Lupus is an autoimmune condition in which widespread inflammation can affect multiple organs including skin, hair, and nails. While many of the side effects of lupus remain hidden within the body, visible inflammation of the skin presents as rashes or sores. These can be especially challenging to manage but there are resources available to help understand changes in hair quality and ways to its appearance.
What causes hair loss in lupus braves?
The inflammation can be caused by a flare or medications used for the treatment of lupus itself. Hair loss in particular occurs due to this very inflammation and the follicle changes that accompany it. In some patients, hair loss can actually occur before a lupus diagnosis that can prompt a doctor to investigate further. Many other conditions can also cause hair loss. Be sure to consult with your doctor if you notice unusual thinning of your hair or hair loss.
Hair loss that occurs in lupus falls into the simplified categories of scarring versus non-scarring. All hair loss does occur due to the inflammation caused by active disease. There are several types of classifications and your healthcare team which includes a rheumatologist or dermatologist would be able to classify your specific subtype. The following are examples of scarring versus non-scarring types seen in patients:
- Alopecia areata causes an inflammatory non-scarring patchy hair loss seen on the scalp. It can also be associated with other autoimmune conditions, such as rheumatoid arthritis and diabetes. It causes the hair on your scalp to gradually thin out, although a few people lose clumps of hair. Loss of eyebrow, eyelash, beard, and body hair also is possible. This type of hair loss is reversible with treatment because it is related to the level of autoimmune activity occurring in the body. Once the activity has been reduced and inflammation goes down, hair loss stops and hair can begin to grow back. Medications such as antimalarial hydroxychloroquine or corticosteroids can be used for treatment.
- Discoid lupus on the other hand causes scarring through round, disc-shaped sores, which usually occur on the face and scalp. These sores can cause changes to underlying skin color and hair follicles. Because discoid lesions scar your hair follicles, they do cause permanent hair loss. This can be especially challenging as you navigate your overall health and treatment. There are treatment options available for discoid lupus, which prevent new lesions from forming and heal current ones. These include the use of antimalarial hydroxychloroquine and corticosteroids including topicals and injections. Preventing active disease is the best treatment for this type of skin presentation.
So, what can you do to keep hair healthy and prevent further hair loss?
- Prevent disease flares by avoiding triggers (direct sun exposure, stress, illness from viruses, poor diet, and sleep) and using your medications as prescribed by your doctor.
- Treat lupus flares by using medications such as antimalarials, corticosteroids, and immunosuppressants as prescribed by your doctor.
- If your medication is causing your hair loss, talk to your doctor about alternative treatment options. Many over the counter medications can interact with your lupus medications. You should not begin any treatment without consulting your doctor.
- Hair loss may be reversible only if you are able to control lupus flares.
- Keep your hair healthy by using gentle hair products without harsh chemicals. Also, avoid tight hairstyles that put stress on roots and can lead to hair loss. You may also choose to wear a wig or embrace your thinning hair and find looks that work for it.
- Participate in clinical trials which are underway to find new treatments for hair loss associated with autoimmune inflammation. One that I’ve found particularly interesting is the possible use of stem cell therapy to promote hair growth in patients with underlying autoimmune conditions.
- Advocate for yourself and speak up about how your hair loss is affecting your quality of life.
By Nadia Bhatti