Hair Loss When You Have Lupus

Causes, Treatment, and How to Cope

Hair loss is common in people with lupus. The autoimmune disease causes body-wide inflammation that attacks the joints and skin, including the scalp. This can result in hair loss (alopecia).

Lupus-related hair loss can occur slowly, causing hair to become noticeably thinner gradually. In addition, lupus can sometimes cause hair to fall out in clumps, leaving small, round bald patches behind. Medications used to treat lupus are also linked to hair loss.

This article takes an in-depth look at lupus and hair loss, including the causes, common medications that promote hair loss, and photos of lupus hair loss. It also discusses other possible causes of hair loss, treatment options, and the best ways to camouflage lupus hair.

Hairbrush with many strands of hair on white background
Maciej Toporowicz / Getty Images

Symptoms of Hair Loss in Lupus

Alopecia—the medical term for hair loss—affects roughly 45% of people with lupus at some time and to some degree. It is common enough to have been coined "lupus hair." Hair loss most often occurs early on with the disease, and it can even be one of the first signs of the autoimmune disease.

Lupus-related hair loss can take different forms, depending on the type of lupus. In systemic lupus erythematosus (SLE), the most common form of lupus, hair loss can occur all over the scalp (diffuse) or only in certain spots (localized).

Localized alopecia in systemic lupus tends to occur on the front of the scalp and has a distinctive look. Sometimes referred to as lupus hairs, this type of hair loss results in lots of shorter or baby hairs framing the face and thinning patches along the hairline.

Another type of hair loss known as scarring alopecia is more common in lupus varieties that only affect the skin. This includes chronic cutaneous or discoid lupus erythematosus and subacute cutaneous lupus.

Scarring alopecia results from skin lesions on the scalp. Lesions (sores) can be red, thick, and scaly and typically do not itch or hurt. These lesions damage hair follicles, leaving behind bald patches that are round or misshapen and about the size of a coin. Perfectly round lesions are known as discoid plaques. Discoloration of the skin is common.

Lupus can also cause hair loss in parts of the body other than the scalp, including eyebrows, eyelashes, beards, and body hair.

Normal Growth vs. Hair Loss

Differentiating between diffuse hair loss from lupus and normal hair shedding can sometimes be challenging. People typically shed between 50 to 100 hairs a day.

In general, 90% of a person’s hair grows at any given moment, with the remaining 10% in a “resting phase.” The growth phase (anagen phase) can last from two to six years, after which the hair follicle enters the resting phase (telogen phase), which lasts about three months. After the resting phase, hair is shed. A new hair grows where the last one was shed, and the cycle begins anew.

Lupus-related diffuse hair loss can start subtly. You may notice more hair coming out when you brush it or collecting in your shower drain. You may not even see it at first until the thinning becomes evident when you look in the mirror.

In some people with lupus, hair loss comes on suddenly, and strands come out in clumps leaving noticeable bald patches behind.

This photo contains content that some people may find graphic or disturbing.

systemic lupus hair loss
Hair loss caused by systemic lupus.

DermNet / CC BY-NC-ND

Causes of Hair Loss From Lupus

Lupus-related hair loss takes on two different forms: scarring and non-scarring alopecia. Both are caused by an autoimmune reaction where the immune system mistakenly attacks healthy tissue. Hair loss typically coincides with lupus flare-ups and resolves when the disease is under control.

Scarring alopecia is the result of skin lesions on the scalp that damage hair follicles. Inflammatory cells infiltrate the outer root sheath of hair follicles, causing fibrosis (thickening) of the follicular structure. This results in scarring that causes permanent bald patches. Scarring alopecia is not reversible. 

Non-scarring alopecia associated with lupus is primarily caused by inflammation that attacks the scalp. This type of lupus-related hair loss often causes diffuse hair loss and not distinct bald patches.

Non-scarring hair loss in lupus is commonly mistaken for stress-related hair loss (telogen effluvium). Research, however, suggests that hair loss is related to the autoimmune basis of systemic lupus.

Medications used to treat lupus such as prednisone and other immunosuppressives can also lead to hair loss.

What Lupus Medications Cause Hair Loss?

Some medications used to treat lupus can potentially cause hair loss. Immunosuppressives, in particular, often have a side effect of hair loss. These include:

  • Cellcept (mycophenolate mofetil) 
  • Cytoxan (cyclophosphamide)
  • Imuran (azathioprine) 
  • Methotrexate
  • Lupkynis (voclosporin)
  • Plaquenil (hydroxychloroquine) 

Prednisolone and other corticosteroids used to treat lupus symptoms also have the potential to cause hair loss, however, this is a rare side effect.

Other Causes of Hair Loss

Sometimes people with lupus experience hair loss that is not related to the autoimmune disease. Other potential causes of hair loss include:

  • Heredity/genetics: Known medically as androgenetic alopecia, hereditary hair loss and thinning is the most common cause of hair loss. Typically, women will experience thinning hair while men will experience thinning hair, baldness, or both. There is no cure for this form of hair loss, but medical treatments may help stem the onset.
  • Alopecia areata: A bit of a mystery, alopecia areata is believed to be an autoimmune disease in which the body forms antibodies that attack its own hair. The disease causes hair loss marked by totally smooth, round patches about the size of a coin or larger. It may even result in complete loss of scalp and body hair, though this is rare.
  • Chemical treatments: Hair dyes, tints, bleaches, straighteners, and other hair products with chemicals can cause weakness in the hair, making it brittle and causing it to break and fall out. If you encounter this form of alopecia, simply stop using chemical treatments until your hair has a chance to grow out.
  • Telogen effluvium: Many people lose hair after a severe illness, stress, as well as after pregnancy. (Learn more about telogen effluvium.)
  • Tinea: Fungal infections can lead to hair loss.
  • Traumatic alopecia: Continuously playing with hair can cause hair breakage.
  • Nutritional deficiencies: Deficiencies in protein, iron, biotin, and zinc are all associated with hair loss.
  • Thyroid conditions: Both hypo and hyperthyroidism can lead to hair loss.

How to Treat Lupus-Related Hair Loss

Hair loss from lupus often stops once the autoimmune disease is treated and under control. Types of medications used to treat lupus and put the disease into remission include:

  • Antimalarial drugs such as Plaquenil and Aralen (chloroquine phosphate)
  • BlyS-specific inhibitors such as Benlysta (belimumab) are newer biologic drugs delivered intravenously to inhibit B-lymphocyte stimulator (BLyS) protein
  • Immunosuppressants such as Imuran, Cellcept, and methotrexate

Plaques on the skin and scalp are treated with a combination of topical, oral, and injectable medications. In addition to those listed about, medications to treat skin lesions include:

  • Corticosteroids are delivered topically, orally, or by injection directly into the plaques to relieve inflammation
  • Protopic (tacrolimus), a topical immunosuppressant ointment 

Skin lesions can cause scarring and significant damage to hair follicles. Treating scalp plaques promptly may prevent bald spots.

Stay Out of The Sun

Lupus can make your skin and scalp more sensitive to the sun. A mild sunburn on your scalp can trigger an outsized autoimmune response that causes skin lesions. These plaques can damage hair follicles and lead to bald patches.

To prevent sunburn that leads to hair loss, keep your head covered when it is sunny outside.

Natural Remedies for Lupus Hair Loss

In addition to managing lupus flares, these other things can help with lupus hair loss:

  • Eat a balanced diet with ample protein, fats, and micronutrients.
  • Get regular exercise which can help to keep stress in check.
  • Lower stress levels using stress-reduction techniques such as yoga, meditation, and breathing.

Vitamins, minerals, and other supplements may help to keep hair healthy. Biotin, a B vitamin, is often recommended for hair health, however, there is limited research to prove its effectiveness.

Other nutrients that may promote healthy hair include healthy fats including omega-3 fatty acids, vitamins A, B, C, and D, and minerals including zinc, iron, copper, selenium, calcium, and magnesium.

Interaction Warnings

Dietary supplements may interfere with some medications, it is important to talk to your rheumatologist or pharmacist before taking any supplements.

Styling Lupus Hair

The right hairstyle can help camouflage thinning lupus hair. Changing your part, cutting it shorter, or adding layers will give the illusion of thicker and fuller hair while hiding bald spots. Hair extensions, wigs, scarves, and hats can also be used to hide bald spots and thinning.

To minimize hair breakage, be gentle with your hair. Avoid heated styling tools like hot curlers, curling irons, and flat irons or straighteners. Blow-dry hair on cool or low settings. You should also not tease hair or secure it too tightly with an elastic or barrette and use caution when dying or bleaching hair.

Can Hair Transplants Treat Lupus Hair Loss?

Hair transplants may help people with lupus fill in bald patches caused by scarring alopecia as well as overall hair thinning.

A hair transplant is a surgical procedure that moves hair from one part of your body and implants it into bald spots. Hair grafting, the most common hair transplant procedure, removes small pieces of skin (a graft) with healthy hairs from the back of your head to transplant into bald or thinning areas. This is typically done by a dermatologist or plastic surgeon using a local anesthetic.

A hair transplant should only be considered if your lupus is well controlled. Otherwise, the underlying inflammation that contributed to hair loss in the first place makes it difficult for transplanted hair to become established.

Are There Tests To Diagnose Lupus-Associated Hair Loss?

Your rheumatologist may recognize your symptoms and be able to diagnose you based on your history, physical exam, and laboratory tests alone. In addition, non-lupus causes of hair loss, ranging from fungal infections to thyroid disorders should be ruled out, rather than simply assuming the hair loss is due to your lupus.

A biopsy of the scalp is sometimes needed to determine the exact reasons for hair loss. The procedure removes a small patch of skin that is examined under a microscope. Local anesthesia is typically used to numb the scalp before using a scalpel to take a skin sample.

This photo contains content that some people may find graphic or disturbing.

discoid lupus lesions on scalp
Discoid lesions on scalp.

DermNet / CC BY-NC-ND

When to See a Healthcare Provider

A health care professional should evaluate any type of excessive shedding or hair loss. Your hair loss may be caused by a condition other than your lupus, or you may have a combination of hair loss from lupus and something else.

Skin lesions on the scalp should be treated promptly to prevent scarring and permanent bald spots. Call your rheumatologist immediately if you have a lesion or rash on your scalp. You should also call the office if you are losing clumps of hair or if the hair loss coincides with starting a new medication.

People with lupus generally see their rheumatologist every three to four months. If you are experiencing mild hair loss, be sure to tell your healthcare provider at the next appointment.

While hair loss can be a side effect of certain medications, it is also associated with conditions unrelated to lupus, such as anemia and thyroid disease. Your doctor may take blood work to rule out other potential causes of hair loss.

Summary

Hair loss associated with lupus is typically due to an autoimmune response that attacks the scalp. This inflammation can lead to excessive hair shedding that causes overall thinning. Medications used to treat lupus can cause hair loss as well.

Lupus subtypes that affect the skin can also cause scalp lesions and clumps of hair to fall out. If not promptly treated, these lesions can scar leaving permanent bald spots. 

The primary treatment for lupus-related hair loss is managing the underlying autoimmune disease. Lupus-modifying medications include immunosuppressants, antimalarial drugs, and biologics.

Lesions are treated with topical immunosuppressants and corticosteroids, which can be applied topically or injected directly into lesions to speed healing and prevent scarring.

Hair loss can also be caused by other underlying health conditions, including thyroid disease and anemia. Excessive hair shedding and hair loss should be evaluated by your healthcare provider.

A Word From Verywell

Hair loss is common in people with lupus. While other lupus symptoms are concerning from a medical standpoint, hair loss often takes a toll on your emotional health. In addition to treating the underlying causes of hair loss, a good hair stylist can help. The right hairstyle can minimize the appearance of your hair loss and help you feel more confident.

Frequently Asked Questions

  • Is hair loss from lupus reversible?

    It depends. Lupus-related hair loss is often reversible once treatment begins, or in the case of drug-induced hair loss, when the offending drug is discontinued.

    Hair loss caused by lesions on the scalp, on the other hand, may be permanent if scarring is involved. Scarring alopecia is common in types of lupus that affect the skin, including discoid lupus.

  • What does lupus hair look like?

    The term "lupus hair" refers to broken hairs and hair regrowth of shorter hairs along the hairline.


  • What does lupus on the scalp look like?

    Some types of lupus cause lesions on the scalp. These can be perfectly round or misshapen patches that are red and covered in crusty scales. Hair loss is common at the site of these lesions.


  • What autoimmune disease makes your hair fall out?

    Autoimmune conditions that can cause hair loss include: 

    • Alopecia areata
    • Alopecia universalis
    • Crohn’s disease
    • Graves’ disease
    • Hashimoto’s disease
    • Lupus
    • Psoriasis
    • Rheumatoid arthritis
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Concha JSS, Werth VP. Alopecias in lupus erythematosus. Lupus Science & Medicine. 2018;5:e000291. doi:10.1136/lupus-2018-000291

  2. American Academy of Dermatology. Do you have hair loss or hair shedding?

  3. Saleh D, Cook C. Anagen effluvium. In: StatPearls.

  4. Udompanich S, Chanprapaph K, Suchonwanit P. Hair and scalp changes in cutaneous and systemic lupus erythematosus. Am J Clin Dermatol. 2018;19(5):679-694. doi:10.1007/s40257-018-0363-8

  5. Lupus Foundation of America. Medications used to treat lupus.

  6. Mayo Clinic. Prednisolone (oral route).

  7. Cleveland Clinic. Is my thyroid condition to blame for my hair loss?

  8. Gong Y, Ye Y, Zhao Y, et al. Severe diffuse non-scarring hair loss in systemic lupus erythematosus - clinical and histopathological analysis of four cases. J Eur Acad Dermatol Venereol. 2013;27(5):651-4. doi:10.1111/j.1468-3083.2011.04388.x

  9. Centers for Disease Control and Prevention. Diagnosing and treating lupus.

  10. Cleveland Clinic. Cutaneous lupus (skin lupus)

  11. Milam EC, Ramachandran S, Franks AG. Treatment of scarring alopecia in discoid variant of chronic cutaneous lupus erythematosus with tacrolimus lotion, 0.3. JAMA Dermatol. 2015;151(10):1113-6. doi:10.1001/jamadermatol.2015.1349

  12. Hosking AM, Juhasz M, Atanaskova Mesinkovska N. Complementary and alternative treatments for alopecia: A comprehensive reviewSkin Appendage Disord. 2019;5(2):72–89. doi:10.1159/000492035

  13. American Society of Plastic Surgeons. Hair transplantation and restoration: What hair transplant procedures are recommended for women?

  14. Ekelem C, Pham C, Atanaskova Mesinkovska N. A systematic review of the outcome of hair transplantation in primary scarring alopeciaSkin Appendage Disord. 2019;5(2):65–71. doi:10.1159/000492539

  15. Lupus Foundation of America. Hair loss and lupus.

Additional Reading

By Jeri Jewett-Tennant, MPH
Jeri Jewett-Tennant, MPH, is a medical writer and program development manager at the Center for Reducing Health Disparities.