Abstract:

A 21-year-old woman presented with 3-month duration alopecic atrophic plaques with pigmentary alteration, concomitant with an initial flare of systemic lupus erythematosus (SLE), suggesting discoid lesions of SLE. Scalp biopsy showed near total catagen/telogen shift and dramatic miniaturization, along with panfollicular lymphoplasmacytic infiltrate. There were no findings of scaring and none of the other classic findings of alopecia due to discoid lupus. In short, these early discoid lesions of systemic lupus demonstrated findings identical to those described for the nonscarring alopecia of SLE, which resembles alopecia areata. After 15 days of clobetasol, there was substantial regrowth. This is noteworthy because chronic alopecic discoid lesions of SLE often exhibit scarring changes identical to isolated discoid lupus, while the nonscarring alopecia of SLE is classically a diffuse alopecia with findings like these. This case suggests that acute discoid lesions of SLE may begin with pathophysiology identical to the nonscarring alopecia of active SLE. The findings lead us to hypothesize that the nonscarring alopecia of active SLE and alopecia associated with chronic discoid lupus may not be distinct conditions, as their classical descriptions would imply, but instead simply different stages of a similar or identical pathophysiologic process. The alternate hypothesis would be an SLE eruption analogous to classic alopecia areata. More extensive study of early alopecic discoid lesions of SLE and of alopecic localized discoid lupus is needed. Our patient’s excellent response also implies that there may be the potential to avert permanent hair loss from discoid lesions of systemic lupus and perhaps even of all discoid lupus with early and aggressive treatment.

Financial Disclosure:
No current or relevant financial relationships exist.

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Timothy Freeman, BS