Alopecia Areata

[Mommy16]

Hello,
I have Alopecia Areata and have not treated it since before being pregnant. Now that my baby is six months old, I would like to resume treatment to hopefully regrow the hair on my scalp, eyebrows, and eyelashes. I would like to know if the medications are compatible with breastfeeding, how long I would need to discard the milk, or if I need to completely wean. I will be receiving an intramuscular(IM) injection(in the rear) of Kenalog 40mg once per month. Additionally, I will be applying 12% Minoxidil in GLY/H20 to my entire scalp once per day and applying Betamethasone lotion to my entire scalp once per day. Please let me know if this is all of the information you need. Your detailed response is much appreciated. Thank You.
-Mommy16

[cpride]

Dear Mommy16,

All of the medications you will be using are considered moderately safe (L3 category). Triamcinolone acetonide (Kenalog) is a typical corticosteroid. We do not have data on how much triamcinolone enters breastmilk, but steroids in general enter human milk in minimal amounts. The half-life (time it takes for half of the drug to be eliminated from the body) with intramuscular injection of triamcinolone is 18 to 36 hours. Due to this kinetic data, Dr. Hale suggests mothers should pump and discard for 12 hours to 24 hours after the injection. For minoxidil, with topical application, only 1.4 percent of the dose enters breastmilk, which is minimal. It is unlikely that the amount absorbed via topical application would produce clinically relevant concentrations in breastmilk. Betamethasone 0.025 percent to 0.05 percent lotion is considered an intermediate potency corticosteroid. Application to small areas of the body are usually compatible with breastfeeding as minimal absorption is expected. Steroids in large doses over extended time periods may affect infant growth. If you have concerns, you may contact your pediatrician to have your infant monitored during your period of treatment. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center