Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. Many people with SLE experience hair loss, medically termed alopecia, which can be distressing and often signals disease activity. Alopecia occurs frequently, affecting over half of all SLE patients at some point. The severity and reversibility depend on the underlying mechanism, ranging from temporary thinning to permanent bald patches. Understanding the specific type of hair loss is the first step toward effective management and treatment.
Why Lupus Causes Hair Loss
The primary reason lupus causes hair loss is the chronic, widespread inflammation characteristic of the disease. The immune system generates autoantibodies that target and damage healthy cells, including those in the skin and scalp. This inflammatory response disrupts the normal hair growth cycle by creating a hostile environment around the hair follicles.
Hair growth involves four phases, with the anagen phase being the period of active growth. Autoimmune inflammation can prematurely force many hair follicles out of the anagen phase into the resting and shedding phases, known as telogen effluvium. This systemic stress, often linked to a lupus flare, results in noticeable shedding and diffuse thinning across the entire scalp.
Hair loss can also be an unintended consequence of the medications used to control the disease. Certain immunosuppressive drugs or high-dose corticosteroids can sometimes contribute to non-scarring hair shedding. This form of hair loss is temporary and often resolves once lupus activity is controlled or the medication dosage is adjusted under a doctor’s supervision.
Distinct Types of Hair Loss
Lupus-related hair loss is divided into two categories: non-scarring and scarring alopecia, which determines the potential for hair regrowth. Non-scarring alopecia, often called “lupus hair,” is the most common form and is usually reversible. It presents as generalized thinning, often visible around the hairline and temples, without signs of scalp damage or inflammation.
This diffuse thinning is often a sign of systemic disease activity or a lupus flare. The hair shaft may become brittle and coarse, leading to easy breakage and a sparse appearance. Once systemic inflammation is controlled with effective lupus treatment, the hair follicles typically resume their normal growth cycle, and regrowth is expected within a few months.
In contrast, scarring alopecia is specifically associated with chronic cutaneous lupus or Discoid Lupus Erythematosus (DLE). DLE manifests as distinct, coin-shaped lesions on the scalp that are typically red, scaly, and may display pigmentation changes. These lesions cause deep, chronic inflammation that permanently damages the hair follicle stem cells.
As the inflammation resolves, the follicle is replaced by scar tissue, resulting in a smooth, permanent bald patch where hair will not regrow. Prompt treatment is important for this type, as preventing scarring is the only way to preserve the hair follicles. A dermatologist can confirm the type of hair loss through a detailed scalp examination and sometimes a skin biopsy.
Medical Approaches to Treatment
The most effective medical approach involves controlling the underlying autoimmune disease activity. Antimalarial medications, such as Hydroxychloroquine, are foundational first-line therapies for managing SLE and cutaneous manifestations like non-scarring alopecia and DLE. Hydroxychloroquine modulates the immune response, reducing the inflammation that attacks the hair follicles and skin.
For active lesions indicative of scarring alopecia, local, targeted treatments quickly suppress inflammation and prevent permanent damage. These commonly include high-potency topical corticosteroids or corticosteroid injections administered directly into the inflamed scalp areas. Intralesional steroid injections rapidly reduce inflammation, halting the destructive scarring process.
If first-line therapies are insufficient, stronger systemic immunosuppressants may be necessary, especially for extensive or rapidly progressing scarring alopecia. Medications such as Methotrexate or Mycophenolate Mofetil further suppress the overactive immune system. The goal is to achieve disease remission, stopping the attack on hair follicles and allowing for potential regrowth in non-scarred areas.
Adjuvant therapies can stimulate hair growth alongside primary lupus treatments. Topical Minoxidil is recommended to expedite recovery and encourage regrowth in non-scarring hair loss areas. Newer treatments, including biologics and Platelet-Rich Plasma (PRP) injections, are being explored for their potential to reduce inflammation and activate dormant hair roots.
Daily Care and Hair Maintenance
Individuals with lupus can take specific steps in their daily routine to minimize hair shedding and maintain hair health. Gentle handling is paramount, as lupus-affected hair is often brittle and prone to breakage. Avoid tight hairstyles, such as braids or ponytails, that pull on the hair roots and cause tension.
Use a wide-toothed comb or a soft brush and avoid excessive brushing or aggressive towel-drying after washing. A gentle shampoo and conditioner can prevent irritation to a sensitive scalp inflamed by lupus activity. Switching to a satin or silk pillowcase reduces friction on the hair shaft while sleeping, preventing unnecessary breakage.
Scalp protection from the sun is an important daily measure for those with lupus. Ultraviolet (UV) light exposure is a known trigger for lupus flares, which can worsen scalp lesions and exacerbate hair loss. Wearing a wide-brimmed hat outdoors and using UV-protective hair products or scalp sunscreens minimizes this risk.
If hair loss is significant, several non-medical options are available to help manage appearance and restore confidence:
- Specialized haircuts.
- The use of hair fibers to conceal thinning areas.
- Incorporating high-quality wigs.
- Using scarves.
These practical steps, combined with medical management, form a comprehensive approach to living well with lupus-related hair changes.