Lamotrigine and Hair Loss
Yes, lamotrigine (Lamictal) can cause hair loss, though it occurs less frequently than with other mood stabilizers like valproate or lithium, and the hair loss is typically reversible.
Incidence and Clinical Features
Lamotrigine-induced alopecia has been documented in 355 reported cases in the literature, making it the second most commonly reported antiseizure medication associated with hair loss after valproate 1
The hair loss pattern is characteristically diffuse and non-scarring, typically presenting as telogen effluvium rather than focal or permanent alopecia 1
Hair loss occurs less frequently with lamotrigine compared to other mood stabilizers: approximately 10% with lithium, up to 12% with valproate, and less than 6% with carbamazepine 2
The mechanism of lamotrigine-induced hair loss is related to toxic effects on the hair matrix, though the exact pathophysiology remains incompletely understood 3
Management Algorithm
Step 1: Confirm the Diagnosis
- Obtain a careful history to establish temporal relationship between lamotrigine initiation/dose escalation and onset of hair loss 2
- Rule out other causes including thyroid dysfunction, nutritional deficiencies, and concurrent medications that may contribute to alopecia 2, 4
Step 2: Initial Conservative Management
- Provide reassurance that the condition is typically reversible and does not indicate a serious underlying problem 2
- Consider dose reduction if clinically feasible while maintaining therapeutic efficacy, as this almost always leads to complete hair regrowth 4
- Implement proper hair care techniques to minimize mechanical trauma and optimize scalp health 2
Step 3: Adjunctive Interventions
- Trial of trace mineral supplementation (particularly zinc and selenium) may be considered, though therapeutic value remains unclear 4
- Topical minoxidil application can be used to promote hair regrowth while continuing lamotrigine if the medication is otherwise efficacious 2
Step 4: Medication Adjustment if Necessary
- Discontinuation or dose reduction of lamotrigine almost always leads to complete hair regrowth, making this the definitive solution if conservative measures fail 4
- Consider alternative mood stabilizers or antiseizure medications if hair loss is intolerable and lamotrigine is not uniquely effective for the patient's condition 2
Critical Clinical Considerations
Hair loss is a cosmetic side effect with high intolerance rates that frequently leads to medication non-adherence, making early recognition and management essential 1
The reversibility of lamotrigine-induced alopecia is a characteristic feature that distinguishes it from permanent scarring alopecias and should guide counseling 1
Clinicians should maintain a high index of suspicion for medication-induced alopecia in patients on lamotrigine, as patients may not spontaneously report this side effect 2, 4
Hair replacement pieces remain an option for patients who require continued lamotrigine therapy at current doses and experience persistent, bothersome hair loss despite conservative measures 2