Hair loss: Risk factors for ‘irreversible’ shedding may include lichen planus and lupus

The life source of hair follicles is stem cells that sit beneath the epidermis. When these come under attack, hair can begin to shed. The spectrum of hair loss conditions is broad, but at the severe end stands “scarring alopecia”, which is irreversible. Two rash-inducing conditions that are common in the UK, are known to drive this type of permanent hair loss.

Scarring alopecia – also known as cicatricial alopecia – occurs when inflammation replaces the hair follicle with scar tissue.

The condition remains rare, affecting only three percent of hair loss patients, but it can strike otherwise healthy men and women of all ages.

Two rash-inducing conditions interlinked with scarring alopecia are lupus and lichen planus.

Lupus is an autoimmune disease that occurs when the connective tissue comes under attack from the immune system by mistake.

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This can cause significant collateral damage to some of the vital organs, such as the joints, kidneys, brain and heart.

The condition is currently believed to affect several tens of thousands of people in the UK.

In fact, the Lupus Association UK states there are 50,000 people thought to be living with the condition, which equates to an incidence rate of roughly one in 1000 individuals.

The signs of the disease are wide-ranging and ill-defined, but a key characteristic is a butterfly-shaped rash that bridges the nose and upper cheeks.


Swelling around the joints, heightened sensitivity to sunlight, and mouth ulcers can also compromise the sufferer’s quality of life.

According to JAMA, lupus is a “common cause of scarring alopecia among patients with scalp involvement”.

The health body continues: “The inflammatory cell infiltrate is especially prominent around the hair follicle at the levels of the sebaceous gland and bulge – the location of the hairs regenerative stem cells.”

Lichen planus, on the other hand, is defined by Hopkins Medicine as a “common disease that causes inflammation on your skin and inside your mouth”.

The body continues: “On your skin, lichen planus causes a rash that is usually itchy. Inside your mouth, it may cause burning or soreness.”

The reaction can develop as a result of exposure to hepatitis C, certain drugs to treat high blood pressure and diabetes, or metal fillings in the teeth.

Occasionally, lichen planus emerges as an autoimmune disease when the skin cells inside the mouth come under attack.

The condition can be broken down into several subtypes, and the one linked to hair loss is lichen planopilaris.

According to Dermnetz, lichen planopilaris is characterized by patchy, progressive loss of hair that affects mainly the scalp, although brows and pubic hair can sometimes be affected.

It is important to consult a doctor as soon as hair loss starts to reveal patches of bare skin, as there may still be a chance to restore hair follicles.

Depending on the cause of hair loss, dermatologists will opt for one of several treatments, ranging from steroid creams to medication that suppresses the immune system.

If treatment isn’t administered on time, the condition may progress to the scarring phase, whether the follicles become permanently destroyed.

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