Characterizing Hair Loss in Female Patients with Systemic Lupus Erythematosus

The study aimed to characterize the histologic features of diffuse hair loss in female patients with systemic lupus erythematosus (SLE). Over a 3-month period, 8 patients from a single rheumatology practice, aged between 46 and 75, participated by completing a questionnaire, providing scalp photographs, and undergoing scalp biopsies. All patients had active SLE and an average disease duration of 13 years. They exhibited diffuse non-scarring hair loss without scalp inflammation, and three showed a positive hair pull test for telogen hair. Histological examination revealed no inflammation, scarring, follicular plugging, or other abnormalities, but a decrease in total hair follicles with a median count of 14 hairs. Direct immunofluorescence (DIF) identified lupus in four patients. The study concluded that patients with SLE and diffuse hair loss had non-scarring alopecia with a reduced number of total hair follicles, and DIF was not useful for identifying lupus in these cases. The underlying cause of follicular drop out in these patients remains unknown.