I am taking Asacol for ulcerative proctitis, and I'm losing my hair. My doctor said this is a trade-off, and that I have to choose between losing my health or my hair. He hasn't done anything on me but a colonoscopy and then said I should take this medicine for the rest of my life. I'm worried that if I keep taking this drug the rest of my life I'll be bald. I'd like to go to another doctor who says he can test me for parasites, bacteria, candida and thyroid problems, but my doctor said this guy is a quack. Isn't there some other test I could have done? Is there another medicine I could try?

M.

Ulcerative proctitis is an inflammatory condition characterized by ulcerations and other deterioration in the lining of the rectum. In its full-blown form, it can involve the whole colon, and is then referred to as ulcerative colitis.

By definition, the term "ulcerative proctitis" implies that the cause of the inflammation is unknown and that other conditions that can cause proctitis have been excluded. These can include bacteria (chlamydia, gonorrhea), viruses (herpes, cytomegalovirus), radiation therapy and parasites.

Before a diagnosis of ulcerative proctitis is made, a colonoscopy must be done. The purpose is to take stool samples and biopsies to rule out the other causes of proctitis, since the therapy differs based on the cause. Another reason for the colonoscopy is to see the extent of the disease, as this can also affect therapy. The therapy for ulcerative proctitis is based on medications that contain the compound mesalamine. These include Asacol, Dipentum, Pentasa and Sulfasalazine. Rectal formulations (enemas) are also available. The principle of therapy is that the mesalamine is not absorbed into the bloodstream, but acts locally on the colonic/rectal lining to reduce the inflammation. We don't know exactly how this works, but it does.

People with significant inflammation that extends throughout the colon benefit from the oral formulations mentioned above. However, patients with proctitis only can sometimes be treated with the rectal formulations alone -- as the amount of drug that can be delivered to the rectum is greater when it is introduced in this way. Finally, at least one-third of patients with proctitis will eventually go into remission and not require lifelong therapy.

In your case, I would like to know if the proper studies were done during your colonoscopy to rule out the other causes of proctitis. I'd also like to know the extent of the inflammation. Is it truly just proctitis? If so, you may not need the oral Asacol, but may get just as much benefit from the rectal formulation (Rowasa enemas). I have not seen hair loss as a side effect of Asacol or any of the similar medications, but it has been reported in the literature as an extremely rare side effect.

You should discuss with your doctor whether you can change to another oral formulation -- which might not have the same side effect -- or whether you may be able to change to the enema form if you have proctitis only.