Hair loss in autoimmune systemic diseases

Area of Science:

• Dermatology
• Autoimmune Diseases
• Rheumatology

Background:

• Hair loss (alopecia) is frequently observed in various autoimmune and connective tissue diseases.
• While scalp involvement is common in pemphigus, hair loss is a rare manifestation.
• Alopecia is not typical in classical bullous pemphigoid but occurs in specific variants.

Purpose of the Study:

• To review and summarize the types and associations of hair loss in different autoimmune and connective tissue diseases.
• To differentiate between scarring and non-scarring alopecia in the context of these conditions.
• To highlight specific conditions where alopecia is a reported feature.

Main Methods:

• Literature review of autoimmune diseases with reported hair loss.
• Analysis of clinical presentations and disease variants associated with alopecia.
• Categorization of alopecia as scarring or non-scarring based on disease characteristics.

Main Results:

• Hair loss is frequent in lupus erythematosus (LE), with both non-scarring (acute systemic LE) and scarring (discoid LE on scalp) forms.
• Scarring alopecia is characteristic of the Brusting-Perry variant of bullous pemphigoid and epidermolysis bullosa acquisita.
• Dermatomyositis typically presents with generalized, non-scarring alopecia.
• Scleroderma, particularly en coupe de sabre morphea, is associated with alopecia.

Conclusions:

• Alopecia presents diversely across autoimmune and connective tissue diseases, ranging from non-scarring to cicatricial forms.
• Specific disease variants and presentations dictate the type and pattern of hair loss observed.
• Understanding these associations aids in diagnosis and management of hair loss in autoimmune conditions.