According to chemocare.com, methotrexate is an "antimetabolite chemotherapy drug." This means that it interferes with the metabolism of folic acid in rapidly dividing cells leading to a deficiency in folic acid and to the death of the cell. Folic acid is an important B vitamin which helps form new blood cells and helps new tissues and cells such as hair follicles to grow. Prolonged treatment with methotrexate can lead to a deficiency in folic acid, and for this reason, many doctors give folic acid supplements to patients on methotrexate to help to minimise the side effects. Folic acid is not routinely used as a treatment specifically for hair loss associated with methotrexate.
Methotrexate is used in the treatment of certain cancers that are characterised by rapidly dividing cells such as breast cancer. It is also used to treat autoimmune diseases such as rheumatoid arthritis and psoriasis and to cause miscarriage in the early stages of an ectopic pregnancy.
Methotrexate affects different people in different ways. According to medicineworld.org, the most common side effects include gradual hair loss, changes in blood cell count, diarrhoea, shortness of breath, kidney damage, watery eyes, skin and nail colour changes. Less common side effects include liver damage, allergic reactions, skin rash and neurological problems such as headache, behavioural problems, seizures and difficulty in speaking. If you are on methotrexate, it is very important to discuss any side effects with your doctor. Make sure that you attend any scheduled appointments to test for blood abnormalities.
Hair follicles, the structures under the skin that produce hair, are some of the fastest dividing cells in the body. They divide on average every 23 to 72 hours. Methotrexate targets cells that divide fast, and as a result, sometimes it causes death of hair cells and subsequent hair loss. Although it can happen, hair loss is quite rare at the smaller doses of methotrexate commonly used to treat things like psoriasis. It becomes more common at the higher doses used to treat cancer. Your doctor should reassure you that hair loss and many other side effects associated with methotrexate are reversible once the medication is stopped. Total hair loss is rare on methotrexate.
It is vital that the treatment regimen is adhered to and any ill effects discussed with your doctor. There are things that you can do to help minimise the hair loss and to maximise regrowth once you have been taken off methotrexate. For example, you can use certain topical creams, certain oral medications, laser treatment, folic acid which may be prescribed by your doctor, and make sure you have adequate protein in your diet. It is important to discuss any steps you are considering taking with your doctor first, as some vitamin supplements may interfere with the action of methotrexate.
There is no specific evidence that folic acid supplementation prevents hair loss during treatment with methotrexate. It is used to minimise the side effects caused by the folic acid deficiency, and one of these side effects is potential hair loss. Some doctors avoid prescribing folic acid supplements to patients receiving methotrexate for cancer therapy as it is feared that it may interfere with action of methotrexate on the cancer cells. If you are receiving methotrexate for cancer and are concerned about hair loss and lack of folic acid, please discuss with your doctor.
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