Does Skyrizi Cause Hair Loss?
Skyrizi (risankizumab-rzaa), an IL-23 inhibitor for plaque psoriasis, Crohn's disease, and ulcerative colitis, lists hair loss (alopecia) as an uncommon side effect in its prescribing information, occurring in less than 1% of patients in clinical trials.[1] Post-marketing reports and patient forums note rare cases, but no causal link is firmly established—hair loss often ties to underlying conditions like psoriasis or stress rather than the drug itself.
How Common Is Hair Loss on Skyrizi?
In phase 3 trials (e.g., UltIMMa-1/2 for psoriasis), alopecia affected 0.4-0.7% of Skyrizi users versus 0.3% on placebo.[2] Crohn's trials (ADVANCE/ MOTIVATE) reported it in under 1%, similar to ustekinumab rates.[1] Real-world data from FAERS (FDA adverse event database) shows ~200 hair loss reports since 2019 approval, but these are unverified and don't prove causation.[3]
Why Might Hair Loss Happen with Skyrizi?
Skyrizi targets IL-23, reducing inflammation without broadly suppressing immunity like methotrexate. Potential mechanisms include:
- Paradoxical reactions: Psoriasis treatments can trigger localized hair loss flares.
- Telogen effluvium: Stress from disease or treatment shifts hair into resting phase.
- Coincidental factors: Autoimmune overlap (e.g., alopecia areata in psoriasis patients).[4]
No evidence of direct hair follicle toxicity in studies.
Compared to Other Biologics
| Drug | Hair Loss Frequency in Trials | Notes |
|------|-------------------------------|-------|
| Skyrizi | <1% | Lowest among IL-23s |
| Cosentyx (secukinumab, IL-17) | 1-2% | Slightly higher[5] |
| Tremfya (guselkumab, IL-23) | 0.5-1% | Similar profile[6] |
| Humira (adalimumab) | 1-3% | More reports[7] |
| Stelara (ustekinumab, IL-12/23) | <1% | Comparable[1] |
Skyrizi has fewer complaints than TNF inhibitors but matches other IL-23s.
What Do Patients Report?
On Drugs.com and Reddit (r/Psoriasis, r/Crohns), ~5-10% of Skyrizi reviews mention thinning hair, often resolving after 3-6 months or dose adjustment.[8] Some attribute it to psoriasis scalp involvement improving slowly. Dermatologists advise monitoring; biopsy if persistent.
What If You Experience Hair Loss on Skyrizi?
Consult your doctor—don't stop abruptly, as psoriasis/Crohn's flares risk worsening. Options include switching biologics, adding minoxidil, or ruling out thyroid issues/nutritional deficiencies. No black-box warning for hair loss.[1]
When Does Hair Loss Typically Start or Stop?
Onset: 1-3 months into treatment. Resolution: Often within 6 months of discontinuation, per case reports.[4] Long-term data (up to 5 years) shows no cumulative risk increase.[2]
[1]: Skyrizi Prescribing Information (FDA)
[2]: JAMA Dermatology, UltIMMa trials (2020)
[3]: FDA FAERS Public Dashboard
[4]: Journal of the American Academy of Dermatology (2022 review)
[5]: Cosentyx Label
[6]: Tremfya Label
[7]: Humira Label
[8]: Drugs.com Skyrizi Reviews