Systemic Lupus Erythematosus (SLE) frequently causes hair loss. SLE is an autoimmune disorder where the immune system mistakenly attacks healthy tissues, including the skin and hair follicles. This activity leads to inflammation that interferes with the normal cycle of hair growth, resulting in thinning, breakage, or bald patches (alopecia). Controlling the underlying disease activity is the primary way to manage this visible symptom.
Disease Activity and Hair Loss Types
The inflammation triggered by active lupus causes hair loss, manifesting as non-scarring or scarring alopecia. Non-scarring alopecia often occurs during a systemic lupus flare, indicating higher disease activity. This type is sometimes called “Lupus Hair,” characterized by brittle hair that breaks easily near the hairline, leading to diffuse thinning across the scalp.
This diffuse thinning is often telogen effluvium, where inflammation prematurely pushes growing hairs into the resting phase. Since the hair follicle is not destroyed, this hair loss is reversible once the lupus flare is controlled with treatment. Regrowth typically begins in the months following the suppression of systemic inflammation.
Scarring alopecia is a more permanent type of hair loss associated with Discoid Lupus Erythematosus (DLE). DLE causes coin-shaped, inflamed lesions on the scalp, leading to the complete destruction of the hair follicle. Once the lesions heal, they leave behind permanent scar tissue that prevents future hair growth. Early diagnosis and aggressive treatment are necessary to prevent this irreversible scarring.
Hair Changes Caused by Lupus Medications
Some medications used to manage lupus can also contribute to hair thinning. This type of hair loss is usually non-scarring and temporary, though it can be difficult for patients to distinguish if the shedding is due to a flare or a side effect of treatment.
The drugs most commonly implicated are immunosuppressants, such as methotrexate and cyclophosphamide, used to control severe systemic lupus. These medications disrupt the hair growth cycle, causing increased shedding known as anagen or telogen effluvium. Corticosteroids (prednisone) and antimalarial drugs (hydroxychloroquine) can also occasionally cause temporary hair changes.
Drug-induced hair loss is typically temporary and often resolves when the medication is stopped or the dosage is adjusted. Since these medications treat the underlying autoimmune disease, adjustments must be made in consultation with a doctor. Successfully treating lupus often outweighs the temporary cosmetic side effect.
Strategies for Managing and Regrowing Hair
Managing hair loss begins with controlling the underlying disease activity to stop inflammation. For non-scarring alopecia, treating the lupus flare with systemic medications often leads to hair regrowth within months. For localized inflammation, such as discoid lesions, doctors may use topical or injected corticosteroids directly on the scalp to reduce damage and prevent scarring.
Topical minoxidil may be recommended by a dermatologist to expedite recovery for non-scarring loss. In scarring alopecia, treatments focus on stopping the spread of new lesions, since hair regrowth is not possible in scarred areas. Advanced options like hair transplants or Platelet-Rich Plasma (PRP) injections are being explored.
Beyond medical treatments, adopting a gentle hair care routine is important. This includes avoiding harsh chemical treatments, limiting heat styling, and brushing with a wide-tooth comb to reduce breakage. Protecting the scalp from sun exposure is also advised, as UV light can trigger lupus activity. Wigs, scarves, or hats offer comfort, and professional support can help cope with the emotional strain.