Dialysis is a medical procedure used to filter waste from the blood in patients with kidney disease. Close to 500,000 Americans and 25,000 Canadians are receiving dialysis. The most common reasons for dialysis is end stage kidney disease due to diabetes and high blood pressure.

Hair loss and hair changes occur time to time in patients receiving dialysis. One needs to consider a range of nutritional issues (including protein intake, zinc deficiency, iron deficiency), thyroid abnormalities, as well as hair loss from systemic disease itself (ie. autoimmune disease). The use of medications must be considered.

Anticoagulants are a group of blood thinning medications used during hemodialysis to prevent blood clotting when blood is filtered through machines. Several different types of anticoalgulants may be used and many can rarely cause hair loss. The mechanism by which they cause hair loss is typically a telogen effluvium although other mechanisms may occur as well.

Apsner and colleagues, in 2001, reported 5 hemodialysis patients who had hair loss from the low molecular weight heparin blood thinner dalteparin. All patients reported that their hair loss stopped when the dalteparin was stopped and a different method of anticoagulation (regional citrate anticoagulation) was used. 4 of the 5 patients even regained hair. In 2003, Sarris and colleagues reported a hemodialysis patient who had hair loss after switching from one low molecular weight heparin (enoxaparin) to tinzaparin. Hair regrowth resumed after switching back to enoxaparin.

Conclusion

There are many potential reasons for hair loss in patients receiving hemodialysis. Careful review of all factors is needed. Anticoagulants used during hemodialysis, including the low molecular weight heparins, need to be considered.

Reference

Sarris E, et al. Am J Kidney Dis. 2003.

Apsner R, et al. Blood. 2001

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.

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Nausea with Doxycycline: What strategies can help reduce nausea?

July 21, 2017

Doxycycline and Nausea

Doxycycline is an antibiotic. It's used of course in treating infections but it is commonly used for a variety of scarring alopecias including lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, folliculitis decalvans and sometimes dissecting cellulitis.

The drugs has two important properties: it stops infection and reduces inflammation. For some conditions such as lichen planopilaris, it's the anti-inflammatory properties that are useful. For other conditions such as folliculitis decalvans, it's the anti-bacterial and anti-inflammatory properties that are key.

The drug has a number of potential side effects even though it is generally well tolerated for most. It can cause nausea, vomitting, sun sensitivity, headaches, increased chance of yeast infections in women, rash.

Doxycycline and Nausea

Some patients developed considerable nausea with doxycycline. Some will even vomit. This can be a short term issue for some users which improves over time. For others it is something that continues and may even require the patient to stop the medication. Anyone with nausea from doxycycline should speak to their prescriber for advice on how to reduce the nausea.

Tips to reduce nausea

1. Take doxycycline with food. Unlike tetracycline, doxycycline still gets absorbed quite well into the blood stream if the patient takes it with food. The food intake really helps to reduce nausea and this should be encouraged

2. Avoid spicy foods with the doxycycline. Anything that upsets the stomach has the potential to makes things worse with doxycycline. I generally recommend avoiding spicy foods with doxycycline.

3. Take Gravol. If nausea continues despite food intake, dimenhydrate (Gravol) can be used 1 hours before the doxycycline is taken. I generally recommend starting with 25 mg Gravol and then 50 mg and then 100 to see what dose can help reduce the nausea. Gravol can make people drowsy and sleepy so this needs to be considered if one is driving or doing anything that requires focus.

4. Use Ginger. Ginger is also a helpful anti-nausea treatment. There are a number of candies, lozenges on the market that contain ginger and can be used prior to the patient taking the doxycycline. The company that makes Gravol also has a product "Ginger-Gravol" which can be very helpful. this does not contain Gravol and therefore does not cause drowsiness.

5. Reducing the doxycycline dose. For some users, the nausea is dose related. Reducing the dose can help.

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.

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