Lupus Hair Loss: What To Expect and How To Address It

By
The Shapiro MD Team

2021-06-12

Lupus is an autoimmune disease that encompasses a wide variety of symptoms, caused when your body attacks its own tissues or organs.

One of the more common symptoms involves hair loss or thinning.

The American Academy of Dermatology estimates normal daily hair loss at around 50 to 100 hairs per day. You may lose considerably more hair when you have lupus, and this hair loss may even develop into bald patches or noticeably thinner spots on your scalp.

The good news? Lupus hair loss is often resolved with proper lupus treatment.

Symptoms of Lupus Hair Loss

Although some hair loss is expected as we age, hair loss due to lupus can sometimes exceed 50% of the hair on your body. Recognizing the symptoms can help you slow hair loss sooner and, potentially get your hair back faster.

Lupus hair loss manifestations vary from person to person, just as hair loss symptoms differ without lupus. If you see excessive breakage or thinning, it could be an indication of lupus hair loss. Another sign is losing your hair in clumps. Generally speaking, lupus hair loss tends to manifest as thinner hair shafts, broken hairs, and incomplete bald patches. Compared to androgenic alopecia, the name for genetic baldness, lupus patches are often incomplete in their hair loss.

Unfortunately, there are not many perfectly clear symptoms of lupus-related hair loss, and only you can tell if you’re losing more hair than normal. Remember that this can be an overall thinning, broken hair around your hairline, or loss in only one section of your hair. One standout with lupus is the development of round (discoid) lesions on the scalp, which can scar and cause more permanent hair loss.

Lupus doesn’t only cause loss of hair on the scalp. Sometimes patchy or thinning hair can involve your eyebrows, facial hair, or eyelashes. There may not be a particular pattern to the issue either.

Causes of Hair Loss

When you’re dealing with disorders involving the immune system, hair loss, also known as alopecia, is quite common. There are three main causes of lupus-related alopecia.

Inflammation

Lupus is an inflammatory disease. It causes skin inflammation, particularly around the face and scalp. When your skin becomes inflamed, so can hair follicles.

Widespread inflammation is the most common cause of lupus hair loss, particularly when it comes to body and facial hair in addition to scalp hair. Fortunately, if your hair loss is due to inflammation, there is a good chance that with proper treatment, you can regrow your hair once the lupus is in remission.

Scarring

Scarring is another common trait of lupus. This happens when you develop discoid scars or lesions. Although these scars and lesions can appear anywhere on your body, they are often found on the head, neck and scalp.

When lesions form, they leave behind scar tissue and damaged hair follicles. This may cause hair loss or an inability to grow wherever scarring exists, and it’s hard or impossible to naturally regrow hair in these areas.

Medication

Treating lupus involves some pretty strong medications, including cyclophosphamide among others. One of the side effects of this particular drug is hair loss.

Corticosteroids, some anti-inflammatories, and certain NSAIDs are also useful in treating lupus. These can also damage your hair and dry the scalp. Although hair loss is not a direct side effect of these medications, they do contribute to thinning hair.

Stress

Stress is another primary cause of hair thinning. Dealing with an immune disorder such as lupus is extremely stressful, particularly when you’re first diagnosed. This stress on your body can contribute to hair loss as well.

Other Factors Contributing to Hair Loss

One of the first things that a doctor may do when determining the cause of your hair loss is to screen out other factors.

Alopecia Areata

You may have multiple immune disorders at the same time. One of these is alopecia areata. This condition occurs when your immune system attacks your hair follicles specifically. It creates large, smooth bald spots that differ from the bald spots caused by lupus scarring, which often retain some hairs, just not all.

Chemicals

Some hairstyling methods, bleaches and dyes can contribute to hair loss. Your damaged hair might result from one of these treatments rather than lupus. In this case, some of the damage is reversible by discontinuing the offending product or method.

Heredity

Your genetics can work against you and your hair. If you have pattern baldness or another genetic predisposition, your hair loss could be perfectly natural. In this case, certain shampoos, topical products, and FDA-approved medications can help to slow and sometimes reverse the loss of hair, though nothing is 100% effective. Minoxidil 2% for women or 5% for men is often a good place to start.

Fungal and Bacterial Infections

Since lupus creates lesions, it is possible for them to become infected or contaminated by bacteria and certain fungi. Some of these infections not only cause scarring, but they can also cause hair loss all by themselves.

Trauma

The stress from lupus can develop habits such as playing with your hair. This can cause your hair to break, which sometimes contributes to hair loss.

Nutrition

Malnutrition and even autoimmune disorders themselves can lead to vitamin deficiencies that cause you to lose your hair. In this case, correcting the deficiency and adding supplements may help to restore your hair.

You can have one or more of these issues in addition to your lupus. Once your doctor confirms or rules out these factors, your treatment can begin.

Prevention of Hair Loss

You can help prevent lupus related hair loss. Taking a few proactive measures makes a difference.

Medication Changes

By coordinating with a hair loss specialist and your rheumatologist, you might be able to reduce or change your medications. This requires careful planning and cooperation between your doctors. If this is possible, make sure you clear everything with your rheumatologist first, as your autoimmune disorder should be a first concern.

Nutrition

A quality diet also helps. Your doctor might prescribe a specific diet for both lupus and your hair. Ask your doctors about vitamin C, biotin, vitamin D, zinc and iron. All of these can slow hair loss and support your immune system.

Stay Out of Sunlight

Your doctor may recommend that you avoid excessive sun exposure since this can cause your symptoms to flare and get worse, further damaging your hair.

Stress Reduction

Limiting stress and getting plenty of rest are healthy practices in general. Make sure to practice stress-relieving techniques and get adequate sleep each night.

Treatment of Lupus Hair Loss

Hair loss affects approximately 45% of lupus patients. Fortunately, there are ways to treat it.

Specialized Products

The first course of treatment is to get your lupus under control. Fortunately, with proper diagnosis, there are a few things that you can do while the disease is still active. Many doctors recommend specialized shampoos, conditioners, topical treatments and supplements to help slow or stop hair loss. Topical minoxidil is typically a good place to start, as it’s FDA approved, inexpensive, easy to use, and has clear benefits for most people.

Most important, however, is to get your lupus under control with the right medications.

Hairstyle

Although your hair will grow back if the loss is due to inflammation, there are some cases, particularly scarring, when it might be permanent. You might want to consider a hairstyle that minimizes this loss or serves to hide it.

Medications

Dermatologists may recommend prescription and non-prescription medications such as finasteride or minoxidil, both shown to regrow hair. Finasteride, for example, lowers the amount of the hormone that contributes to hair loss by up to 60%. This can slow or stop hair loss.

Telemedicine

Hair loss can be frustrating, and you might not want to leave the house if you have a particularly bad case. Fortunately, many providers now use telemedicine services to treat patients from home.

Lupus hair loss can be devastating to self-esteem and confidence. Fortunately, there are ways to prevent and treat it.

Shapiro MD can help with a personalized plan and prescription solutions delivered to your door, if approved, after a virtual visit. Your consultation is free, and it's all online - click here to get started.