Imuran (azathioprine) and HT

[aasyd]

Hi,

Has anyone been on the immunosuppressant drug Imuran (azathioprine) and had a hair transplant? If so how did it go?

 

[Bill - Seemiller]

Hi there, sorry for the delay in replying.  I’m personally not familiar with that medication and I’m guessing by the lack of replies that nobody who has read this can relate to so far. But it is a legitimate question and I think it should be discussed. For starters, perhaps you can tell us about the medication, what it is, what it does and why you are concerned about  it affecting a hair transplant.   If you are considering her transplant surgery, I do suggest consulting with a few top surgeons recommended by this community and asking them this question. I’m sure they would have a direct answer. 

Now, don’t take this as an answer but I would doubt that this or most medications would really affect your hair transplant unless it thins the blood in which case, there may be some complications during surgery. 

If anybody has any information on this medication or an answer to this question, please reply.

Best,

Bill

[DrTBarghouthi]

Hi aasyd,

I just came across your question which I find worth discussing. Azathioprine is a medication considered to be a Disease modifying anti rheumatic drug/immuno suppressant. It goes by the brand name Imuran as it is most commonly known. I assume it is being used for some anti inflammatory condition that you may have such as crohns disease or other auto immune disease. 

With regards to HT, here are my thoughts on how it should be approached:

1. This medication can suppress blood counts including white blood cells and platelets, so it is important to check these levels before going forward as it can indicate whether there is a risk of excessive blood thinning or bleeding. Reduced white cells can also lead to more severe infections followong HT, especially if FUT is considered (wound infection)

2. In the early stage of taking this, hair loss related to the hair cycle abnormality can occur such as telogen effluvium or anagen effluvium. These are hair loss conditions un related to damage to the follicle but rather issues related with hair cycle disturbances, similar to what happens in shock loss or hair loss following chemotherapy. 

Because of these factors above, approaching a HT on this med in my opinion should be approached carefully. One should see how long a patient has been on it, the blood works, the fact that whether hair loss actually occured due to it or has stabalized following the treatment. There is no evidence that says that HT would fail using it, but I think it should be approached with good planning and on a case by case basis. I had one patient with a very limited genetic loss who has been on it for years. All his tests above were reasonable so we moved on with it and things are great. Where as if someone just started, has irregular bloods and possibly some non genetic hair loss due to it, then I would personally hold off and most likely proceed with an FUE once things are better.

  

[Melvin- Admin]

^Great information. 

That said, I truly feel you should consult with some of our surgeons online. The virtual consultation can provide a lot of information. 

https://www.hairtransplantnetwork.com/Consult-a-Physician/hair-transplant-surgeons.asp

[aasyd]

Hi Bill, DrTBarghouthi and Melvin. Thank you for the replies.

Dr T.B thank you for that informative post and yes you are correct I have Inflammatory bowel disease (Ulcerative colitis/crohns disease). I have been on Imuran for almost 5 years now on a lower dose of 50mg together with allopurinol 100mg. Also on Stelara injection (ustekinumab) and mesalazine. Been on other biologics before like infliximab and Humira. I did have an initial thinning of my hair when I first started Imuran but it now has stabilised and 5000mcg of biotin has helped but still a little thinner.

I checked my blood results after your post. My WBC have been high but the last 6 months they have been in the normal range. My platelets have been high but the last 5 months they have been in the normal range. Others are, RBC constantly slightly low, MCV constantly slightly high, MCH constantly slightly high, RDW constantly slightly high and CRP has been high and now back to normal. 

I guess I was most concerned if the grafts and donor area will heal properly and if the HT will look good when finished. Maybe also if I'm more prone to infection. (Side note: I got a small cut on my hand under the thumb a couple months ago and it healed with a red/darker mark so I was worried that the grafts will heal like that, but I guess its different and a different area).

 

Edited May 13, 2019 by aasyd

[DrTBarghouthi]

Thanks. It is different ofcourse from area to area. I dont think there is a set protocol on how to proceed, but yes infection is one of the concerns after HT on Imuran and especially in a big FUT scar. It might be wise to do a small test area first and proceed from there. This way you can assess how your excision sites and recipient sites heal and also the overall hair growth success. I also quoted the link Melvin sent about consulting one of the recommended surgeons online. 

11 hours ago, Melvin-Moderator said:

https://www.hairtransplantnetwork.com/Consult-a-Physician/hair-transplant-surgeons.asp