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Non-Cicatricial Alopecia in Systemic Lupus Erythematosus
Non-cicatricial alopecia is a common presenting sign of systemic lupus erythematosus (SLE) and can accompany a flare of the disease. It is a criterion in both the SLICC (Systemic Lupus International Collaborating Clinics) and the EULAR/ACR criteria for SLE (see Tables 41.4 & 41.5). Three clinical forms have been described: (1) diffuse hair loss that resembles typical telogen effluvium; (2) focal hair loss that resembles alopecia areata; and (3) โlupus hairsโ. The latter represent short hair shafts that are brittle and fragile. They are occasionally observed in other autoimmune connective tissue diseases. The trichoscopic findings include thick, arborizing and tortuous, interfollicular blood vessels (see Fig. 69.7K), decreased hair density and shaft diameter, and hair shaft hypopigmentation; randomly distributed wavy hair shafts (โlupus hairsโ) are also seen.