Alopecia

Three types of alopecia can be detected in patients with LE (Sontheimer and Provost 1996). In addition to the permanent scarring alopecia associated with discoid lupus lesions, patients with SLE may experience transient alopecia with increased disease activity. Two types of transient hair loss, a result of the severe catabolic effect of the

Table 7.4. Comparative histologic findings in chilblain lupus erythematosus (LE) vs idiopathic chilblains (see Cribier et al. 2001,Viguier et al. 2001)

Histopathologic Findings

Patients (%)

Chilblain LE (n=

7)

Idiopathic Chilblains (n=17)

Epidermal spongiosis

0

58

Basal vacuolation

43

6

Perieccrine infiltrate

57

76

Dermal edema

86

70

lupus disease flare, have been detected. One is classic telogen effluvium, in which the patient develops prominent and at times alarming loss of hair all over the scalp. If the patient's SLE is a chronic active disease process, the telogen effluvium may persist for a prolonged time. However, with quiescence of the lupus disease process, normal growth of hair resumes. The second form of alopecia, related to a flare of the SLE process, is termed "lupus hair" or "woolly hair". It is most likely a type of telogen effluvium characterized by the development of thin, weakened hairs most prominent at the periphery. These hairs easily fragment; the hair becomes unruly, giving a characteristic appearance. Conceptually, it is theorized that with the negative nitrogen balance of the lupus disease flare, normal hair growth is interrupted, leading to a reduced number of thin, weakened hairs, which easily fragment above the surface of the scalp.

Alopecia areata has also been seen in patients with SLE. In all probability, it probably reflects the occurrence of two autoimmune disease processes in the same individual.

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