Severe diffuse non-scarring hair loss in systemic lupus erythematosus - clinical and histopathological analysis of four cases.

Background  Although diffuse non-scarring hair loss been found common in systemic lupus erythematosus (SLE), study that conduted on the severe type has been scarce. Objective  This study aims to explore the dermoscopic and pathological features of severe diffuse hair loss in SLE. Method  Data including clinico-laboratory, dermoscopic and histopathological findings of four patients with SLE with severe diffuse hair loss were analysed retrospectively. Results  All four patients were women aged 41, 39, 14 and 48 with complaints of hair loss involving 55%, 100%, 60% and 55% of their scalp respectively. Common clinical findings observed in the patients were sparse scalp hair with clusters of newly regrown hair. Scalp dermoscopy showed scaling, perifollicular telangiectasia, increased numbers of short vellus hairs, focal atrichia and decreased hair shaft pigmentation. Scalp tissue histopathology revealed typical changes of SLE such as epidermal atrophy with focal liquefaction, degeneration of the basement membrane zone, pigment incontinence, mild focal perivascular and perifollicular lymphocytic infiltrates and deposition of immunoglobulins at the dermal–epidermal junction. Treatment and improvement in SLE disease activity indices had a favourable impact on hair regrowth. Conclusion  The severe type of hair loss in patient with SLE presents a unique set of clinical, dermoscopic and histopathological features.