Prednisone and Hair Loss
Yes, prednisone can cause hair loss (alopecia) as a documented adverse effect, as explicitly listed in the FDA drug label. 1
Direct Evidence of Prednisone-Induced Hair Loss
The FDA-approved prescribing information for prednisone explicitly lists alopecia among the dermatologic adverse reactions associated with corticosteroid therapy. 1 This appears alongside other cosmetic changes including:
- Acne and acneiform eruptions 1
- Hirsutism (paradoxically, increased body/facial hair growth) 1
- Thinning scalp hair 1
- Skin atrophy and thinning 1
Clinical Context and Frequency
Cosmetic changes occur in 80% of patients after 2 years of corticosteroid treatment, regardless of the specific regimen used. 2 These cosmetic side effects are so common and distressing that:
- 13% of patients discontinue treatment due to complications 2
- 47% of those who stop prednisone do so because of intolerable cosmetic changes or obesity 2
The hair loss associated with prednisone is part of a broader constellation of appearance-related side effects that significantly impact quality of life. 2
Important Clinical Distinction
Paradoxically, prednisone is also used to treat certain types of hair loss, specifically alopecia areata (an autoimmune condition). 2 This creates potential confusion:
- When treating alopecia areata with short-term prednisone (6-week taper), 30-47% of patients show hair regrowth 3
- However, long-term prednisone therapy can cause hair loss as an adverse effect 1
- The hair regrowth achieved with prednisone for alopecia areata typically does not persist after discontinuation 4, 5
Duration and Severity Considerations
The risk of hair loss and other cosmetic complications increases with:
- Prolonged therapy (especially beyond 18 months) 2
- Higher doses (particularly prednisone 20 mg daily or more for extended periods) 2
- Continuous daily dosing versus alternate-day regimens 2
Clinical Recommendations
If a patient develops hair loss while on prednisone, consider:
- Evaluating whether the underlying condition being treated could be contributing to hair loss 2
- Assessing the dose and duration of therapy—lower doses and shorter courses carry less risk 2
- Discussing the risk-benefit ratio, as cosmetic side effects are the leading cause of treatment discontinuation 2
- Considering steroid-sparing agents (such as azathioprine) to minimize corticosteroid exposure 2
The hair loss from prednisone is typically reversible upon discontinuation, though recovery may take months. 1