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You are here: Home / Articles / Tips for Treating Lupus-Related Renal Disease, Pain, Alopecia

Tips for Treating Lupus-Related Renal Disease, Pain, Alopecia

January 19, 2018 • By Susan Bernstein

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In lupus patients with alopecia arreata, a gentle hair pull test may reveal dystrophic androgen hairs, and a dermoscopy often shows “exclamation point” hairs. Biopsy of these patients may show mononuclear cell infiltrate and mucin deposition, as well as inflammatory cells around the hair follicle that look like swarms of bees, she said. Direct immunofluorescence may show signs of inflammation.

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Patients with tightly pulled hairstyles may also have traction alopecia, she said. Lupus patients with alopecia should avoid sun exposure and wear hats, said Dr. Werth. “If you can see through the hat, it’s not good enough for sun protection,” she added. Treatments include topical and intralesional steroids, topical tacrolimus or pimecrolimus, antimalarials, methotrexate and, in severe cases, thalidomide or lenalidomide. Hair weaves or hairpieces help conceal areas of permanent hair loss, she concluded.

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Susan Bernstein is a freelance journalist based in Atlanta.

References

  1. Okpechi IG, Ayodele OE, Jones ESW, et al. Outcomes of patients with membranous lupus nephritis in Cape Town, South Africa. Nephrol Dial Transplant. 2012 May;27(9):3509–3515.
  2. Hahn BH, McMahon MA, Wilkinson A, et al. American College of Rheumatology guidelines for the screening, treatment and management of lupus nephritis. Arth Care Res. 2012 Jun;64(6):797–808.
  3. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012 Nov;71(11):1771–1782.
  4. Wiedenbusch M, Rommele C, Schrottle A, et al. Beyond the LUNAR trial. Efficacy of rituximab on refractory lupus nephritis. Nephrol Dial Transplant. 2013 Jan;28(1):106–111.
  5. Birnbaum J, Bingham CO III. Non-length-dependent and length-dependent small-fiber neuropathies associated with tumor necrosis factor (TNF)-inhibitor therapy in patients with rheumatoid arthritis: Expanding the spectrum of neurological disease associated with TNF-inhibitors. Semin Arthritis Rheum. 2014 Apr;43(5):638–647.
  6. Sommer C, Lauria G. Skin biopsy in the management of peripheral neuropathy. Lancet Neurol. 2007 Jul;6(7):632–642.
  7. Chai J, Herrmann DN, Stanton M, et al. Painful small fiber neuropathy in Sjogren syndrome. Neurology. 2005 Sep;65(6):925–927.
  8. Werth VP, White WL, Sanchez MR, et al. Incidence of alopecia arreata in lupus erythematosus. Arch Dermatol. 1992 Mar;128(3):368–371.

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Meeting Reports, SLE (Lupus) Tagged With: AC&R, ACR/ARHP Annual Meeting, alopecia, American College of Rheumatology, Lupus, Pain, patient care, Renal, rheumatologist, TreatmentIssue: January 2018

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