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A variety of inflammatory conditions, many of them autoimmune diseases,
are associated with follicular inflammation leading to temporary
hair loss or permanent hair loss with scarring. Some of these are:
| Discoid lupus erythematosus |
Often referred to as “DLE”,
this form of Lupus is often accompanied by thick, scaly
red rashes on the scalp, face and elsewhere on the body
that last for days, months or years. Unlike systemic
lupus erythemasosus (SLE), this rash can lead to patches
of scarring alopecia.
Treatment is similar to that for alopecia in SLE.
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| Insect bites |
Insect bites (e.g., bee stings, tick, flea or ant bite)
may cause localized swelling and consequent patchy hair
loss similar to that seen in alopecia
areata. Hair usually regrows after inflammation subsides.
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| Lichen planus |
Lichen planus is a common, variable disorder that comprises
about 1% of all dermatologic patients. Its cause is uncertain,
but as it often presents with other autoimmune disorders,
it is believed to have an autoimmune origin. In the most
common form of this disease shiny, flat papules form plaques,
destroying hair follicles. Onset occurs at 30-65 years
and treatment with drugs, including corticosteroids,
offers varying degrees of success.
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| Lichen planopilaris |
A form of lichen planus, lichen planopilaris is a common
skin disorder that accounts for up to 40% of scarring
alopecia cases. It presents with inflammation, hair
loss (sometimes permanent) and scarring and may resemble
a SLE or pseudopelade.
Small papules appear, usually on the scalp, causing patchy
hair loss. Skin biopsies are used for diagnosis, and affected
individuals often have high white blood-cell and protein
levels. Initial presentation is typically in middle age,
and early treatment with antihistamines
and topical or systemic corticosteroids
may prevent permanent hair loss.
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| Pseudopelade |
This rare condition is a form of cicatrical
alopecia in which patchy hair loss can lead to near-total
scalp hair loss. It primarily affects women (and children),
but the cause is unknown. Treatment with corticosteroids
may help with inflammation, and hair
transplant surgery is also often used as treatment.
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| Psoriasis |
Psoriasis is common condition caused by allergic reaction
to one’s own sebum or scalp oils. Inflammation within
the follicle interferes with the hair’s nutrient
supply, eventually causing hair loss. There is no cure,
and the diverse available treatments (including coal-tar
preparations, ultraviolet light therapy and antibiotics)
are variously successful among affected individuals.
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| Scleroderma |
A disease of uncertain origin, scleroderma (also called
“morphea”) is characterized by hardening of
the skin on the scalp (and elsewhere), due to excessive
production of collagen; in more extreme cases, one or
more organ systems may also be affected. This condition
usually affects women aged 35-60, and there is no known
cure, although a variety of treatments may be used, depending
on the nature of the individual case.
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| Sterile eosinophilic folliculitis |
Sterile eosinophilic folliculitis (SEF) is a recurrent
skin condition of unknown origin thought to be caused
by an autoimmune process. Symptoms include recurring pustules
on the scalp and sometimes on the face, and a high white
blood-cell count. Over 80% of those affected are men,
with onset occurring from the early 20s to 40s. SEF can
affect infants and is often seen in people with HIV. Symptoms
respond well to topical corticosteroids,
or left untreated usually resolve over time.
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| Seborrheic dermatitis |
This condition presents as a scaly, itchy rash on various
areas of the body, including the nose, eyelids, eyebrows,
behind the ears and on the chest, and areas that have
a high concentration of sebaceous glands. The cause is
unknown, although yeast organisms may play a role. Treatment
usually consists of application of topical corticosteroids
and cleansing with a mild shampoo.
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| Systemic lupus erythematosus |
Systemic lupus erythematosus (Lupus or SLE) is a chronic
autoimmune disorder involving multiple organ systems and affecting
women disproportionately over men (10:1), and African American
women over other ethnic groups. The generalized autoimmune
response can lead to diffuse hair loss on various parts of
the body, and non-scarring alopecia occurs in about 20% of
cases. Treatment may involve topical or injected corticosteroids,
antimalarial
medications or immunosuppressants,
and patients should avoid ultraviolet (UV) light.
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Further Resources
Lupus Foundation of America
The Scleroderma Foundation
International Scleroderma Network
National Psoriasis Foundation
Lichen Planus
(American Academy of Dermatology)
Lichen Planus Treatment Program
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