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Hair loss in SLE patients indicative of active disease: JAAD

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Thailand: Hair loss in patients with systemic lupus erythematosus (SLE) can be indicative of active disease, according to a recent study published in the Journal of the American Academy of Dermatology. Also, nonscarring alopecia in SLE shows lupus erythematosus–specific changes on histology and direct immunofluorescence (DIF).

Systemic lupus erythematosus is a chronic, incurable, autoimmune disease associated with a range of symptoms that can fluctuate over time including painful or swollen joints, extreme fatigue, unexplained fever, skin rashes, and organ damage. SLE is the most common form of lupus, affecting approximately 70 percent of an estimated 5 million people with lupus worldwide.

SLE is widely recognized, but reports on it’s clinical, trichoscopic, histopathologic, and DIF features are still limited. Poonkiat Suchonwanit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, and colleagues summarized the different clinical patterns, trichoscopic, histopathologic, and DIF features of nonscarring alopecia in SLE and to prove its association with disease activity.

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“A majority of patients present with mild diffuse alopecia, but hair loss can also be localized in patches or along the anterior hairline,” wrote the authors. “Common trichoscopic findings were arborizing/interconnecting vessels, blue-grey speckled pigmentation, and thin hypopigmented hair shafts.”

SLE patients with and without nonscarring alopecia were made to undergo full physical/trichoscopic examination and scalp biopsy. Their disease activity scores and laboratory data were evaluated and statistically analyzed.

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Thirty-two patients with SLE had different patterns of nonscarring alopecia, including mild diffuse alopecia (43.8% [n = 14]), severe diffuse alopecia (15.6% [n = 5]), patchy alopecia (28.1% [n = 9]), and lupus hair (12.5% [n = 4]).

Key findings of the study include:

  • The most common trichoscopic findings were arborizing/interconnecting vessels (83% [n = 26]).
  • Histopathologic examination showed interface changes along the dermoepidermal junction (87.5% [n = 28]) and follicular epithelium (40.6% [n = 13]).
  • On DIF, homogeneous granular deposition was detected along the dermo-epidermal junction (78.1% [n = 25]) and follicular epithelium (78.1% [n = 25]).
  • When compared with 10 patients with SLE without alopecia, there was a significantly higher SLE Disease Activity Index 2000 score and prevalence of proteinuria (>1 g/d).

“Nonscarring alopecia in SLE shows lupus erythematosus–specific changes on histology and DIF. Hair loss in SLE can be considered as an indicator of active disease,” concluded the authors.

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The article, “Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses,” is published in the Journal of the American Academy of Dermatology.

DOI: https://doi.org/10.1016/j.jaad.2019.05.053




Source: Journal of the American Academy of Dermatology

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