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Lupus panniculitis clinically simulating alopecia areata.

Steven Kossard¹

¹Skin and Cancer Foundation Australia, Sydney, New South Wales, Australia. skossard@scfa.edu.au

The Australasian Journal of Dermatology

|July 18, 2002

Summary

Deep lupus panniculitis can mimic alopecia areata by affecting deep hair follicles, causing temporary hair loss. Biopsy is crucial for differentiating this lupus variant from true alopecia areata.

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Area of Science:

Dermatology
Rheumatology
Pathology

Background:

Lupus erythematosus (LE) can manifest with various cutaneous findings, including alopecia.
Alopecia areata is an autoimmune condition causing non-scarring hair loss.
Distinguishing LE-induced alopecia from alopecia areata is clinically important.

Observation:

A 27-year-old woman with known lupus erythematosus presented with patches of hair loss resembling alopecia areata.
Scalp biopsy revealed a deep lymphocytic infiltrate around hair bulbs and deep follicular segments, with hyaline fat sclerosis.
The epidermis and upper follicular segments were spared, unlike typical lupus erythematosus.

Findings:

The deep variant of lupus panniculitis can selectively target the lower hair follicle and bulbs.
This pattern can lead to temporary, non-scarring hair loss, clinically mimicking alopecia areata.
Histopathological findings, including deep inflammation and fat sclerosis, are key diagnostic features.

Implications:

Recognizing this deep variant of lupus panniculitis is essential for accurate diagnosis and management of hair loss in lupus patients.
This condition highlights the diverse scalp manifestations of lupus erythematosus.
Early differentiation prevents misdiagnosis and ensures appropriate treatment, potentially avoiding unnecessary therapies for alopecia areata.

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