Can Humira cause hair loss? It is a question many patients starting adalimumab understandably ask. Humira (adalimumab), a TNF-alpha inhibitor widely prescribed across the UK for rheumatoid arthritis, Crohn's disease, psoriasis, and ankylosing spondylitis, does list alopecia as an uncommon adverse reaction in its MHRA-authorised Summary of Product Characteristics. However, because many conditions treated by Humira can themselves cause hair shedding, determining whether the drug or the disease is responsible requires careful clinical assessment. This article explores the evidence, possible mechanisms, and practical steps to take if you notice hair changes whilst on adalimumab.

Does Humira Cause Hair Loss?

Yes — the MHRA-authorised Humira UK SmPC lists alopecia as an uncommon adverse reaction, occurring in fewer than 1 in 100 but more than 1 in 1,000 patients. Careful clinical assessment is needed to distinguish drug-related from disease-related hair loss.

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Humira (adalimumab) is a biologic medication classified as a tumour necrosis factor-alpha (TNF-alpha) inhibitor. It is widely prescribed in the UK for a range of inflammatory conditions, including rheumatoid arthritis, Crohn's disease, psoriasis, and ankylosing spondylitis. As with any medication, patients and healthcare professionals must weigh its benefits against potential side effects — and hair loss is one that is occasionally reported.

In the UK, the authoritative reference for a medicine's safety profile is the Summary of Product Characteristics (SmPC), which is authorised and overseen by the Medicines and Healthcare products Regulatory Agency (MHRA) and accessible via the electronic Medicines Compendium (eMC). The Humira (adalimumab) UK SmPC lists alopecia as an uncommon adverse reaction in Section 4.8 — meaning it has been identified as occurring in fewer than 1 in 100 but more than 1 in 1,000 patients. It is therefore a recognised, if infrequent, adverse event rather than solely a post-marketing observation. The European Medicines Agency (EMA) European Public Assessment Report (EPAR) provides additional EU-level pharmacovigilance context, though the MHRA/eMC SmPC is the primary UK regulatory reference.

It is important to note that there is no definitive established causal mechanism linking adalimumab to significant hair loss in the majority of patients. Some individuals may experience mild, temporary shedding, whilst others report more noticeable changes. Because many patients taking Humira also have underlying inflammatory conditions that can themselves cause hair loss, attributing the symptom solely to the medication requires careful clinical assessment.

Authoritative UK references: MHRA/eMC Humira (adalimumab) SmPC, Section 4.8; NHS adalimumab medicines page; BNF adalimumab monograph.

How Common Is Hair Loss as a Side Effect of Humira?

Alopecia is classified as 'uncommon' in the Humira UK SmPC, meaning it affects between 1 in 1,000 and 1 in 100 patients. The majority of people taking adalimumab will not experience noticeable hair loss directly attributable to the drug.

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According to the MHRA/eMC Humira (adalimumab) UK SmPC, alopecia is classified as an uncommon adverse reaction. Using standard MHRA/EU regulatory frequency definitions:

• Uncommon: affects ≥1 in 1,000 to <1 in 100 patients

• Rare: affects ≥1 in 10,000 to <1 in 1,000 patients

• Very rare: affects fewer than 1 in 10,000 patients

This means that the large majority of people taking adalimumab will not experience noticeable hair thinning or loss directly attributable to the drug. The precise real-world incidence is difficult to quantify, partly because confounding factors — such as the underlying condition, concurrent medications, and nutritional status — make attribution challenging.

Case reports and observational studies have documented instances of alopecia areata — a condition in which the immune system attacks hair follicles — in patients receiving TNF-alpha inhibitors, including adalimumab. Published case series and reviews in dermatology literature (including reports in the Journal of the European Academy of Dermatology and Venereology and the Journal of the American Academy of Dermatology) have described this association, though the absolute frequency remains uncertain. This presents a clinical paradox: TNF-alpha inhibitors are immunosuppressive agents, yet in rare cases they may trigger or unmask autoimmune hair conditions.

It is also worth noting that:

• Diffuse hair shedding (telogen effluvium) can occur as a non-specific response to systemic illness or medication changes

• Alopecia areata has been reported in isolated cases with biologic therapies

• Reporting bias may influence how frequently these events appear in pharmacovigilance databases

Patients who notice hair changes after starting Humira should document when the shedding began, its pattern, and any other new symptoms, as this information will assist their clinician in determining the most likely cause. The NHS hair loss (alopecia) overview provides useful patient-facing context on different types of hair loss and when to seek help.

Why Adalimumab May Affect Hair Growth

Adalimumab blocks TNF-alpha, a cytokine thought to regulate the hair follicle cycle, which may theoretically disrupt follicular cycling in susceptible individuals. In rare cases, immune modulation may paradoxically trigger autoimmune alopecia areata.

To understand why adalimumab might, in some cases, influence hair growth, it helps to consider its mechanism of action. Adalimumab is a fully human monoclonal antibody that binds specifically to TNF-alpha, a pro-inflammatory cytokine involved in the body's immune response. By blocking TNF-alpha, the drug reduces systemic inflammation — which is central to its therapeutic benefit in conditions such as rheumatoid arthritis and Crohn's disease.

TNF-alpha is also thought to play a role in regulating the hair follicle cycle. Some research suggests that TNF-alpha signalling is involved in the transition between the growth phase (anagen) and the resting phase (telogen). By altering this signalling pathway, TNF-alpha inhibitors could theoretically disrupt normal follicular cycling in susceptible individuals, potentially leading to increased shedding. It is important to emphasise, however, that this mechanistic explanation remains hypothetical and is not confirmed in the general patient population; the evidence base is largely derived from small case series and laboratory studies rather than robust clinical trials.

Additionally, because adalimumab modulates immune function broadly, it may — in rare circumstances — shift the immune balance in a way that paradoxically promotes autoimmune activity against hair follicles. This is the proposed mechanism behind reported cases of new-onset alopecia areata in patients receiving biologic therapies, a phenomenon sometimes termed a 'paradoxical reaction'. Reviews of paradoxical immune-mediated events with TNF inhibitors have been published in rheumatology and dermatology literature, and the British Association of Dermatologists (BAD) guideline on alopecia areata provides specialist context on the autoimmune basis of this condition.

Individual susceptibility, genetic factors, and concurrent medications are all likely to contribute. Patients should be reassured that these effects, whilst recognised, are uncommon, and that the mechanistic understanding continues to evolve.

Managing Hair Loss While Taking Humira

Speak to your prescribing specialist or GP before making any changes to Humira, as abrupt cessation risks disease flare. Investigation should include a review of concurrent medications, nutritional blood tests, and thyroid function, with NHS dermatology referral if alopecia areata is suspected.

If you notice hair thinning or increased shedding whilst taking Humira, the first and most important step is to speak with your prescribing specialist or GP before making any changes to your medication. Stopping a biologic therapy abruptly without medical guidance can lead to a flare of your underlying condition, which may carry its own risks — including further hair loss caused by uncontrolled inflammation.

Your clinician will likely consider the following approach:

• Review your full medication list — other drugs used alongside biologics, such as methotrexate, are more commonly associated with hair loss and may be the primary cause. It is worth noting that folic acid supplementation (typically 5 mg once weekly, as per BNF guidance) is routinely recommended alongside methotrexate and may help reduce hair thinning associated with that drug.

• Assess nutritional status — a first-line blood screen in UK primary care typically includes a full blood count (FBC) and ferritin (iron stores), plus thyroid-stimulating hormone (TSH). Vitamin D, B12, zinc, and a coeliac screen may be added where clinically indicated, as deficiencies in these are well-recognised contributors to hair shedding.

• Evaluate thyroid function — thyroid disorders are prevalent in people with autoimmune conditions and are a well-recognised cause of hair loss.

• Consider an NHS dermatology referral — if alopecia areata is suspected, a dermatologist can confirm the diagnosis and discuss treatment options. NICE Clinical Knowledge Summaries (CKS) on alopecia areata and the Primary Care Dermatology Society (PCDS) guidance on telogen effluvium provide useful frameworks for assessment and referral in UK primary care.

In many cases, hair loss may be temporary and resolve without any change to treatment. Gentle hair care practices — avoiding excessive heat, tight hairstyles, and harsh chemical treatments — can help minimise further breakage during this period.

Topical minoxidil is licensed in the UK for androgenetic alopecia (male and female pattern hair loss). Its use for diffuse shedding such as telogen effluvium is off-label and should only be considered under the direction of a healthcare professional, particularly in the context of ongoing biologic therapy.

When to Speak to Your GP or Specialist

Seek prompt medical advice if hair loss is sudden, patchy, accompanied by new symptoms, or begins shortly after starting or changing your Humira dose. Significant or distressing hair loss warrants specialist assessment to identify the cause and discuss management options.

Whilst mild, temporary hair shedding may not require urgent attention, there are certain circumstances in which you should seek prompt medical advice. Contact your GP or specialist if you experience:

• Sudden or rapid hair loss, particularly in patches (which may suggest alopecia areata)

• Hair loss accompanied by other new symptoms, such as fatigue, weight changes, skin rashes, or joint pain

• Significant psychological distress related to changes in your appearance

• Hair loss that begins shortly after starting or changing your dose of Humira

Because adalimumab suppresses part of the immune system, people taking it should also seek prompt medical advice for any signs of serious infection — such as a high fever, chills, persistent cough, or breathlessness — even if hair loss is the presenting concern. This is consistent with NHS and British Society for Rheumatology (BSR) safety guidance for patients on immunosuppressive therapies.

Your specialist — whether a rheumatologist, gastroenterologist, or dermatologist — is best placed to assess whether the hair loss is related to your medication, your underlying condition, or another cause entirely. They may arrange blood tests, a scalp examination, or a referral to NHS dermatology depending on the clinical picture. If a trichologist is mentioned, it is worth being aware that trichologists are non-medical practitioners and are not typically part of the NHS referral pathway; NHS dermatology is the appropriate specialist route for suspected alopecia areata or other medically significant hair loss.

In some cases, if adalimumab is strongly suspected as the cause and the hair loss is significantly affecting quality of life, your specialist may discuss switching to an alternative biologic with a different mechanism of action. This decision must be carefully balanced against the risk of disease relapse and should never be made without specialist input.

You and your healthcare professional can report suspected side effects of Humira directly to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk. This contributes to ongoing pharmacovigilance and helps improve the safety information available to all patients in the UK.

Hair Loss and Your Underlying Condition

Conditions treated by Humira — including rheumatoid arthritis, Crohn's disease, and psoriasis — can independently cause hair loss through inflammation, nutritional deficiency, or physiological stress. In some cases, effective disease control with Humira may actually improve hair health over time.

It is essential to consider that many of the conditions for which Humira is prescribed are themselves associated with hair loss, independent of any medication effect. This can make it genuinely difficult to determine whether the drug or the disease is responsible.

Rheumatoid arthritis is linked to diffuse hair thinning due to systemic inflammation and the physiological stress of chronic illness. Psoriasis can affect the scalp directly, leading to scaling and associated hair shedding. Crohn's disease and other inflammatory bowel conditions may contribute to nutritional deficiencies — particularly in iron, ferritin, and B vitamins — that are well-established drivers of hair loss, as outlined in NHS and PCDS guidance on telogen effluvium. In these contexts, effective treatment of the underlying condition with Humira may actually improve hair health over time by reducing systemic inflammation.

Furthermore, the psychological burden of living with a chronic illness — including stress, anxiety, and disrupted sleep — can itself trigger telogen effluvium, a form of diffuse shedding that typically occurs two to three months after a significant physical or emotional stressor. This timeline can coincide with the initiation of a new medication, leading patients to understandably, but sometimes incorrectly, attribute the hair loss to the drug. The NHS hair loss (alopecia) overview provides accessible information on the different types of hair loss and their causes.

A holistic approach to assessment is therefore essential. Rather than focusing solely on Humira as a potential cause, your healthcare team will consider your full medical history, current disease activity, nutritional status, and any other relevant factors. In many cases, optimising the management of your underlying condition — with or without adjustments to your biologic therapy — will be the most effective strategy for addressing hair loss.

If you are concerned about hair loss in the context of your condition or treatment, the NHS website, NICE CKS resources, and your GP or specialist team are the most reliable sources of personalised guidance.

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