Sjögren’s Syndrome (SS) is a long-term autoimmune disorder primarily recognized for attacking moisture-producing glands, leading to severely dry eyes and dry mouth. This systemic condition affects the entire body and can manifest in numerous ways beyond dryness. A common symptom patients experience is hair loss, which occurs as a direct consequence of autoimmune activity or as an indirect result of related factors.
Direct Autoimmune Effects on Hair Health
The core of Sjögren’s Syndrome is a misguided immune response that causes chronic, systemic inflammation throughout the body. This persistent inflammation, driven by immune cells, does not strictly limit itself to the salivary and lacrimal glands. The body’s inflammatory state can profoundly disrupt the natural growth cycle of hair follicles.
This widespread inflammation can trigger a condition known as telogen effluvium, characterized by excessive hair shedding. Telogen effluvium occurs when a significant stressor, such as the ongoing autoimmune disease, forces a large number of hairs prematurely into the resting (telogen) phase of the growth cycle. Approximately three to five months following an autoimmune flare-up, this hair then sheds, often noticed as a sudden increase in hair loss when brushing or showering.
In rarer instances, the autoimmune assault can directly target the hair follicles, leading to more permanent forms of hair loss. Sjögren’s has been associated with conditions like frontal fibrosing alopecia, a type of scarring hair loss where inflammation destroys the hair stem cells. This process results in the irreversible loss of hair, typically seen as a receding hairline or a widened part. The presence of a systemic autoimmune disease creates an environment where the immune system is primed to mistakenly attack various tissues, including the hair follicle structures.
Secondary Factors Contributing to Hair Thinning
While the disease itself can cause hair loss through inflammation, other factors commonly associated with managing Sjögren’s Syndrome also contribute significantly to hair thinning. Many medications used to treat the underlying autoimmune activity have hair shedding as a potential side effect. Drugs such as methotrexate and certain immunosuppressants can interfere with the rapid cell division necessary for hair growth.
Even milder treatments like hydroxychloroquine, often used to manage joint pain and fatigue in SS, have been reported to cause hair thinning in some users. Additionally, corticosteroids, frequently used during flare-ups to reduce inflammation, can also contribute to hair shedding. Patients must weigh the benefits of controlling the systemic disease against the known side effects of their treatment plan.
Sjögren’s frequently co-occurs with other autoimmune conditions that are themselves major causes of hair loss. It is not uncommon for a patient to also have Systemic Lupus Erythematosus (Lupus) or a thyroid disorder, such as Hashimoto’s thyroiditis. If Lupus is present, it can cause both diffuse thinning and scarring hair loss on the scalp, making it difficult to isolate the exact cause. An untreated or poorly managed thyroid condition can also be a significant factor in hair shedding.
Chronic illness, changes in diet due to dryness, and gastrointestinal issues associated with SS can lead to nutritional deficiencies that impair hair health. Deficiencies in key micronutrients, such as iron, Vitamin D, and Vitamin B12, are more prevalent in SS patients and are known causes of hair thinning. Vitamin B12 deficiency is frequently observed in Sjögren’s patients, sometimes due to an associated condition called pernicious anemia, and correcting this deficiency is necessary for proper hair growth.
Navigating Diagnosis and Treatment Options
Addressing hair loss in the context of Sjögren’s Syndrome requires a comprehensive and multi-specialty approach, typically involving both a rheumatologist and a dermatologist. The first step involves a thorough diagnostic workup to pinpoint the specific cause of the hair loss, which may include reviewing all current medications. Blood tests are essential for checking for nutritional deficiencies, particularly Vitamin D, iron, and B12, and for screening for comorbid conditions like thyroid disease.
A dermatologist may perform a physical examination of the scalp and sometimes a scalp biopsy to determine the type of hair loss, distinguishing between non-scarring types like telogen effluvium and scarring types like frontal fibrosing alopecia. Treatment then focuses on managing the underlying autoimmune disease, as controlling SS activity often leads to a reduction in inflammation-induced shedding. Adjusting or substituting certain medications may be considered if a specific drug is identified as the likely cause.
For non-scarring hair loss, treatments may include topical minoxidil to stimulate hair growth or targeted supplementation to correct identified deficiencies. In cases of scarring alopecia, anti-inflammatory medications, such as specialized steroid injections or oral therapies, are used to halt the immune attack on the follicles and prevent further permanent loss. A collaborative effort between specialists ensures the treatment plan targets both the systemic disease and the specific dermatological manifestation of hair loss.