Trichoscopic signs in systemic lupus erythematosus: a comparative study with 109 patients and 305 healthy controls

Abstract

Background Hair and scalp involvement in systemic lupus erythematosus (SLE) can manifest as scarring alopecia, non-scarring alopecia or scalp/hair shaft changes without apparent hair loss. While trichoscopic signs in chronic cutaneous lupus are well established, data on SLE patients with normal-looking or non-scarring scalp are limited.Objectives To investigate trichoscopic features of SLE patients without chronic cutaneous scalp lesions and compare the findings with normal controls, as well as determine which feature associates with systemic disease. Furthermore, we aim to explore different clinical presentations of the scalp in SLE patients and their association with disease activity.Methods Trichoscopic photographs were taken from patients and healthy controls and evaluated by one blinded hair specialist. For SLE patients, their clinical presentations and evaluations for cutaneous, extracutaneous involvement; SLE Activity Index 2000 (SLEDAI-2K) score were documented. ResultsOf 109 SLE patients and 305 healthy controls were included. Hair shaft changes were significantly more common in SLE and associated with higher SLEDAI-2K (P < 0.05). The most common feature was prominent arborizing blood vessels (60.6% vs. 18.4%, P < 0.001), followed by thick arborizing blood vessels (57.8% vs. 10.2%, P < 0.001), black dots (47.7% vs. 2%, P < 0.001), brown scattered pigmentation (5.5% vs. 0.7%, P = 0.005) and blue-grey speckled pigmentation (44% vs.0.3%, P < 0.001). When hair loss is diffuse and severe, there were associations with haematologic (P = 0.002) and renal involvement (P = 0.027 for proteinuria > 500 mg/day, P = 0.004 for proteinuria > 1 g/day).Conclusions Trichoscopic examination is a valuable tool for SLE diagnosis and monitoring. Severe diffuse non-scarring alopecia most likely indicates active disease.

Dermatologic Manifestations, Histologic Features and Disease Progression among Cutaneous Lupus Erythematosus Subtypes: A Prospective Observational Study in Asians

“…Remarkably, non-scarring alopecia in SLE has been documented to hold prognostic values for SLE, and its coexistence with CLE may imply a higher risk of translation to SLE [41,42]. Future prospective studies with larger sample sizes are needed to confirm our findings.…”

Recent Insight on the Management of Lupus Erythematosus Alopecia

“…2,4,5,8,9,21,22 In a recent study, the presence of certain trichoscopic features in patients with SLE was found to correlate with disease severity; patients with hair shaft changes (including decreased number of hairs, decreased diameter, and hypopigmentation) had more active systemic disease, as determined by significantly higher mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, than those without these trichoscopic features. 23 Non-scarring alopecia of SLE may assume a diffuse, patchy, or "lupus hair" pattern. 5 It therefore must be distinguished from telogen effluvium or AA which may also occur concomitantly with SLE.…”

Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls

“…Hair and scalp dermoscopy, also known as trichoscopy, has become a standard evaluation for alopecia and other scalp disorders (14). Currently, trichoscopic features among CTDs have been well described and may indicate their diagnostic and prognostic values (15)(16)(17)(18)(19). Onychoscopy refers to the examination of the nail unit using dermoscopy.…”