Lupus is an autoimmune disease that causes inflammation and damage to various organs and tissues in the body, including the skin and hair. Lupus can affect the hair in different ways, causing hair loss or thinning in some people.
Hair loss can be a distressing symptom of lupus, affecting one’s self-esteem and quality of life. However, there are ways to manage lupus hair loss and keep the hair as healthy as possible. In this article, we will explore the causes, types, treatments, and tips for lupus hair loss.
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What causes lupus hair loss?
Lupus hair loss can have different causes depending on the type and severity of the disease. Some of the common causes are:
Inflammation
Lupus causes inflammation throughout the body, which can affect the scalp and hair follicles. Inflammation can cause non-scarring alopecia, which is a reversible type of hair loss due to inflammation around the scalp and hair follicles.
Inflammation can also cause lupus hair, which is a poorly characterized entity that may be a form of telogen effluvium, a condition where more hairs than normal enter the resting phase and fall out.
Scarring
Lupus can also cause discoid lesions or sores on the skin, which can leave scars. Scars can damage the scalp and hair follicles, causing scarring alopecia, which is a permanent type of hair loss due to destruction of the hair follicles.
Medication
Some of the medications used to treat lupus can have side effects that affect the hair. For example, corticosteroids, immunosuppressants, antimalarial drugs, methotrexate, leflunomide, and cyclophosphamide can cause hair loss or thinning in some people.
Not everyone with lupus experiences hair loss. But many people living with this condition notice gradual thinning or hair breakage along their hairline. Sometimes the hair grows back, and sometimes it doesn’t. Hair loss can also affect other parts of the body, such as eyebrows, eyelashes, and beard.
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What are the types of lupus alopecia?
Lupus alopecia can be classified into two main types: non-scarring and scarring.
Non-scarring alopecia
Non-scarring alopecia is a type of hair loss that does not leave scars on the scalp. It is caused by inflammation around the scalp and hair follicles that disrupts the normal growth cycle of the hair.
Non-scarring alopecia can be diffuse or patchy, affecting different areas of the scalp. It can also be acute or chronic, lasting for a short or long time.
Non-scarring alopecia can be reversible if the inflammation is controlled and the disease goes into remission. However, some people may experience recurrent episodes of non-scarring alopecia due to flares of lupus.
Scarring alopecia
Scarring alopecia is a type of hair loss that leaves scars on the scalp. It is caused by damage to the scalp and hair follicles due to discoid lesions or sores that form on the skin.
Discoid lesions are red, raised, scaly patches that can itch or hurt. They can occur anywhere on the body but are more common on sun-exposed areas such as the face and scalp.
Scarring alopecia is permanent because the scars destroy the hair follicles and prevent new hair growth. Scarring alopecia can also cause changes in skin color and texture on the affected areas.
Lupus hair
Lupus hair is a poorly characterized entity that may be a form of telogen effluvium. Telogen effluvium is a condition where more hairs than normal enter the resting phase and fall out. Lupus hair may be caused by inflammation or medication side effects that affect the hair growth cycle.
Lupus hair may manifest as diffuse thinning or brittleness of the hair shafts. It may also affect other parts of the body such as eyebrows and eyelashes. Lupus hair may be reversible if the underlying cause is treated.
What does lupus hair loss looks like?
Here are some lupus hair loss pictures:
Image from DermNet / CC BY-NC-ND
© Waikato District Health Board, image from DermNet / CC BY-NC-ND
© Waikato District Health Board, image from DermNet / CC BY-NC-ND
Masryyy, CC BY-SA 4.0, via Wikimedia Commons
What are some case studies and research findings on lupus hair loss?
Lupus hair loss is an active area of research that aims to understand its causes, mechanisms, diagnosis, and treatment. Here are some recent case studies and research findings on lupus hair loss:
Recent insight on the management of lupus erythematosus alopecia
A review article published in 2020 summarized the current insight on the management of lupus erythematosus alopecia. The authors suggested that the diagnosis of lupus alopecia should be based on clinical, histopathological, and immunofluorescence findings.
They also recommended that the treatment of lupus alopecia should be tailored to the type and severity of hair loss, as well as the activity and extent of lupus. They highlighted the potential role of novel therapies such as JAK inhibitors and biologics in treating refractory cases of lupus alopecia.
TL;DR: Doctors have learned more about how to diagnose and treat lupus hair loss in different ways. They have also found some new drugs that may help people with lupus hair loss who do not get better with other treatments.
Case report of reversal of long-standing refractory diffuse non-scarring alopecia due to systemic lupus erythematosus following treatment with tofacitinib
A case report published in 2020 described the reversal of long-standing refractory diffuse non-scarring alopecia due to systemic lupus erythematosus following treatment with tofacitinib.
Tofacitinib is a JAK inhibitor that blocks the signaling of cytokines involved in inflammation and immune responses. The patient was a 36-year-old woman who had been suffering from hair loss for 10 years despite multiple treatments.
She was given tofacitinib 5 mg twice daily for 6 months and showed significant improvement in her hair density and quality. The authors suggested that tofacitinib may be an effective option for patients with severe lupus alopecia who do not respond to conventional therapies.
TL;DR: A new drug called tofacitinib helped a woman with lupus hair loss who had tried many other treatments without success. Tofacitinib works by blocking some chemicals that cause inflammation and hair loss in lupus.
A case of neuropsychiatric systemic lupus erythematosus with hair loss as the first diagnostic symptom
A case report published in 2019 described a case of neuropsychiatric systemic lupus erythematosus with hair loss as the first diagnostic symptom. Neuropsychiatric systemic lupus erythematosus is a rare and severe manifestation of lupus that affects the central nervous system.
The patient was a 23-year-old woman who presented with hair loss, headache, seizures, and cognitive impairment. She was diagnosed with neuropsychiatric systemic lupus erythematosus based on her clinical features, laboratory tests, and brain imaging.
She was treated with corticosteroids, immunosuppressants, anticonvulsants, and anticoagulants. She showed improvement in her neurological symptoms and hair growth after 6 months of treatment.
TL;DR: A woman with lupus had hair loss as the first sign of a serious condition that affected her brain and nerves. She was diagnosed and treated with different drugs that helped her recover from her symptoms and grow her hair back.
What are the treatment options for lupus hair loss?
The treatment of lupus hair loss depends on the cause, type, and severity of hair loss, as well as the activity and extent of lupus. Some of the treatment options are:
Medications
Medications that are used to treat lupus can also help with hair loss by reducing inflammation and suppressing the immune system. These include corticosteroids, immunosuppressants, antimalarial drugs, and biologics.
However, some of these medications can also cause hair loss as a side effect, so it is important to monitor the response and adjust the dose accordingly.
Topical treatments
Topical treatments are applied directly to the scalp or skin to stimulate hair growth or reduce inflammation. These include minoxidil, which is an over-the-counter solution that can help with non-scarring alopecia, and corticosteroid creams or injections, which can help with discoid lesions or sores.
Consult a healthcare professional for alternative options to Minoxidil.
Iron supplements
Iron deficiency is a common cause of hair loss in general population and may also contribute to lupus hair loss. Iron supplements can help improve iron levels and support hair growth.
However, iron supplements should only be taken under medical supervision as too much iron can cause side effects or interfere with other medications.
Stem cell therapy
Stem cell therapy is an experimental treatment that involves injecting stem cells into the scalp to regenerate hair follicles and promote hair growth. Stem cells are undifferentiated cells that can develop into different types of cells.
A pilot study published in 2019 reported that stem cell therapy was safe and effective in improving hair density and quality in patients with scarring alopecia due to discoid lupus erythematosus. However, more research is needed to confirm the long-term efficacy and safety of this treatment.
Tofacitinib
Tofacitinib is a novel therapy that belongs to a class of drugs called JAK inhibitors. JAK inhibitors block the signaling of cytokines involved in inflammation and immune responses.
Tofacitinib has been shown to be effective in treating various autoimmune diseases such as rheumatoid arthritis, psoriasis, and ulcerative colitis. It has also been reported to improve hair growth in patients with alopecia areata, a condition where the immune system attacks the hair follicles.
Tofacitinib may also be beneficial for patients with lupus alopecia who do not respond to conventional therapies, as shown by some case reports .
However, tofacitinib is not approved by the FDA for treating lupus or hair loss, and it may have serious side effects such as infections, blood clots, and cancer. Therefore, it should only be used under strict medical supervision and with informed consent.
Are there natural remedies for lupus hair loss and thinning?
Yes, there are natural remedies that can potentially help manage lupus hair loss and thinning. However, their effectiveness and safety is not well-known:
- Aloe vera
- Rosemary oil
- Lavender oil
- Onion juice
- Fenugreek seeds
- Green tea
- Ginger
- Flaxseeds
Aloe vera
This plant is widely known for its healing properties. Aloe vera gel applied to the scalp can soothe inflammation and might help stimulate hair growth.
Rosemary oil
Some studies suggest that rosemary oil may promote hair growth. Try massaging a few drops diluted in a carrier oil (like olive or coconut oil) into your scalp.
Lavender oil
Known for its growth-promoting effects, it can be applied similarly to rosemary oil. always dilute essential oils before applying to the scalp to avoid irritation.
Onion juice
While it may sound unconventional, some research shows onion juice, applied topically, can stimulate hair growth.
Fenugreek seeds
Fenugreek seeds have been used traditionally to reduce hair fall and promote hair growth. You can make a hair mask by grinding soaked fenugreek seeds into a paste and applying it to your scalp.
Green tea
Green tea is rich in antioxidants, which can help strengthen hair follicles. Apply cooled green tea to your scalp, leave it for 10 minutes, and then rinse it off.
Ginger
Ginger may stimulate circulation and promote hair growth. You can grate fresh ginger, extract the juice, and apply it to your scalp.
Flaxseeds
Rich in Omega-3 fatty acids, ground flaxseeds or flaxseed oil can be applied to the scalp to promote hair health.
You should always consult a healthcare professional before starting natural remedies.
What are some prevention and hair care tips for lupus hair loss?
Lupus hair loss can be prevented by controlling the inflammation and treating the underlying cause of lupus. However, some preventive measures and hair care tips can also help reduce the risk and impact of lupus hair loss. Some of these are:
Avoid unnecessary sun exposure
Sunlight can trigger or worsen lupus skin problems and hair loss. It is advisable to avoid sun exposure as much as possible, especially between 10 a.m. and 4 p.m., when the sun rays are strongest.
If going outdoors is unavoidable, consider applying sunscreen with SPF 50 or higher, which protects the skin from UVA and UVB light. Wearing a hat, scarf, or wig can also help protect the scalp from sun damage.
Eat a healthy diet
A balanced diet that provides adequate vitamins and nutrients can help support hair growth and overall health. Some nutrients that may be beneficial for hair health include iron, zinc, biotin, vitamin C, and omega-3 fatty acids.
Foods that are rich in these nutrients include lean meats, eggs, nuts, seeds, beans, citrus fruits, and fatty fish. However, some foods may trigger or worsen lupus symptoms in some people, so it is important to consult a doctor or a nutritionist before making any dietary changes.
Avoid harsh hair care treatments
Chemical treatments such as coloring, bleaching, perming, or straightening can damage the hair shafts and make them more prone to breakage. Heat styling tools such as curlers, blow dryers, or flat irons can also weaken the hair and cause dryness and split ends.
It is advisable to avoid or limit these treatments and use gentle hair products that are sulfate-free and pH-balanced. It may also help to use a leave-in conditioner, shampoo for damaged hair or a hair mask to moisturize and nourish the hair.
Use hair growth supporting products
Some over-the-counter products such as minoxidil (Rogaine) can help stimulate hair growth in people with non-scarring alopecia.
Minoxidil is a topical solution that can be applied to the scalp twice a day. It may take several months to see noticeable results, and the hair loss may resume if the treatment is stopped.
Minoxidil may also cause side effects such as itching, irritation, or unwanted hair growth on other parts of the body. Therefore, it is important to follow the instructions carefully and consult a doctor before using minoxidil.
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Limit stress
Stress can affect the immune system and trigger or worsen lupus flares and hair loss. Stress can also cause a type of hair loss called telogen effluvium, which occurs when more hairs than normal enter the resting phase and fall out.
Therefore, it is important to manage stress levels and practice healthy coping strategies such as relaxation techniques, meditation, exercise, hobbies, or social support.
Get plenty of rest
Getting enough sleep is essential for maintaining physical and mental health. Sleep helps regulate the immune system and reduce inflammation. It also helps repair and regenerate the cells and tissues in the body, including the hair follicles.
Lack of sleep can impair these processes and contribute to lupus symptoms and hair loss. The National Sleep Foundation recommends that adults get seven to nine hours of sleep per night for optimal health.
What are some coexisting conditions that can affect lupus hair loss?
Lupus hair loss can be influenced by other factors or conditions that may coexist with lupus. Some of these are:
Thyroid disorders
The thyroid gland produces hormones that regulate metabolism, growth, and development. Thyroid disorders such as hypothyroidism (low thyroid function) or hyperthyroidism (high thyroid function) can affect the hair growth cycle and cause hair loss.
Thyroid disorders are more common in people with autoimmune diseases such as lupus. A blood test can check for thyroid function and hormone levels. Thyroid disorders can be treated with medication that restores the normal balance of thyroid hormones.
Stress
As mentioned earlier, stress can affect the immune system and trigger or worsen lupus flares and hair loss. Stress can also cause telogen effluvium, which is a type of hair loss that occurs when more hairs than normal enter the resting phase and fall out.
Managing stress levels and practicing healthy coping strategies can help prevent or reduce stress-related hair loss.
Medications
Some medications that are used to treat lupus or other conditions can cause hair loss as a side effect.These include antimalarials,steroids, methotrexate, leflunomide, cyclophosphamide, and some blood pressure drugs.
If medications are the cause of hair loss, a doctor may be able to adjust the dose or switch to a different medication that does not affect the hair. However, this should only be done under medical supervision and with informed consent.
Alopecia areata
Alopecia areata is a condition where the immune system attacks the hair follicles and causes patchy hair loss. It can affect any part of the body, but most commonly the scalp. Alopecia areata is more common in people with autoimmune diseases such as lupus.
The cause of alopecia areata is unknown, but it may be triggered by stress, infection, or genetics. Alopecia areata can be treated with corticosteroid injections, topical immunotherapy, or other medications that suppress the immune system or stimulate hair growth.
FAQs
Is lupus hair loss reversible?
Yes, lupus hair loss can be reversible if it is not caused by scarring and if the inflammation and disease are controlled.
How to stop hair loss from lupus?
To stop hair loss from lupus, one may need to treat lupus with medications, adjust the medications that cause hair loss, take iron supplements, use hair loss products, and follow hair care tips.
Does hair grow back after lupus?
Hair growth after lupus depends on the type of hair loss, the effectiveness of the treatment, and other factors or conditions. Hair may grow back after non-scarring hair loss or lupus hair, but not after scarring hair loss.
Conclusion
Lupus hair loss, while challenging, can be managed and even prevented. Treatment varies based on the cause and severity and may include medications, topical treatments, or lifestyle adjustments.
It's crucial to protect your hair from sun damage, maintain a nutritious diet, minimize stress, and get ample rest. Factors like thyroid disorders, stress, and certain medications can also influence lupus hair loss.
In some cases, hair loss may be reversible if lupus goes into remission, though it can be permanent if there's significant scalp damage. Seek medical advice for diagnosis, treatment, and proper management.
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