Crohn’s Disease (CD) is a long-term inflammatory condition that primarily affects the gastrointestinal tract, causing chronic inflammation anywhere from the mouth to the anus. While commonly associated with digestive symptoms like abdominal pain and diarrhea, the systemic nature of the disease can manifest outside the gut. Crohn’s disease can lead to hair loss, as chronic inflammation, nutrient deficiencies, and medical treatments can all disrupt the normal hair growth cycle.
Inflammation and Systemic Stress
The generalized inflammation characteristic of Crohn’s disease triggers a widespread physical stress response. When the body experiences severe shock, such as a flare-up, surgery, or significant weight loss, it can temporarily halt non-essential processes like hair production. This response is a common form of temporary hair shedding known as Telogen Effluvium (TE).
During a flare-up, hair follicles prematurely shift from the growing phase (anagen) into the resting phase (telogen). This synchronized shift results in noticeable shedding two to three months after the initial inflammatory trigger. Inflammatory mediators circulating during active disease can directly interfere with the hair follicle’s normal growth cycle. Hair loss from Telogen Effluvium is diffuse, affecting the entire scalp rather than creating distinct bald patches, and is usually reversible once inflammation is controlled.
Malabsorption and Key Nutrient Deficiencies
Inflammation within the digestive tract, especially in the small intestine, severely impairs the body’s ability to absorb essential vitamins and minerals. This malabsorption, often compounded by diarrhea and dietary restrictions, leads to deficiencies that impede hair growth. Hair follicles are among the fastest-dividing cells, requiring a constant supply of specific micronutrients to sustain rapid growth.
Iron deficiency is a frequent complication in CD patients, often causing anemia and hair thinning. Iron is necessary for red blood cell production, carrying oxygen to the hair follicles; deficiency can shorten the hair’s growing phase. Zinc is another mineral often deficient in CD patients, playing a significant role as a cofactor in enzymatic reactions within the hair follicle. Insufficient zinc levels can lead to structural changes in the hair shaft, resulting in brittleness and loss.
B vitamins, specifically Folate and Vitamin B12, are critical for cell division and are often poorly absorbed if Crohn’s disease affects the terminal ileum. Deficiencies in these vitamins can slow the cellular machinery required for hair production. Protein-energy malnutrition (PEM) is also a concern, as hair is primarily composed of keratin. Poor absorption of protein directly starves the follicles of their main building material. Addressing these deficiencies through medical intervention is necessary to resolve hair loss related to the disease.
Hair Changes Related to Crohn’s Medications
While the disease itself causes hair loss, certain medications used to manage Crohn’s disease may also contribute to hair thinning. Immunosuppressant drugs, such as methotrexate and thiopurines, are designed to slow rapid cell multiplication to control inflammation. This mechanism can inadvertently affect other fast-growing cells, including those in the hair follicles, sometimes resulting in a diffuse shedding pattern.
The incidence of hair loss from these medications is low and is typically dose-dependent. For example, hair loss is a less common side effect of methotrexate, affecting less than one in 100 people taking the drug. Biologic therapies have also been rarely associated with hair loss, though controlling inflammation with these drugs may reduce the risk of hair thinning. Medication-related hair loss is temporary and may improve with dosage adjustments or a change in therapy, which should be discussed with a gastroenterologist.
Managing Hair Health While Living with Crohn’s
The most effective strategy for managing hair loss associated with Crohn’s disease is achieving and maintaining disease remission, as this addresses the root causes of inflammation and systemic stress. Working closely with a gastroenterologist to keep disease activity under control is the first step toward restoring normal hair growth. Since multiple factors can be involved, consulting a dermatologist is beneficial to accurately diagnose the specific type of hair loss, distinguishing between Telogen Effluvium and other types of alopecia.
Regular blood tests are necessary to monitor the levels of key nutrients like Iron, Zinc, and Vitamin B12, which helps in identifying deficiencies before they become severe. Targeted supplementation should only be undertaken under the guidance of a healthcare provider or a registered dietitian. Over-supplementation, particularly with fat-soluble vitamins like Vitamin A, can paradoxically cause hair loss.
Adopting gentle hair care practices can minimize further breakage and loss. This includes avoiding harsh chemical treatments, limiting the use of high-heat styling tools, and gently handling the hair when washing and brushing. Since Telogen Effluvium is reversible, patience is necessary, as the hair growth cycle requires several months before full regrowth becomes noticeable after the underlying issue has been resolved.