Alopecia Treatments in Breastfeeding: Safety and Clinical Considerations

Despite the wide variety of treatment options for alopecia areata (AA), androgenetic alopecia (AGA), and primary cicatricial alopecias, these options become more limited for women who are breastfeeding, given concerns surrounding potential transfer into breast milk and subsequent adverse effects (AEs) on the newborn infant. Alopecia is associated with significant psychological distress, poorer quality of life (QOL), and negative impacts on self-esteem and body image, which may be exacerbated by undergoing the physical, hormonal, and emotional changes of pregnancy and breastfeeding. Furthermore, many of these medications must be taken continuously to maintain their benefits, reinforcing the importance of understanding which therapies are compatible with breastfeeding. This review aimed to help guide clinicians in choosing safe and appropriate hair loss therapies for women during lactation, including a detailed discussion of medication transfer to breast milk and infant blood serum levels, potential neonatal AEs, and further clinical considerations specific to each treatment option.