Hair loss in Rheumatic Diseases

All women, more so Indian women, take pride in having long, lustrous flowing hair. But one problem that all face, at some point in their lives, is hair loss. This can happen with increased severity in patients with Rheumatic diseases. There are multiple reasons for this – general causes such as harsh handling of hair, stress, lack of nutrients in diet and body, other ailments, rheumatic illness itself and medication induced. There are 2 types of hair loss – generalized, and localized.

How do we go about minimizing hair loss?

First of all – avoid harsh handling of hair. Oil well before hair wash. Do no use harsh shampoos. Use luke warm water, neither too hot nor too cold. After shampoo wash, if you are using a conditioner, rub small quantity on the hair, do not rub over the scalp. Do not comb extremely wet hair. Run the comb gently only after half dry. Do not tie hair very tightly. Leave it open/loose intermittently if possible.
Stress of any kind increases hair loss, so try to stay calm, sleep adequately, read good books, see happy movies, stay cheerful – try to look at positives rather than negatives.

Regarding nutrition, your diet should have adequate fruit, vegetables and proteins. Deficiency of iron, vitamins like C, D, folic acid and B12 should be corrected by supplements. Biotin is an important vitamin for hair loss. It is available in tablet for adults and syrup for children.

There are other ailments like hypothyroidism (fig 1.), which many patients with Rheumatic diseases have, that can cause coarse and sparse hair with increased hair loss. Thyroid tests should be done as a baseline in all patients and then once year. Those who need thyroid medications should test more frequently as advised by the doctor.

Fig 1. Diffuse hair loss in a female with hypothyroidism
Keen MA, Hassan I, Bhat MH – Indian journal of dermatology (2013)

Among Rheumatic diseases, patients with SLE, Scleroderma, and MCTD can have severe hair loss. In these cases, there is usually a generalized hair loss. Localized can be a male pattern of baldness or frontal hair loss that is usually hormonal, often perimenopausal. In SLE there can be generalized excessive hair loss (fig 2.) or there are localized patches of scarring alopecia called cicatricial alopecia (fig.3) which is seen in discoid lupus.

Fig. 2. Generalised alopecia in a young girl of SLE

Fig 3. Scarring / cricatracial alopecia in Discoid lupus
https://www.actasdermo.org/en-scarring-alopecia-articulo-S1578219012001709

In all Rheumatic disorders, hair loss is often medication induced – most common with Methotrexate and Leflunomide. One must take adequate supplements of vitamins and iron as mentioned above. In case hair loss is excessive you can discuss with the doctor for reduction in dosage or change of medication. If that cannot be done, because of risk of flare of the disease, you can try to use Minoxidil scalp lotion every night. It is available as solution and foam (2.5, 5 and 10% ). If that also doesn’t work, for severe cases, one has the option of false hair or wigs (partial or complete). You will be amazed to know how many celebrities suffer from severe hair loss.

At the end of the day, what matters is that you as a woman, stay confident and happy.. so keep smiling.. Let hair loss not depress your morale and spirit! Take care.