In lupus patients with alopecia arreata, a gentle hair pull test may reveal dystrophic androgen hairs, and a dermoscopy often shows “exclamation point” hairs. Biopsy of these patients may show mononuclear cell infiltrate and mucin deposition, as well as inflammatory cells around the hair follicle that look like swarms of bees, she said. Direct immunofluorescence may show signs of inflammation.
Patients with tightly pulled hairstyles may also have traction alopecia, she said. Lupus patients with alopecia should avoid sun exposure and wear hats, said Dr. Werth. “If you can see through the hat, it’s not good enough for sun protection,” she added. Treatments include topical and intralesional steroids, topical tacrolimus or pimecrolimus, antimalarials, methotrexate and, in severe cases, thalidomide or lenalidomide. Hair weaves or hairpieces help conceal areas of permanent hair loss, she concluded.
Susan Bernstein is a freelance journalist based in Atlanta.
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