Alopecia across the spectrum of rheumatic disease

Hair loss is a common clinical concern with significant diagnostic and psychosocial implications, particularly in patients with rheumatologic disease. This review examines the association between rheumatologic conditions and alopecia, exploring underlying mechanisms, clinical presentations, and diagnostic considerations. Rheumatologic diseases may precipitate hair loss through a variety of immune, fibrotic, and vascular mechanisms. In addition, pharmacologic therapies commonly used to treat rheumatologic diseases, as well as coexisting autoimmune scalp disorders, can also contribute to alopecia. Recognition of shared mechanisms linking autoimmune disease and hair loss is essential for identification of systemic disease, adverse therapeutic effects, or distinct dermatologic conditions. For optimal diagnosis and management, a structured approach to hair loss should be taken by obtaining a targeted history, physical examination, and laboratory testing or biopsy. Increased awareness of the relationship between alopecia and rheumatologic disease enhances interdisciplinary collaboration, ultimately facilitating earlier diagnosis, more efficient treatment and, most importantly, better patient outcomes.