An Atypical Clinical Presentation of Alopecia in Two Patients with Systemic Lupus Erythematosus

In March 2021, a study was conducted on two male patients with systemic lupus erythematosus (SLE) who presented an atypical form of alopecia. The patients had large circular non-scarring alopecic plaques on the scalp with central hyperpigmentation and scarring, a presentation that deviated from typical lupus-related alopecia. The findings were reminiscent of but distinct from both discoid lupus erythematosus (DLE) and lupus erythematosus tumidus (LET). A punch biopsy from the hyperpigmented area of alopecia revealed peri-follicular lymphocytic infiltrate, follicular dropout, and increased dermal mucin consistent with lupus erythematosus. The study highlighted the morphologic heterogeneity of chronic cutaneous lupus erythematosus (CCLE) and the need for thorough evaluation of systemic disease in patients presenting with both scarring and non-scarring alopecia.