Lupus & Hair Loss
Lupus is a chronic, autoimmune disease affecting an estimated 1.5 million people in the U.S. The actual number may be higher because no large-scale studies include the actual number of people living with the disease. Lupus has been identified as having a familial risk factor. Inheriting specific genes can increase the likelihood of getting lupus, however, a combination of genes and other factors may trigger it. While the disease most often strikes women ages 15 to 44, men, children, and teenagers can also develop lupus. People of all races and ethnic groups can be impacted, however, women of color are two to three times more likely to develop lupus than Caucasians.
Lupus affects many different systems and organs in the body, creating a wide range of symptoms such as fatigue, headache, painful joints, anemia, and abnormal blood clotting. The connection between hair loss and lupus is not always mentioned, however, it affects many patients. There are two major types of lupus – systemic lupus erythematosus, the most common type; and cutaneous lupus erythematosus, which only affects the skin. Each of these is associated with different symptoms, including hair loss patterns. About 10% of people who have cutaneous lupus will develop systemic lupus.
Diagnosis of Lupus
Lupus is often referred to as the "great imitator" because its symptoms also occur in many other disorders, thereby making diagnosis challenging. A physician looks for signs of inflammation including pain, heat, redness, swelling, and loss of function in a particular place in the body. Inflammation can be internal, impacting organs such as the kidneys, brain and heart, or external and limited to the skin, or it can affect both. While there is not a single laboratory test to confirm diagnosis, tests yield invaluable clues in addition to symptoms, a thorough exam, and personal and family medical histories. Sometimes it’s a matter of ruling out other diseases to confirm a lupus diagnosis.
Before a dermatologist can make a definitive connection between lupus and hair loss, other potential causes need to be ruled out. These include medications, recent severe illness, thyroid problems, certain vitamin or nutritional deficiencies, genetics, other diseases, as well as specific skin diseases of the scalp.
Lupus Hair Loss
Hair loss occurs when antibodies created by the body infiltrate the hair follicles, causing the hair shaft to be rejected by the body and fall out. Hair loss or brittle hair are common side effects of lupus and the medications used to treat it, such as prednisone and immune system-suppressants. While these drugs can cause hair loss, it is usually reversible after one stops taking the medication. One study compared the diameter of hairs in patients with lupus and found they were much thinner than hairs in people without lupus. A common cause of brittle hair is so-called “lupus hair,” which tends to occur along all the edges of the scalp, especially in the front.
Systematic lupus: Hair loss due to systemic lupus is known as “telogen effluvium” and is basically due to the insult of being very ill. Hair loss tends to be diffuse, however, it may be most pronounced around the front areas of the scalp. Patchy hair loss can also be the result of a flare-up in lupus disease activity. Hair typically grows back when lupus is well controlled or in remission.
Cutaneous (or discoid) lupus): Discoid lupus causes a thick, scaly red rash and lesions, typically on the scalp, face, and ears. This can actually scar the hair follicles to the point where they can no longer produce hair, resulting in permanent hair loss. The degree of hair loss depends on how widespread and severe the lesions are on the scalp.
Hair Loss Tips
There are several ways to help disguise hair loss caused by lupus. Hats and scarves can provide coverage while also adding a fashionable element to outfits. Choose colors, patterns, and shapes that compliment your skin tone and facial features. If hair is only thinning at the front hairline or temples, extra wide headbands are a great way to cover these areas.
While some people with lupus hair loss opt for a full wig, wiglets and hair toppers add fullness to thinning hair while also covering areas where hair loss occurs. If hair loss affects eyebrows or eyelashes, a wide array of eyebrow and eyelash replacement options can provide the perfect solution.
Hair Loss Treatment
When hair loss is due to scarring from cutaneous lupus, hair transplantation can be a very useful cosmetic treatment. One should only consider transplantation when lupus is in remission. Preferably, there should be no signs of lupus activity (in terms of hair loss) in the past six months, and the patient should also be on some type of therapy to keep the disease in remission. It is important to keep in mind the trauma induced by the hair transplant procedure itself can re-activate or induce a lupus flare-up (and hair loss).
Experts advise avoiding over-the-counter medications like Rogaine because this is used to treat male- and female-pattern baldness, a completely different type of hair loss than that of lupus. Prompt diagnosis and lupus treatment are key to controlling the many symptoms of this painful autoimmune disorder.
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