A dialysis patient with hair loss is seen on dialysis rounds with hair loss post failed kidney transplant on tacrolimus. Why is she losing hair?

The patient 58-years-old and has been on dialysis for 6 months. Her prior transplant failed after 15 years. The initial cause of the end-stage kidney disease was hypertension.

The transplant team has stated they are planning to retransplant the patient in the future. Her thyroid function tests are normal.

Dialysis patient with hair loss

Status post failed transplant. What is the cause?

Please answer the following questions:

Quiz: Why is this dialysis patient with hair loss losing her hair? What should you consider doing?

She is losing her hair because she is on dialysis. Women with hair loss related to dialysis, called telogen effluvium, can suddenly lose their hair and this can occur at any point during dialysis treatment, either when beginning kidney replacement therapy or later on. Telogen effluvium is characterized by widespread and noticeable hair shedding.

The immunosuppressant tacrolimus may be a contributing factor but would be less likely after 15 years on the medication without prior issues.

Telogen effluvium caused by tacrolimus usually occurs up to 14 months after starting tacrolimus and is felt to be caused by vasoconstriction.

We could consider switching to cyclosporin in this dialysis patient with hair loss, after giving the patient some time on dialysis and talking with the transplant team to confirm the best strategy moving forward (they plan to retransplant and tacrolimus may be the preferred immunosuppressive therapy of choice).

Telogen effluvium is a type of hair loss that can occur suddenly after starting dialysis in a dialysis patient with hair loss.
A
True
B
False

A. True

Tacrolimus is known to cause hair regrowth in patients experiencing hair loss.
A
True
B
False

B. False

The mechanism by which tacrolimus causes telogen effluvium is fully understood.
A
True
B
False

B. False

Discontinuing tacrolimus can lead to the reversal of hair loss.
A
True
B
False

A. True

Telogen effluvium is characterized by scarring of the hair follicles.
A
True
B
False

B. False

Discussion:

Dialysis Patient With Hair Loss Status Post Failed Transplant on Tacrolimus

Overview: Dialysis Patient With Hair Loss

Women undergoing dialysis may experience a specific type of hair loss known as telogen effluvium. This condition is characterized by sudden hair loss that typically occurs approximately three months after the initiation of dialysis treatment. That said, this condition can manifest at any time during the course of dialysis therapy.

Characteristics of Telogen Effluvium

Telogen effluvium is a form of non-scarring, diffuse alopecia. It is marked by:
* Widespread hair shedding
* Noticeable thinning of hair

Telogen Effluvium and Tacrolimus

Telogen effluvium is also commonly observed in patients who are treated with tacrolimus, an immunosuppressant medication. The onset of hair loss because of tacrolimus can occur up to 14 months after starting the medication. Some transplant centers have reported this condition in patients taking tacrolimus for longer periods of time.

Mechanism of Action

The exact mechanism by which tacrolimus induces telogen effluvium is not fully understood.

However, it is believed to be associated with:
* Premature transition of hair follicles into the telogen phase
* Potential vasoconstriction in the hair follicle unit

Reversibility of Hair Loss

Discontinuation of tacrolimus typically leads to the reversal of hair loss. Patients may experience regrowth of hair once the medication is stopped.

Alternative Treatments

For patients experiencing hair loss because of tacrolimus, cyclosporine may be a better-tolerated alternative. Cyclosporine has a side effect of hirsutism, which may help promote hair regrowth.