Hair loss, methotrexate

Hi, I am looking for some help. I am currently on 20mg / wk methotrexate plus 5 mg / day prednisone and also celocoxib daily. My hair is really starting to worry me, thinning out all over and coming out badly when washed and brushed. My worry is losing all of my hair.
I have been on methotrexate over 6 months, blood work is fine. It worked well to start with but I have had a bad week, stiff ,sore and fatigued . My nurse practitioner wants me to lower prednisone .5 mg weekly over several months to come off it altogether.
I am really struggling to know what to do for the best, ask for a whole new medication?, accept how it is and see how much more hair falls out?, stay on just prednisone?.
Helpful advice appreciated, Melissa.

For hair loss - you really need to be upping your biotin and collagen. And look for shampoos which help - like those advertised for ‘women over 40’ as our hair changes considerably as we enter the peri-menopause and indeed menopause. All take some months to help but I have friends whose hair has returned doing this. Research it on line and there are reputable products available which go a long towards helping. There can also be several reasons for the hair loss not just mxt too. But get on to it and start doing something about it as that will help you feel better.

As regards the pred - I really think your nurse is right. Long term pred use can cause so many other problems. I’m a life long asthmatic so over the years I’ve had several high dose short courses of pred, lots of them. Asthma requires higher doses than PsA too. Then nearly 4 years ago PsA hit me and I spent virtually the first year on pred.
Then I developed two unexplained stress fractures in my pelvis. Two years later I suffered 3 compressed lumber vertebrae fractures. All the tests point to osteopenia but with the fractures it’s now urgent I start taking osteoporosis meds. All the pred throughout my life made this happen. There’s no family history.

Pred is great as short tapering dose for PsA, but it truly isn’t a great idea to take long term. So I would really urge you to get off it over the several months as your nurse has suggested.

Six months on mxt is a relatively short time. But already it’s helped. That’s fabulous really. There are so many other meds to take as well so explore them.

I couldn’t tolerate mxt but could sulfasalazine. That worked well but sadly stopped all of a sudden. Then I finally qualified for biologics (I’m in the UK) the first a biosimilar of enbrel only worked for 3 of the 11 months I was on it. Then I was changed to a biosimilar of humira - that didn’t like me at all and didn’t work either. Now I’m on Cosentyx - just finished the loading doses and boy does this want to work and work well for me this far. So there’s always something to try.

Hope this helps. x


Hi nzbee.

Are you taking Folic Acid? That’s the main thing that helps offset Mtx side effects. Same goes for ample water intake daily, I’ve no idea whether that might help reduce hair loss, but adequate hydration is good for everything and vital when on Mtx.

I’d be very cautious about assuming that hair loss is due to Mtx. Stress can have the same effect. I’m sure you’re doing this, but anyway … avoid anything that tugs on the roots such as brushing it when tangled.

I’ve noticed that the thickness of my hair goes in phases … it’s in a bit of a thin-ish stage, though is usually fine despite 7 years of Mtx. Plus I’m getting more ‘mature’. I wash it just once a week, I give it a damn good talking to sometimes.

There was one time when my hair fell out in clumps - we are talking big bald patches. I was having a psoriasis flare but not all the bald patches were affected by psoriasis. I believe there was a stress element - physical stress caused by the extensive psoriasis. Some derms suggested that anyway. Curiously, my psoriasis & hair loss was triggered by stopping Mtx, when I re-started the hair grew back with a vengeance. I’ve not heard of anyone who has had exactly the same experience, but the stress factor is worth considering.

I know how important hair is. My rheumy at the time took my hair loss so seriously, even understanding that it hit me harder than a bod covered in the dreaded P. Women derms with heads full of hair didn’t get it, but he did and oh boy did he fight my corner with the dermatology people. What does your rheumy say?


FWIW my hair is going quick too… Has nothing to do with MTX and everything to do with age and hormonal changes LOL (not to mention a fair dose of heredity) :grinning: :grinning: :grinning:

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Thanks everyone, it’s great to not feel alone in this. I have asked for an appointment with my Dr to figure out what to do next. I will look into the shampoos and supplements mentioned. I am taking folic acid as well and will ask Dr if I may need more. :grinning:


Worth noting, perhaps, that the hair ‘cycle’ is a long one. I’m struggling to think how exactly this was explained to me … I think, basically, if your hair is coming out by the roots, chances are that trigger factors occurred or started quite some time back … months at least.

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Hello. I can’t comment on the hair loss as I have not experienced that.
I was on prednisolone for 10 years plus…not ideal. The nurse reduced my 5mg dose over a long period, i’ve not being taking any for over a year now. I think stopping daily steroid is a good idea if possible. I’ve also been on Methotrexate for many years now. I would say persevere the side effects if you can. For me the medication took a long while to get things under control. I would recommend discussing increasing your folic acid dose. That has greatly help me with the fatigue. Also, even when my inflation was reducing I still had soreness in my joints. PSA can take a long long time to get under control but I’ve been flare free for a couple of years so don’t give up hope.

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Thanks for your support. :grinning:

Thanks, hopefully I will find out more at my appointment tomorrow.

I’ve been on Mtx (and Leflunomide) for five years. Started out with 5mg of prednisone daily, but have it down to 2.5mg every other day. Seems to be a good combination for me, and hair loss isn’t a problem, yet, lol! My mum also had PsA - before there was much besides prednisone to treat it. She took some massive doses for long periods. Didn’t seem to affect her hair. What DID cause her much hair loss was a combination of peri-menopause/menopause and an undiagnosed low functioning thyroid. Maybe get that checked? She was low/borderline and while the docs hemmed and hawed she lost a lot of hair!

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When started Methotrexate soon after diagnosis a couple years ago, I remember hair loss when rheumy upped injection dose from 10 mg to 20- felt so upset went to talk about it and dosage was lowered once again to 10 mg, current dosage. Got off prednisone after one plus year, had put on 30 kg excess weight, and broke my femur at hip level too, as well as getting an osteopenia diagnosis. at the moment am on a carnivore diet, and on methotrexate 10mg as well as cosentyx. take folic acid 3 times a week, vit d, osteopenia pills medeoros, and things are pain free and energy level and brain fog ok, also second idea to limit prednisone as soon as poss, and to explore different treatments, all the best

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I was on methotrexate 5 years and stopped because of hair loss. Prescription strength folic acid can help as well as biotin over the counter. You have the right to request a different medication.

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I started methotrexate in 2002 for severe psoriasis. I was 32 so I knew the loss was all from the drug. I went to a wig store, bought a beautiful ponytail and lived like that for a couple years. My hair was super thick and straight all my life. Suddenly my hair started filling in but the new hair was very wavy. It’s been 17 years since, I haven’t used mtx in a year and my hair remains long and curly- spiral curls. I do take collagen and folic and use a shampoo and conditioner for thinning hair called Color Proof. Good luck! Hang in there.

Thanks for your support. May I ask, did you lose all your hair?. I have been stopped on the methotrexate by my Dr, we plan to try a new drug once it’s out of my system. I am still losing hair and wondering if it will all be gone at some point or turn a corner and start to grow back. I suspect the wig store idea might be useful soon. Thanks, Melissa.