More than five million people worldwide suffer from lupus, a chronic disease causing the immune system to attack healthy organs and tissues – including hair follicles. With hair loss one of the most common symptoms of lupus (reported by up to 85% of systemic lupus erythematosus patients), here’s what you need to know about the different types of lupus-related hair loss, whether your locks will recover, and what you can do to help your hairline and boost your overall hair health.
Autoimmune diseases such as lupus occur when the body’s immune system mistakenly perceives healthy cells, tissues, or organs as foreign invaders. The immune system loses the ability to differentiate between normal cells and external pathogens such as viruses or bacteria and instead attacks the body as it would invading cells.
Unlike conditions such as alopecia areata, where the immune system specifically targets hair follicles, lupus hair loss occurs as a complication of inflammation. This chronic inflammation is caused by antibodies attacking healthy cells and tissue which in turn, disrupts the normal hair growth cycle. Not only can this damage hair follicles but it can also impede the growth of new hairs.
The causes of autoimmune diseases are not yet fully understood, but genetics, hormones, infection, and environmental triggers are all believed to contribute to their development. There is no cure for autoimmune diseases, but they can be effectively managed to prevent damage to the body.
Not everyone suffering from lupus will experience hair loss, and not everyone who does suffer hair shedding will experience it in the same way. The type of lupus-related hair loss depends on the particular variant of the disease, and it is categorised as either scarring or non-scarring, with unique experiences and implications for each. Additionally, a third type of hair loss caused by the medications used to treat lupus, such as corticosteroids and immunosuppressants, can also affect individuals.
Lupus is a disease characterised by inflammation leading to joint pain, swelling, fever, and a host of other symptoms. Non-scarring hair loss occurs when this inflammation develops around hair follicles, which become too weak to remain anchored or too damaged to produce healthy strands. Hair loss and degeneration aren’t restricted to the scalp: eyebrows, eyelashes, and beards can also be affected.
Non-scarring hair loss doesn’t always present in the same way. It may be experienced as patchy areas, widespread hair thinning, bald spots, or a combination of symptoms. Patients with SLE (systemic lupus erythematosus) often experience ‘lupus hair’, a state characterised by the development of coarse, broken hairs at the front of the scalp and around the hairline.
Alongside shedding as a result of damaged follicles, the quality of hairs degenerates as the body enters a catabolic state. This state is induced by inflammation, where the body begins to break down its own fat and muscle to produce energy, negatively affecting hair growth.
Non-scarring hair loss is often reversible with the treatment and remission of the disease. Once lupus activity is under control, regrowth is expected to occur within three months and doctors may also prescribe topical medications such as prescription steroid creams to aid recovery.
Patients may also be prescribed Minoxidil, an FDA-approved topical treatment available over the counter. Unlike other approved treatments such as Finasteride and Dutasteride, which work by blocking hormones, Minoxidil is a vasodilator. This is a crucial distinction for lupus patients, 90% of whom are female, as hormone-blocking treatments can cause negative reactions in women. For women looking to buy Minoxidil OTC, check the labels closely as a 2017 study found that female-branded Minoxidil products contained weaker solutions than male-branded, yet cost the same.
Non-scarring lupus hair loss can often be misdiagnosed as alopecia areata, another autoimmune disease where the immune system only attacks hair follicles. However, treatment varies considerably between the two conditions so accurate diagnosis is key.
Alopecia areata hair loss treatment is more uncertain and variable while non-scarring lupus hair loss can be more reliably treated with control and remission of the disease.
Lupus scarring hair loss (also known as scarring alopecia) is caused by the development of discoid lesions, disc-shaped patches of permanent scarring.
Unlike SLE, which is a form of lupus where antibodies attack whole organ systems (hence the name, systemic lupus erythematosus), scarring alopecia is associated with CLE, or cutaneous lupus erythematosus. This is an umbrella term for the variations of lupus which affect the skin (hence the name cutaneous, meaning relating to the skin).
It’s important to know that while women generally are far likelier to develop lupus than men, Black women specifically are more susceptible to variations of cutaneous lupus.
Discoid lupus erythematosus (DLE) is the most common form of CLE and is so named for the circular discoid lesions that develop on the skin. However, DLE does not guarantee permanent hair loss. In the early stages, the discoid lesions are non-scarring but quickly progress into scars and result in permanent hair loss. The immediate therapies include topical corticosteroids and oral antimalarials, and early treatment is crucial to avoid scarring as hair regrowth is impossible once this has occurred.
Discoid lesions are thick, round patches that may be red, scaly, and accompanied by telangiectasia (small blood vessels visible on the skin, also known as spider veins). In some cases, instead of red presentation, they are marked by patches of either darker or lighter skin, called hyper or hypo-pigmentation.
Scarring alopecia is unfortunately permanent. Follicles are unable to grow in the patches of scar tissue left from the discoid lesions making prompt treatment essential. Following successful remission of the disease, however, several cosmetic options offer the chance to restore patients’ appearance or hair.
Scalp micro-pigmentation can be highly effective for small areas of thinning hair or hair loss, a process whereby the appearance of stubble or hair is simulated by tattooing tiny dots onto the skin.
For more severe cases of hair loss, another option to consider is a hair transplant procedure. Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) are the two major types of hair transplant surgery, and both can be used for scalp transplants, beard transplants, and eyebrow transplants.
Lupus and other autoimmune disease patients should seek medical advice before committing to a surgical hair transplant procedure. It is generally advised that patients wait until at least two years after remission before attempting any surgical procedures so as to reduce the likelihood of a trauma-related flare, also known as the Koebner phenomenon. This refers to the body’s faulty immune system responding to the perceived ‘injury’ of an invasive procedure such as a transplant, causing an increase in disease activity and the development of new lesions in previously healthy skin.
While multiple studies have shown no lupus-related complications following hair transplant surgeries, indicating the viability of the procedure, it is still recommended to get a medical opinion first. If you do experience more instances of permanent hair loss after a transplant, you may not be eligible for further rounds. The sites where follicles are extracted are limited and reputable surgeons will not risk overharvesting.
Another increasingly popular option is platelet-rich plasma (PRP) therapy. Unlike hair transplants, PRP therapy is non-invasive so there is no risk of the Koebner phenomenon. The treatment has proved effective in treating other types of autoimmune-related hair loss, and the side effects of PRP treatment are generally mild. While little documentation exists regarding lupus patients, what exists is promising.
Hair loss and hair thinning can also be caused by key medicines used to treat lupus, such as immunosuppressives or steroids. In this case, changing the treatment plan will end the hair loss and patients should notice a quick improvement. Speak to your doctor if you notice a sudden increase in hair loss after starting treatment.
With so many different presentations and variations of lupus, you should seek medical advice if you are concerned about notable changes to your scalp and hair. It’s normal to lose 50 – 100 hairs a day – if you notice increasing loss, especially if you are below middle age, speak to a doctor.
Remember, there’s no hard and fast rule about what lupus-related hair loss looks like. It may present as bald patches, widespread thinning, or just an overall deterioration in hair quality.
However, you should also consider alternative reasons why you may be noticing hair loss. For example, chemical treatments, age, and genetics are all likely culprits, so keep an eye out for other lupus symptoms such as joint pain, fatigue, a butterfly-shaped rash, or fever.
Unfortunately, there are no sure-fire ways in which to prevent or halt hair loss – the primary treatment for lupus hair loss is controlling the disease. However, there are common lupus triggers that can make the disease activity worsen and lead to a lupus flare, a state characterised by high disease activity and intense symptoms. Taking key steps to avoid these common lupus triggers can help reduce flares and therefore hair loss.
Photosensitivity is a common symptom of lupus, with 40% – 70% of patients reporting increased symptoms in response to UV light. This is because UV radiation causes cell damage, but lupus systems are unable to clear out the broken or dead cells. Instead, the dead cells trigger antibodies which lead to tissue damage and inflammation.
The main source of UV radiation is sun exposure, so lupus patients are advised to always wear a hat, sunglasses, and heavy-duty suncream (over 70SPF with broad spectrum protection against UVA and UVB rays). Medical advice recommends reapplying sunscreen at least every two hours over the whole body, including that covered by clothing as most garments only offer the equivalent of SPF 5 protection.
Fluorescent light bulbs can also trigger flares. While the amount of UV radiation from indoor lighting is considerably lower than the sun, people usually spend much more time inside around fluorescent bulbs. Several options exist to reduce this radiation: UV filters for fluorescent lights, UV-blocking shades for windows, and UV tinting for car windows, although depending on location, this may require a doctor’s note.
The link between smoking and lupus is not entirely clear yet, but studies have established that tobacco reduces the effectiveness of lupus medication – specifically, antimalarial drugs. Scientists have also noted a higher prevalence of smokers among DLE patients, leading them to believe smoking is linked to more extreme variations of the disease.
Multiple studies have found that stress is associated with an increased risk of lupus flares. While people regulate emotions in their own way, techniques such as mindfulness meditation, yoga, and cognitive-behavioural therapy may be useful.
Basic steps such as maintaining a healthy, balanced diet and getting at least 8 hours of sleep a night are also recommended to help both with stress and the disease, and you can discuss further steps with your doctor to help with individual stressors. Read more about the link between sleep, melatonin, and hair loss.
The most common dietary triggers of lupus immune response include salt, alfalfa sprouts, and garlic.
Alongside the usual dangers of too much sodium chloride, or salt, such as the increased risk of a heart attack, initial studies are showing that a high-salt diet also promotes lupus disease activity. Initial studies show a clear progression between high-salt conditions and the production of TH17 cells, an inflammatory type of cell within the immune response. The link between salt and this type of immune response has led scientists to hypothesise that the rising numbers of lupus patients are a result of increased salt in our daily diet.
Contrastingly, garlic has long been used as a natural remedy to combat illness such as colds and is hypothesised to actually prevent cancer in the body. However, key compounds in garlic increase the body’s white blood cell activity and therefore immune system response.
While a small amount of the flavouring should not cause a serious reaction in lupus patients, medical advice recommends taking active steps to avoid eating it in any form. Similarly, alfalfa sprouts contain L-canavanine, an amino acid that also stimulates the immune system, and so should be avoided.
While some lupus patients may suffer from vitamin deficiencies, it is crucial that any natural remedies or supplements are discussed with a medical professional before consumption. Many of these supplements can negatively interact with lupus medications, and some can actively lead to hair loss – excessive vitamin A, for example. Unfortunately, despite the recent popularity of hair tablets and gummies, ultimately there is no scientific evidence that these supplements will improve your hair growth.
Echinacea specifically is an important health supplement to avoid. While the herbal remedy isn’t linked to hair growth, it is associated with many health benefits and works to stimulate the immune system. As such, it should be avoided by lupus patients as it may agitate a lupus flare, causing your symptoms to intensify and hair loss to increase. In certain parts of the world, the supplement is sold with warning labels advising against consumption by those with autoimmune diseases.
On the other hand, vitamin D supplements are rising in popularity and often invoked in discussions of hair loss – a recent study indicated there are strong links between hair loss and low levels of vitamin D.
In fact, lupus patients often suffer vitamin D deficiency due to their increased photosensitivity, yet supplementation isn’t a quick fix. The vitamin also plays a key role within the immune system and so could potentially trigger lupus activity. Before taking any supplements, lupus patients should discuss potential supplements with a medical professional to avoid increasing disease activity (and therefore further hair loss).
Hair regrowth is dependent on the type of hair loss you’re suffering from, and all treatment plans begin with control over the disease. Lupus treatment is also variable, taking weeks or months to find the best treatment plan and progress the disease into remission. If it is caused by the disease treatment, then switching medication will stop the hair loss, and hair should quickly regrow.
If hair loss is caused by non-scarring alopecia, then the scalp is expected to begin recovering in the immediate months after remission. This may be aided by a topical cream (applied to the skin) usually containing steroids or Minoxidil.
If hair loss is scarring, then unfortunately the hair follicle will not regenerate and these topical treatments will be ineffective. Scarring alopecia is a form of hair loss that leaves permanent scars where hair will be later unable to grow. Topical treatments work by stimulating follicles into a growth phase. This cannot help hair loss where no follicles remain. Instead, scarring alopecia can be ‘treated’ through cosmetic procedures after remission.
While lupus-related hair loss is largely dependent upon the progression of the disease, there are still key steps those with lupus can and should take to protect their hair. Our appearance is how we choose to present ourselves to the outside world. While lupus takes away a lot of control, it’s important to know what options are still available.
Firstly, there are simple steps which can help to preserve the existing hair. Lupus patients should avoid putting further strain on the follicle and damaging the hair shaft any further. This means avoiding heat and using chemical treatments such as perms and relaxers to style hair, reducing heavy or frequent brushing, and taking any tight hairstyles out of rotation.
Rough handling can cause traction or trauma alopecia, while many beauty treatments can lead to damaged hair. Instead, focus on protecting and hydrating your tresses with lightweight, moisturising products to keep hair healthy. Additionally, you can also choose to sleep on a silk pillowcase which is great reducing tangles.
To limit choices even further, many patients opt for a short trim of their remaining hair to reduce the strain on the follicles.
A host of choices exist for those looking to cover the changes to their hair. The global wig industry is valued at almost £2 billion and includes a multitude of human hair wigs, wiglets, and hair toppers to provide a range of coverage and fullness effects.
Scarves similarly offer a wide range of customisable colours and patterns to work in lieu of hair dye, or on a smaller scale, bandanas or headbands can help obscure patches of hair loss or thinning.
Lupus hair loss isn’t restricted to hair on the scalp, so styling options shouldn’t be either – hair transplant procedures can also help eyebrow and beard loss.
Less invasive options also exist for facial hair loss. For eyebrow loss, there is a range of solutions including stick-ons, temporary tattoos, permanent tattoos, micro-blading, or brow stencils. Similarly, developments in false eyelashes mean that realistic stick-ons are easily available and highly effective.
Beard patchiness or thinning can be quickly disguised by hair thickening spray, or for a more lasting effect, beard micro-pigmentation is a viable option.
Like scalp micro pigmentation, the process involves tattooing tiny dots onto the face to even out the appearance of patchy growth. We strongly recommend taking the time to really think it through to avoid any regrets, as removing the ink is very difficult.
Like transplants, it is recommended lupus patients seek medical advice before micro-pigmentation procedures and to ensure they understand the causes of their eyebrow hair loss or facial hair loss
Tattoos work with the body’s immune response in order to effectively lock ink into the skin, and so, like hair transplants, may put patients at risk of the Koebner phenomenon (where new lesions appear in response to skin trauma).
However, a 2019 study of lupus patients (in remission) noted a zero increase in disease activity following their tattoos and so this remains a reasonable option if done with care.
Several high-profile hair transplantations have popularised the erroneous idea that the procedure is too expensive to be obtainable. Instead, our survey of transplant clinics across the UK revealed that the average hair transplant cost was actually £4,820. Typically, an eyebrow transplant costs £3,820 on average for both brows.
If you are interested in seeking treatment for your hair loss and would like to know about the services we can provide for you, book a consultation to meet with one of our hair restoration specialists today to discuss your options.
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