Reply to: Severe Diffuse Non-Scarring Hair Loss in Systemic Lupus Erythematosus - Clinical and Histopathological Analysis of Four Cases

The document is a response to a report on four female patients with systemic lupus erythematosus (SLE) who had severe diffuse non-scarring hair loss, suggesting that this hair loss could be an early stage of scalp discoid lupus erythematosus (DLE), a known diagnostic criterion of SLE. The authors argue that the evidence from clinical, histopathological, and dermoscopic findings, as well as the positive response to treatment, supports a DLE diagnosis. They also note that DLE can appear as non-scarring and sometimes non-inflammatory alopecia, which can be confused with alopecia areata, and propose that immunosuppressive therapy for SLE might have aided hair regrowth and prevented permanent hair loss in these cases.