Hair Loss Caused by Discoid Lupus Erythematosus
The most common type of chronic cutaneous lupus erythematosus (CCLE) is discoid lupus erythematosus (DLE). It can cause permanent hair loss if untreated. Women are more prone to DLE (particularly African American women).(2, 24, 185)
DLE typically develops between ages 20-40. Although most people who have DLE only have lupus in the skin, it's important to be tested for systemic lupus since this may require special treatment.(24, 185)
Symptoms of DLE include:(24)
- Itchiness
- Keratin plugs in hair follicles that pull up with scale as it is removed
- Reddened, inflamed skin
- Pigmentation changes
- Round (discoid) shaped lesions with inflammation in center (can appear on body too)
- Scaling
- Scalp pain and tenderness
Systemic lupus (a more serious health condition) also can cause alopecia. However, it is linked to a diffuse type of hair loss that is temporary if treated. Even though DLE can cause permanent alopecia, if lesions are treated early patchy hair loss can be prevented.(2)
Treatment Options for DLE
Medications for skin lesions include:
- Antibiotics (low dosage; anti-inflammatory effects)(24)
- Antimalarial drugs (believed to help by inhibiting the immune response and inflammation)(193)
- Immunomodulating drugs (e.g., mycophenolate mofetil and cyclosporine(24)
- Nonsteroidal creams and ointments (e.g., pimecrolimus and tacrolimus)(24)
- Retinoic acid (Retin-A)(194)
- Steroid injections into active inflammatory lesions (e.g., triamcinolone acetonide 10 mg/cc)(24)
- Systemic drugs such as Dapsone or corticosteroids (e.g., prednisone)(24, 194)
- Vitamin A derivatives (oral)(193)
- Topical steroids (high dose)(24)
DLE is a photosensitive disease, and sun protection is important to avoid flare-ups or making the condition worse. Also, people with this condition should be careful not to use topical tea tree oil on the scalp because it is a potent photosensitizer.(37, 59, 135, 193)
The disease is reversible and hair regrowth can be expected if treated early and aggressively. One successful approach demonstrated to regrow 80% of hair within four months in all lesions used multiple treatments at the same time:(195)
- Oral prednisone, 40 mg/day; eight weeks of treatment with 5 mg less each week
- Hydroxychloroquine, 200 mg two times a day
- Intralesional injections of triamcinolone (10 mg/cc) every four weeks
Quick Tips to Help with DLE
| DIET, LIFESTYLE, AND NUTRIENT TIPS FOR CCLE (DLE) | |
|---|---|
| DO | AVOID |
| Eat lots of fresh pineapple—it's contains the enzyme bromelain, known to reduce inflammation (available in supplements too).(37) | Foods that contain solanine (such as eggplants, peppers, white potatoes, and unripe tomatoes) since it can cause inflammation.(37) |
| Load up on eggs, garlic, and onions—all of these foods contain sulfur, an essential nutrient for hair and skin.(37) | Milk or dairy products, red meat, and sugar or sugar-containing food products —may contribute to inflammation.(37) |
|
Take antioxidant vitamin A (25,000 IU daily or 10,000 if pregnant) and vitamin E (200 IU/day)—both of which promote healing of lesions. Lots of vitamin C helps too—as an antioxidant and for immune system support (take 3,000-8,000 mg/day).(37) |
Large crowds—exposure to lots of people without knowing their health status can increase vulnerability to infection.(37) |
| Use hypoallergenic cosmetic, skin, and hair care products to avoid aggravating or triggering lesions.(37) | Fluorescent lighting and excessive unprotected exposure to UV radiation from sunlight—either can exacerbate or trigger a cutaneous flare-up.(37) |