Can corticosteroid injections cause hair loss?

Corticosteroid Injections and Hair Loss

Corticosteroid injections can cause hair loss as a side effect, though they are paradoxically also used as a treatment for certain types of hair loss such as alopecia areata. 1

Corticosteroid Injections for Alopecia Areata

• Intralesional corticosteroids are recommended as first-line treatment for limited patchy hair loss in alopecia areata, with success rates of up to 62% reported with monthly injections 2
• Commonly used corticosteroids include triamcinolone acetonide (5-10 mg/mL) and hydrocortisone acetate (25 mg/mL), injected just beneath the dermis in the upper subcutis 3
• A small injection of 0.05-0.1 mL will produce a tuft of hair growth about 0.5 cm in diameter 3, 4
• Hair regrowth occurs in 62-64% of treated sites, with effects typically lasting about 9 months 4

Side Effects of Corticosteroid Injections

• Skin atrophy at the injection site is a consistent side effect of intralesional corticosteroid therapy, particularly with triamcinolone 3, 4
• Other local side effects can include:
  • Skin hypopigmentation 1
  • Postinjection flare 1
  • Infection (rare) 1
• Systemic side effects, though less common with localized injections, may include:
  • Adrenal suppression 1
  • Facial flushing 1
  • Hyperglycemia 1
  • Osteoporosis with long-term use 1

Paradoxical Hair Loss from Corticosteroid Injections

• While corticosteroid injections are used to treat hair loss in alopecia areata, they can paradoxically cause hair loss through:
  • Local skin atrophy affecting hair follicles 3, 4
  • Excessive dosing leading to follicular damage 1
  • Improper injection technique 5

Best Practices to Minimize Hair Loss Risk

• Use appropriate dilutions - studies suggest that betamethasone dipropionate at 1.25 mg/dL may have fewer side effects than triamcinolone acetonide at similar concentrations 6
• Limit the total volume and frequency of injections to minimize atrophy risk 4
• Monitor for early signs of adverse effects using dermoscopy, which can detect side effects earlier than clinical examination 7
• Consider alternative treatments for patients with extensive or long-standing hair loss 4

Treatment Considerations

• For patients with limited patchy hair loss of short duration (<1 year), no treatment may be a legitimate option as spontaneous remission occurs in up to 80% of cases 3, 2
• For extensive hair loss, other treatment options may be more appropriate as intralesional corticosteroids are most suitable for treating patchy hair loss of limited extent 3, 4
• Patients with a family history of alopecia areata, recurrent disease, or nail changes may respond less favorably to corticosteroid injections 7