Hair loss in systemic lupus may indicate active disease

Hair loss in systemic lupus erythematosus can indicate active disease, and nonscarring alopecia shows changes unique to lupus on histology and direct immunofluorescence, according to researchers in Journal of the American Academy of Dermatology.

“A majority of patients present with mild diffuse alopecia, but hair loss can also be localized in patches or along the anterior hair line,” Kumutnart Chanprapaph, MD, of the division of dermatology, department of medicine, at Ramathibodi Hospital, Mahidol University, in Bangkok, and colleagues wrote. “Common trichoscopic findings were arborizing/interconnecting vessels, blue-grey speckled pigmentation and thin hypopigmented hair shafts.”

Thirty-two adult patients with SLE with nonscarring alopecia underwent a full physical/trichoscopic examination and scalp biopsy. Ten patients who had lupus without any alopecia or scalp abnormalities were included for comparison. Patients’ age, sex and duration of lupus were similar between the groups. A total of 121 specimens from 42 patients were analyzed.

Mild diffuse alopecia was identified in 14 patients (43.8%), severe diffuse alopecia in five patients (15.6%), patchy alopecia in nine patients (28.1%) and short, fragile hair along the anterior hairline, resembling lupus hair, in four patients (12.5%). Twenty-six patients (81.3%) reported current ongoing hair loss.

Among trichoscopic findings, arborizing/interconnecting vessels were common in 26 patients (81.3%). Five patients (15.6%) had thick vessels with tortuosity and diameters larger than the terminal hair shafts. The hair shafts were thin in 24 patients (75%) and hypopigmented in 14 patients (43.8%).

Upon histopathologic examination, 13 patients (40.6%) had basal vacuolar changes along the follicular epithelium. Additionally, sparse lymphocyte infiltration was seen in superficial perivascular in 24 patients (75%), deep perivascular in 18 patients (56.3%), perifollicular in eight patients (25%), peribulbar in seven patients (21.9%) and perieccrine areas in four patients (12.5%).

Alcian blue staining showed mucin deposition in 27 patients (84.4%), and plasmacytoid dendritic cells were seen in 22 patients (68%) with lupus with nonscarring alopecia.

The horizontal biopsy sections showed a significantly lower total hair count (P = .0004), terminal hair count (P < .001), anagen count (P < .001) and terminal-to-vellus hair ratio (P < .001) and a higher number of vellus hairs (P = .0031) and percentage of catagen/telogen hairs (P = .0029).

The most common extracutaneous feature was renal involvement in 40.6% of patients with nonscarring alopecia and 20% of those without nonscarring alopecia.

Limitations of the study included the cross-sectional, single-center nature, no follow-up period and limited population to Southeast Asians. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.