Nonscarring alopecia in systemic lupus erythematosus: A cross-sectional study with trichoscopic, histopathologic, and immunopathologic analyses

Abstract

Background: Nonscarring alopecia in systemic lupus erythematosus (SLE) is widely recognized, but reports on its clinical, trichoscopic, histopathologic, and direct immunofluorescence (DIF) features are still limited.Objective: To summarize the different clinical patterns, trichoscopic, histopathologic, and DIF features of nonscarring alopecia in SLE and to prove its association with disease activity.Methods: Patients with SLE with and without nonscarring alopecia had full physical/trichoscopic examination and scalp biopsy. Their disease activity scores and laboratory data were evaluated and statistically analyzed.Results: 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]). 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 dermoepidermal 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).Limitations: This was a small, cross-sectional, single-center study.Conclusions: Nonscarring alopecia in SLE shows lupus erythematosusespecific changes on histology and DIF. Hair loss in SLE can be considered as an indicator of active disease.

Dermatologic Manifestations, Histologic Features and Disease Progression among Cutaneous Lupus Erythematosus Subtypes: A Prospective Observational Study in Asians

“…Remarkably, non-scarring alopecia in SLE has been documented to hold prognostic values for SLE, and its coexistence with CLE may imply a higher risk of translation to SLE [41,42]. Future prospective studies with larger sample sizes are needed to confirm our findings.…”

Alopecia areata‐like pattern: A new unifying concept

“…Identifying clusters of CD123+ plasmacytoid dendritic cells is useful in making a definitive diagnosis. 11,12 In contrast to the non-scarring alopecia of SLE, DLE shows large yellow dots on trichoscopy, correlating to dilated follicular ostia, a feature not seen in AA.…”

“…In addition to vacuolar interface change, the lymphocytic infiltrate is generally more intense and diffuse than in AA (Figure 1). Identifying clusters of CD123+ plasmacytoid dendritic cells is useful in making a definitive diagnosis 11,12 . In contrast to the non‐scarring alopecia of SLE, DLE shows large yellow dots on trichoscopy, correlating to dilated follicular ostia, a feature not seen in AA.…”

Discoid lupus erythematosus precipitated by topical diphencyprone immunotherapy for alopecia areata

“…Histopathologically, interface dermatitis was not seen in the earlier scalp biopsy, whereas biopsies of patients with patchy nonscarring alopecia of SLE showed interface change along the dermoepidermal junction in 87.5% and along the follicular epithelium in 40.6%. 6 Our patient had a classic relapsing-remitting course of nonscarring hair loss, with good regrowth of hair in between, which is characteristic of AA. Therefore, favor a diagnosis of AA over alopecic LE.…”