Alopecia Associated with Use of Methylphenidate: A Case Series

By Gnanavel, Sundar; Hussain, Sharafat | Indian Journal of Psychological Medicine, July-August 2018 | Go to article overview

Alopecia Associated with Use of Methylphenidate: A Case Series


Gnanavel, Sundar, Hussain, Sharafat, Indian Journal of Psychological Medicine


Byline: Sundar. Gnanavel, Sharafat. Hussain

In this case series, we report three cases of alopecia associated with use of methylphenidate for ADHD (Attention deficit hyperactivity disorder), that reversed with discontinuation of methylphenidate.

Methylphenidate is a stimulant drug considered the first-choice medication for attention-deficit hyperactivity disorder (ADHD). Although drug-induced alopecia is a common adverse effect with a variety of medications, alopecia with methylphenidate is a rarely reported side effect. In this case series, we present three children and adolescents with ADHD who developed severe alopecia with methylphenidate and improved with discontinuation of the same.

Case Reports

Case 1

Mstr LB is a 9-year-old boy diagnosed with ADHD based on poor attention span, forgetfulness, fidgetiness, restlessness, and reckless behavior in multiple settings including school and home. He was started on immediate-release methylphenidate 5 mg/day which was slowly titrated upward. After about a week of increase in the dose of methylphenidate to 30 mg/day, both the child and his parents noticed some hair loss initially in the temporal region. The hair loss progressed rapidly in the next 2-3 weeks, with patches of lost hair in temporal and parietal scalp regions, with the scalp clearly visible in these areas. The medication was stopped, and he was started on lisdexamfetamine. Within 3-4 weeks of stopping methylphenidate, regrowth of hair follicles was noted, and he regained his hair in around 3 months.

Case 2

Ms NT is a 13-year-old girl who presented to our clinic with a poor concentration in school lessons and being bouncy, always 'on the go,' impatient, and impulsive in different settings as described by her parents. She was diagnosed with ADHD and started on longer-acting preparation of methylphenidate (Concerta XL) 18 mg which was subsequently increased to 27 mg once daily. Subsequently, within a week, she noted diffuse hair loss and thinning of hair which progressively worsened (with an obvious decrease in hair thickness as commented by her friends and family). Discontinuation of methylphenidate and switch to atomoxetine resulted in gradual regrowth of hair over the next 3 months.

Case 3

Mstr WG is a 12-year-old boy who presented to our clinic with risky behaviors, including running across roads unsupervised, highly distracted during school lessons, poorly organized, hyperactive, and finding it difficult to remain still. He was diagnosed with ADHD and started on immediate-release methylphenidate 5 mg/day. The dose was gradually increased to 20 mg/day. He responded well to the medication. However, within a fortnight of increasing the dose to 20 mg, his parents started to notice patchy hair loss in the frontal and parietal region (with scalp being visible in these areas clearly). Discontinuation of methylphenidate and switch to atomoxetine resulted in gradual regrowth of hair over the next 6 months.

There were no losses in the eyebrows, eyelashes, or elsewhere in any of these cases. They were not taking any other medication for ADHD or otherwise. There was no personal or family history of hair loss. …

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