All types of lupus erythematosus (LE) may induce hair loss. Nonscarring alopecia correlates with systemic LE based on its high specificity. Discoid LE may also emerge as nonscarring patches in the early stages. Patchy alopecia LE-specific may mimic alopecia areata (AA) – which can co-exist with LE. A mindful distinction is fundamental to early diagnosis and effective treatment. The present study analyzed clinical, epidemiological, trichoscopic and histopathological features of patients with patchy LE-specific alopecia, nonscarring type, mimicking AA. It reviewed patients′ medical records with a confirmed diagnosis of LE mimicking AA. 

The study observed:

• Inclusion of 10 patients (90% female) with a mean age of 45.9 years for the study.
• Erythema in 60% and incomplete hair loss in 70% of the patients, clinically.
• The common occurrence of interfollicular arborizing vessels (90%) and scattered brown discoloration (80%) in trichoscopy.
• Perivascular inflammation (85.7%), peribulbar lymphocytes (85.7%) and dermal pigment incontinence (71.4%) in most cases, in histology. 

This study describes trichoscopy as an essential first step for diagnosing patchy alopecia, enabling the differentiation of LE from AA. A trichoscopy increases diagnostic accuracy with better outcomes for patients by raising suspicion that leads to a biopsy.

Source: Melo DF, Müller Ramos P, Iorizzo M, et al. Epidemiological, clinical, trichoscopic, and histopathological features of lupus erythematous mimicking alopecia areata: a multicenter retrospective study. Skin Appendage Disord. 2022;8(3):236-40.