Sherry Haynes is currently pursuing a PharmD degree and has experience in both the clinical and management sides of pharmacy.
Many diseases of the skin and internal organ have been known to change hair colour. For instance, Addison’s disease and neurodermatitis cause hair darkening. Whereas hyperthyroidism, vitiligo, and some genetic disorders like Werner’s and Waardenburg syndrome cause hair lightening.
Medicines usually cause hair loss or excessive hair growth but hair colour change is an unusual side effect.
Drugs can cause hair colour changes such as
- Darkening of the original hair colour or repigmentation of grey hair in older people
- Lightening/bleaching (from black or brown to blond hair)
- Greying, reddening or even a complete colour change.
These changes can affect scalp, eyelashes, eyebrows, moustaches or all body hair.
Of a wide variety of drugs implicated in causing hair colour changes, only a few are proved by evidence. In particular chloroquine and chemotherapeutic drugs show a strong link to colour change.
These drugs cause a biochemical interaction within the pigment-producing cells (melanocytes) of a hair follicle. Subsequently causing a reduction or an increase in pigment production. This leads to a hair colour change.
Drugs may also alter the mechanism by which the pigment is absorbed into the hair fibres. For example, minoxidil alters the physical properties of hair affecting light reflectance. As a result amount of reflected light can give an impression of hair colour change to the observer.
The drug is approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of lupus erythematosus and rheumatoid arthritis. This drug has been known to induce lightening on the hair scalp. Besides, it also rarely affects the eyelashes, eyebrows, moustache, and body hair. The starting dosage at which the drugs shows these effects is 250 mg daily.
According to the report, brightening of hair colour occurred from 4 weeks up to 12 months after the treatment initiation. The effect was reversible after discontinuation of the treatment or with dosage reduction. In rare cases, hypopigmented macules were noted on the skin.
Hypopigmentation with chloroquine was more common in patients with blond, light brown, or red hair. This is probably because the drug interacts more with pheomelanin than eumelanin, according to the author. However, people with darker hair may also experience hair lightening.
Tyrosine Kinase Inhibitors (TKI)
These drugs inhibit the c-kit signalling pathway that is involved in the production of melanin and hair pigmentation. To be specific, they do this through the downstream activation of MAP kinase Erk-2 and phosphorylation of microphthalmia transcription factor. But, the complete mechanism is not clearly understood. Also, it is not clear why c-kit inhibitors may cause both hypopigmentation and hyperpigmentation.
Imatinib is an oral TKI that inhibits BCR-ABL, PDGFR and c-kit. It is approved by the FDA and EMA to treat some types of tumours. Specifically, chronic myeloid leukaemia (CML), gastrointestinal stromal tumour, metastatic dermatofibrosarcoma protuberans, and other chronic myeloproliferative diseases.
Imatinib can cause both hair lightening and darkening. The colour change occurs after 1 to 14 months of treatment initiation. The usual treatment dose is 300–800 mg daily. Following drug withdrawal, the colour changed hair usually get back to normal. Skin changes such as diffuse skin depigmentation or skin, nail, or gingival hyperpigmentation can be rarely noted.
It is an oral TKI approved by FDA and EMA for the treatment of cancer. Particularly, metastatic renal cell carcinoma, pancreatic neuroendocrine tumours, and imatinib-resistant GIST. It exhibits direct antiproliferative activity by inhibiting PDGFR, VEGFR, and c-kit.
Bleaching/greying of hair on the scalp, eyebrows, eyelashes, or body hair can occur. The effect is dose-dependent meaning the severity of colour change depends on the dose used. 7–14% patients at a lower dose (50 mg daily) and up to 64% patients at a higher dose (>50mg daily) experienced a hair colour change. The effect started between week 1 and 18 of treatment, according to the report. In all cases, it was reversible after discontinuation of the drug.
In rare cases, patients may also hair loss. Furthermore, hair that may regrow is more brittle, curly and darker than the original hair. Some patients have also experienced a yellowish appearance on the face after consuming the drug at dosage >50 mg daily.
This is an FDA and EMA approved drug used for the treatment of thyroid cancer refractory to radioactive iodine treatment, renal cell carcinoma, and hepatocellular carcinoma. It targets VEGFR, BRAF, and RET tyrosine kinase and inhibits the proliferation and angiogenesis of cancer cells.
Up to 27 per cent of patients show a hair colour change after 2–6 weeks of treatment initiation. According to the report, hair may regrow even while the patient is still receiving sorafenib treatment. But, the newly grown hair is more brittle and curly, and sometimes darker than the original hair.
Pazopanib is an oral selective TKI approved by both FDA and EMA for treating advanced renal cell carcinoma and advanced soft tissue sarcoma. The drug inhibits tumour growth and angiogenesis by inhibiting VEGFR, PDGFR alpha and beta, and c-kit.
Hair depigmentation (of both scalp and body hair) is seen in 32–44% patients sometimes associated with skin hypopigmentation. The effect is usually reversed within the first two months of treatment initiation.
It is an oral TKI approved by the FDA and EMA as a first-line treatment for CML Philadelphia chromosome-positive in the chronic phase and as a second-line treatment for CML in chronic, accelerated or blast phases and for chromosome-positive ALL.
It inhibits bcr-abl, Src family kinase and to a lesser degree, c-kit, PDGFR, and ephrin-A receptor kinase.
Depigmentation is less noted with Dasatanib. Probably because the drug is less commonly used. Also, due to its lower affinity for c-kit and PDGFR. Vitiligo-like skin patches with isolated hair depigmentation were reported at a dosage more than 100 mg daily. The effect is fully reversible.
7. Valproic acid (VPA)
It is an antiepileptic drug, approved by the FDA and EMA. It is widely used for seizures and bipolar disorder.
Reversible hair loss occurred in 20% of patients, while the changes in hair colour and texture are rare. Both bleaching and darkening on the scalp hair have been described after 5–10 months of treatment initiation. No skin colour changes with this drug are documented so far.
It is an anticonvulsant drug used in the management of partial seizures and tonic-clonic seizures. Hair depigmentation due to toxic epidermal necrolysis was reported in one patient.
This anticonvulsant drug caused black hair colour change to blond due to Lyell’s syndrome in one patient. The skin also showed depigmentation in this case.
Post-hair-loss, regrowth of hair with both lighter and darker colour has been shown with this anticancer agent.
11. Tamoxifen, Busulfan, Cyclofosfamide, Vincristine, bleomycin, 5-Fluorouracil and other antimetabolites
Theses drugs showed hair colour change from black to red (vincristine, bleomycin), blond to dark brown (5-Fluorouracil), or red to black.
It is an immunosuppressant drug. Excessive hair growth (hypertrichosis) is a common side effect of cyclosporine. Up to half of the patients taking the drug in a higher dose suffer from this.
In two cases, hair darkening was reported.
13. Acitretin and Etretinate
These are vitamin A derivatives. Infrequently cases of hair whitening/discolouration have been described with the use of these drugs.
A case of hair darkening was reported with the use of verapamil after 12 months of treatment initiation.
Hair discolouration occurred in four people with Mephesin use. The effect was visible after 3–4 months of treatment initiation.
16. P- Amino benzoic acid (PABA)
Four cases showed a reversal from grey to original hair colour. This occurred between 2–12 months of treatment.
17. Interferon low dose
Depigmentation was reported in six cases. The effect was reversible after stopping the treatment.
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How these drugs can induce hair colour changes is not clear, and this association is often hard to prove. Most drugs causing hair color change also tend to cause hair loss. If you are seeing such a change and would like to find out for yourself then check this other article : Medications That Cause Hair Loss.
Note that the above list is not comprehensive. If you notice your hair colour change and suspect a drug, consult your doctor.
- Francesco Ricci, Clara De Simone, Laura Del Regno, Ketty Peris. Drug-induced hair colour changes. European Journal of Dermatology. 2016;26(6):531-536. doi:10.1684/ejd.2016.2844
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: My husband has been taking cyclosporine for a couple of years. I noticed his gray hair is getting darker in places. He is 56 and been gray since his late 20s early 30s. Is this normal?
Answer: There are reports that tell us about hair darkening caused due to cyclosporine, especially in the psoriasis treatment. So I believe this is normal. If you want to be sure, do remember to mention this when you visit the doctor.
Question: Will being on mycophenolate cause red hair dye to not stay in the hair?
Answer: Has your hair become thinner than before? The information provided so far about mycophenolate mofetil is that it can cause hair loss or thinning. Most times, the thinning of hair will result in it not taking up the dye, so this might be a reason hair dye is not staying in your hair.
The hair may become normal in some time even if you continue the treatment, but it is advised to avoid hair dyes or perms for the first few months as your hair will be weaker than usual.
Question: Pills exist for people to lighten & darken their skin. Are there pills we can take to change our hair color & eye color, that leaves our skin color the same? People in the Soleman Islands have dark skin & blonde hair, I'd like to keep my skin dark but have blonde or red hair without using hair dye or bleach.
Answer: Pills to lighten or darken skin? Do you mean the likes of "tanning pills". Tanning pills are not FDA approved. They contain canthaxanthins, a type of color additives used in food substances. Canthaxanthines are not harmful when used in small amounts as present in food additives. But in tanning pills, these are present in large amounts that are harmful to the consumers.
Coming to the next part of your question, there are no pills to change eye color or hair color. Few medicines change the color of your hair and skin and even eye but only as a side effect. To use such drugs with the sole purpose of changing hair color would be totally inappropriate and dangerous.
I would like to add that, medicines are not meant to change the physical appearance of a person. They are just intended to treat or prevent diseases. For changing hair color, a hair dye with perfect care would be always a better option in my opinion.
Question: I have dark blackish-red skin discoloration patches between mouth and chin area. The doctor prescribed Alercet tab (Cetirizine), Icoz tab (Itraconazole), Becadexamin Capsule(multi-vit & multi-mineral capsule) and Limcee+ vit C tab (health supplement). Can it cause hair greying? I am 19 and a half years old, male.
Answer: If I understood your question correctly, you have a fungal-like infection on your chin area and you were prescribed Cetirizine, Itraconazole and vitamin supplements. I found no reported hair greying reactions linked with the use of these drugs. So, you can be assured that these medicines are safe in that matter.
Since you have asked this question, did you see your hair turning grey? Do you suspect these medicines?
If you do then send me an e-mail or ask another question in this section with the details of your symptoms, date of initiating these medicines, date of when you noticed your hair turn grey, and other related things like if you dye your hair and if you are on any hormonal medicines.
Question: Is it safe to get hair colored if on rinvoq?
Answer: Rinvoq (upadacitinib) is a medicine used for rheumatoid arthritis as approved by FDA in 2019. The label for rinvoq does not mention any such dermatological reactions to say that it is not safe to color your hair while you are on it. Since, the drug was approved recently, we do not have sufficient data from trials performed after the approval of this drug.
From the information we have, the drug belongs to a class called JAK inhibitors and drugs of these class are being tested for treating hair loss of some specific types. So, I believe it is safe to color your hair.
Note: If you experience hair thinning or hair loss, please consult your doctor before you color your hair next time.
Question: Does topiramate change hair and/or affect skin? I see changes in hair (coarser, drier, and brittle). I find changes with my skin too (increased wrinkles and laxity). I am wondering if this is because it is a sodium channel blocker and vitamin C is not absorbed as usual, or because the medication dehydrated the body systematically and this reduced water can prohibit the production of hyaluronic acid.
Answer: Hair loss is frequently linked with topiramate. If a drug has the potential to cause hair loss, it means that it can cause the pathologies that lead to it including making your hair brittle and coarser. Some may experience hair loss while others may only go through the changes leading to it.
As for the skin, sodium channel blockers can affect the synthesis of collagen type I and type IV related to vascular structures and skin. Additionally, topiramate dehydrates the body and it is possible that the effects you are seeing on your skin are a result of it.
Question: I take levetiracetam and carbamazepine medicine for my seizures. Can it cause greying hair?
Answer: I could not find any such documented reports of Carbamazepine and Levetiracetam causing hair discoloration. However, both drugs rarely cause hair loss and one report suggest levetiracetam causing skin hyperpigmentation.
To find out a true causal relationship between these drugs and your hair greying I will need to know many more details related to your medicine administration, dosage, date of initiating the medicines in relation to date of you observing grey hair and the likes. Your pharmacist might help you determine the causality and help you report it if it is found to be true.
© 2018 Sherry Haynes
Sherry Haynes (author) on July 24, 2019:
Tamoxifen is one of the most commonly blamed drugs for hair loss. 1 in 3 women see hair loss after using tamoxifen. Before I can tell you anything I will need to know for how long you have been using the drug and whether you see a change in the texture of the hair or may be loss of hair in some areas.
If you feel like everything is alright after been used the drug for a long time, you may go for coloring your hair but generally I would prefer to avoid it for at least a few months of the therapy.
June on June 12, 2019:
I am taking 5 mg Tamoxifen. I was wondering can I color my hair at a salon.
Will it fall out.
Sherry Haynes (author) on August 17, 2018:
Thanks, Liz W.
Liz Westwood from UK on August 14, 2018:
This is an interesting article. Next time I am prescribed a drug I shall be checking out this list.
Sherry Haynes (author) on May 28, 2018:
If she can rule out other things that can have such effect, meds could be suspected. Thanks for reading it.
Pamela Oglesby from Sunny Florida on May 28, 2018:
My mother complains about how oxygen is making her hair darker, but I never thought about meds changing hair color. Interesting article.