Alopecias in lupus erythematosus

Abstract

Several patterns of hair loss can occur in lupus erythematosus (LE). Alopecias which show histological characteristics of LE are LE-specific, and include discoid LE (DLE), diffuse or patchy hair loss in acute LE, subacute cutaneous LE, and rarely tumid LE. Lupus hair in SLE is a poorly characterised entity and may be a form of telogen effluvium. Alopecia areata can coexist with LE and may mimic DLE. Non-lupus alopecias such as telogen effluvium and anagen effluvium have a myriad of causes which include disease flares, drugs and stress in the setting of LE. The latest validated Systemic Lupus International Collaborating Clinics classification criteria for SLE includes non-scarring alopecia as a criterion; therefore, recognising the aetiology of hair loss in the setting of LE is crucial in classifying a patient to have systemic disease.

Keywords: autoimmune diseases; autoimmunity; systemic lupus erythematosus.

Figure 1

(A) Discoid lupus erythematosus. An atrophic porcelain-white plaque on the vertex with areas of erythema, scale, dyspigmentation on the periphery. (B) Dermoscopy of discoid lupus erythematosus. Loss of follicular ostia, areas of follicular plugging, dyspigmentation and pinpoint follicular red dots.

Figure 2

Frontal fibrosing alopecia. Receding hairline on the frontal scalp, with bilateral loss of eyebrows.

Figure 3

Diffuse hair loss in a patient with acute lupus erythematosus. Alopecia resembles patterned hair loss, but occurs in the setting of a lupus erythematosus flare.

Figure 4

Subacute cutaneous lupus erythematosus. Non-scarring, scaly erythematous plaques, with similar papulosquamous lesions on the body (not depicted).

Figure 5

Lupus hair. Fine, brittle hairs on the frontal scalp in a patient with SLE.

Figure 6

Alopecia areata. Non-inflammatory circular patch of hair loss on the parietal scalp.

Figure 7

Patterned hair loss in a female patient. Alopecia resembles a ‘Christmas tree’ configuration on the crown.