully understood, but may be related to:

• Direct toxic effects on hair follicles
• Lithium-induced thyroid dysfunction (hypothyroidism)
• Alterations in zinc metabolism

Diagnostic Approach

When evaluating hair loss in a patient taking lithium:

1. Rule out other causes:

   • Check thyroid function (TSH, free T4) as lithium can cause hypothyroidism
   • Measure serum ferritin, vitamin D, and zinc levels
   • Consider other medications that may contribute to hair loss

2. Assess lithium levels:

   • Determine if serum lithium levels are within or exceeding therapeutic range
   • Hair loss can occur even at therapeutic levels (below 1.5 mEq/L)

3. Evaluate pattern and severity:

   • Document extent of hair loss with photographs if possible
   • Determine impact on patient's quality of life

Management Options

1. First-line approach:

   • Reassurance that hair loss is usually reversible
   • Consider dose reduction if clinically appropriate and psychiatric condition is stable
   • Ensure lithium levels are maintained at the lowest effective dose

2. Supportive measures:

   • Zinc supplementation may be beneficial, though evidence is limited 2, 3
   • Gentle hair care techniques to minimize mechanical damage
   • Avoid harsh chemical treatments and excessive heat styling

3. Pharmacologic interventions:

   • Topical minoxidil 5% may help stimulate hair regrowth 4
   • Consider biotin supplementation, though evidence is limited 5

4. For severe or persistent cases:

   • Consider alternative mood stabilizers if clinically appropriate
   • Valproate and carbamazepine can also cause alopecia (up to 12% and 6% respectively) 3
   • Consultation with dermatology may be warranted

Monitoring Recommendations

• Regular thyroid function tests to detect lithium-induced hypothyroidism
• Monitor serum lithium levels to ensure they remain within therapeutic range
• Follow-up evaluations to assess response to interventions

Important Considerations

• Hair loss from lithium is typically reversible upon dose reduction or discontinuation 6
• The psychological impact of hair loss may affect medication adherence 7
• The benefits of lithium therapy must be weighed against the side effect of hair loss
• Hair loss alone is rarely an absolute indication to discontinue lithium if it's otherwise effective

Common Pitfalls

1. Failure to check thyroid function - Lithium-induced hypothyroidism can contribute to hair loss
2. Premature discontinuation - Stopping lithium abruptly can lead to mood destabilization
3. Overlooking the psychological impact - Hair loss can significantly affect quality of life and medication adherence
4. Missing other contributing factors - Multiple medications or nutritional deficiencies may compound the problem

While hair loss is a recognized side effect of lithium therapy, it should be managed with a systematic approach that balances psychiatric stability with quality of life considerations.