Losing Hair on Plaquenil: The 5 Possibilities

Hydroxychloroquine (also known by its popular brand name Plaquenil) is an oral medication that is commonly used to treat a variety of autoimmune diseases including systemic lupus, dermatomyositis, rheumatoid arthritis, Sjogren’s and many other conditions as well. In the field of hair loss, conditions such as lichen planopilaris, frontal fibrosing alopecia and discoid lupus are frequently treated with hydroxychloroquine.

Can hydroxychloroquine cause hair loss?

It’s possible for any medication to cause hair loss, but for some medications it’s quite rare and for others it’s much more common. Whenever a patient using hydroxychloroquine reports hair loss there are 5 possibilities to consider.

1. The Plaquenil is Causing Hair Loss

One needs to always consider the possibility that Plaquenil is causing the hair loss. Usually Plaquenil related hair loss starts 2-6 months after the Plaquenil was started. We call this a drug induced telogen effluvium. If the Plaquenil was started 10 years ago and a patient reports hair loss last month, it’s not very likely that the Plaquenil is the culprit. That is often forgotten.

2. The Autoimmune Disease the Plaquenil is Used for is Causing Hair loss

Autoimmune disease can cause inflammation in the body and this type of inflammation itself can trigger hair loss in the form of a hair shedding or ‘telogen effluvium.’ When rheumatoid arthritis flares patients can shed hair. When lupus flares, patients can lose hair. If it’s not clear if the disease itself is contributing to hair loss, the specialist (ie rheumatologist) can help chart the activity of the patient’s disease over the past 1-2 years. It this correlates with hair shedding episodes experienced by the patient, then disease activity is likely involved in the patient’s hair loss.

3. A New Autoimmune Disease is Causing Hair Loss

It’s well known that once a patient develops one autoimmune disease that he or she is more likely to develop a second autoimmune disease. One must always keep this in mind. Autoimmune scarring alopecias and autoimmune alopecia areata must always be considered when a patient with one autoimmune disease reports hair loss.

4. A New and Unrelated Hair Loss Condition has Developed

Hair loss is common and other conditions can develop. A 37 year old female with systemic lupus who uses Plaquenil for many years and now reports hair loss may have a number of possible hair loss conditions including telogen effluvium, female pattern (androgenetic alopecia), traction alopecia, or scarring alopecia. 40 % of women by age 50 will develop female pattern hair loss. This means that 40 % of female patients who use Plaquenil will develop female genetic hair loss – not from the drug itself but because that is the expected frequency in the population.

5. A New Treatment that was Introduced is Causing the Hair loss

For any patient who is currently using Plaquenil and develops new hair loss one must keep a very open mind as to the possibilities for the hair loss. In addition to the discussion points above, one must review whether new medication have been started. Was another medication introduced to treat the autoimmune disease? Was another mediation introduced to treat some other health condition. I recently saw patient with lupus who developed hair loss from an antacid type medication. We reviewed the precise course of the hair loss, pinpointed that it must have been the antacid medication and changed the medication. 2 months later the shedding had slowly considerably and 8 months later the patient’s hair has returned.


There are many reasons for hair loss in patients who use Plaquenil. One must always consider the possibility that the drug itself is triggering the hair loss but at the same time keep an open mind to other possibilities.

Article orginally posted at donovanmedical.com


For more information about cicatricial alopecia, visit carfintl.org