Many disorders that scar the skin also affect the scalp. Systemic lupus erythematosus, when associated with high fever and extensive systemic involvement, can cause a diffuse anagen effluvium. Hair loss caused by localized discoid lupus erythematosus (DLE) is more common. DLE may affect the scalp, where it is seen as circumscribed areas of often irreversible hair loss. Redness, flaking, and follicular plugging are evident (A and B). With early treatment, hair follicles may frequently be salvaged before extensive scarring can occur.
If you suspect that a patient's hair loss is caused by DLE, a biopsy can confirm the diagnosis. Only a minority of patients with DLE of the scalp have systemic involvement. Early intervention with intra-lesional and topical medication may minimize hair loss in many cases.