Do Autoimmune Conditions Cause Hair Loss?

Hair loss (alopecia) can be devastating for many people, and that’s understandable. Hair loss can affect quality of life and the way people feel about themselves. And it can happen for a lot of reasons. Common causes of hair loss include aging, stress, and genetics. This is seen in conditions like androgenetic alopecia (AGA), which is a hereditary pattern hair loss in men and women due to hormone changes. 

Less commonly, autoimmune conditions cause hair loss. If you have hair loss, you may be wondering if you have an autoimmune condition. If you have hair loss and an autoimmune condition, you might be wondering how the two are related. Let’s take a closer look at when to get help for your hair loss — and what to expect when you do.  

Which autoimmune diseases can cause hair loss?

Several autoimmune diseases can cause hair loss. We can break them down into conditions that affect only the hair and conditions that affect other parts of the body, too.

Autoimmune conditions that affect only the hair include the following.

Alopecia areata

Alopecia areata (AA) typically causes nonscarring, patchy, round, or oval bald spots on the head. It may also occur anywhere there’s body hair. Alopecia areata affects nearly 700,000 people in the U.S. It can affect people of any race, gender, or age, but is more likely to be diagnosed:

• Early in life (40% of people are diagnosed before age 20)

• In women

• In people of certain ethnicities (more common in Asian, Black, and Latino people)

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Alopecia totalis 

Alopecia totalis (AT) is a more severe and rare nonscarring type of alopecia areata that may cause loss of all hair on the head and/or body. AT is much less common than alopecia areata, but the number of cases have been increasing in recent years. AT is more likely to affect young adults and children, and affects men and women equally.

Lichen planopilaris

Unlike alopecia areata and alopecia totalis, lichen planopilaris (LP) is a very rare, scarring cause of permanent hair loss. LP shows up as smooth white patches on the scalp, with hair loss and loss of the hair follicle. LP is more likely to:

• Affect young adult women, although it can start later in life and affect men.

• Be associated with lichen planus, a condition that causes small bumps on the skin.

• Occur mainly on the scalp, although any hairy area of the body may be affected.

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Frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris. FFA is a pattern of scarring baldness and can typically affect:

• Frontal hairline

• Eyebrows

• Limbs

• Beard or sideburns

FFA is more common in postmenopausal white women, but it can affect people of any race, gender, or age. Although FFA is rare, its incidence is increasing worldwide.

Some autoimmune conditions have more systemwide effects and can affect the hair as well as other body parts. These autoimmune diseases that can cause hair loss along with other symptoms include the following.

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus (SLE)can affect every system in the body. Symptoms often include:

• Joint pain

• Kidney problems

• Skin rashes or sores

• Swelling of the face or limbs

• Heart or lung problems

Lupus is thought to lead to hair loss by causing inflammation around the hair follicle and interrupting the hair growth cycle.

Discoid lupus (DLE)

Discoid lupus (DLE) is a skin condition that affects mostly the scalp, face, and ears. Inflammatory, scaly plaques can cause skin issues that lead to:

• Scarring

• Thinning

• Discoloration

• Hair loss

Autoimmune hypothyroidism

Autoimmune thyroid issues like Hashimoto’s thyroiditis can result in hypothyroidism and hair loss. Thyroid hormone is needed for all growth in the body. When thyroid hormone levels (like T4) are low, the hair growth cycle is slowed down — causing thinning and loss. Other symptoms of hypothyroidism can include:

• Dry skin

• Weight gain

• Constipation

• Cold sensitivity

Autoimmune hyperthyroidism

Autoimmune thyroid conditions like Graves’ disease can lead to hyperthyroidism and hair loss. Experts aren’t entirely clear on why hyperthyroidism causes hair loss. When thyroid hormone levels are high, it signals the hair shaft to weaken and interrupts the hair growth cycle. Treatment for hyperthyroidism may also be a factor in hair loss. 

Hyperthyroid conditions are also marked by:

• Weight loss

• Rapid heart rate

• Diarrhea

• Goiter 

Dermatomyositis

Dermatomyositis causes inflammation in the skin and muscles. Chronic inflammation in areas of the skin can cause damage to the hair follicles and significant hair loss. People with dermatomyositis can also have:

• Muscle weakness

• Rashes

• Fatigue

• Joint pain

• Breathing difficulty 

Localized scleroderma

Scleroderma is an autoimmune condition in which inflammation causes the hardening of the skin. This can also cause damage to the hair follicles and lead to hair loss. Symptoms on other affected areas of the skin include:

• Thickened, shiny skin patches

• Joint pain

• Headaches

• Vision changes

Other autoimmune skin disorders

Certain autoimmune disorders of the skin can affect the skin where hair normally grows. These rashes produce inflammatory blisters on the skin that can lead to hair loss. Autoimmune skin disorders can cause hair loss by disrupting the hair growth cycle or by directly damaging or destroying the hair follicle. This includes conditions like:

• Pemphigus vulgaris

• Pemphigoid

• Dermatitis herpetiformis

How do you diagnose autoimmune conditions?

It depends. There are many different autoimmune conditions, and most of them can’t be diagnosed with a single test. Some are tougher to diagnose than others. Diagnosis frequently involves:

• Physical exam: A healthcare professional will determine where the hair loss is located. They’ll look for other signs, like blisters, scales, thickening of the skin, discoloration, and scarring.

• Blood tests: Tests such as a complete blood count, electrolytes, and hormone levels are often ordered. Special blood tests that look for antibodies associated with specific autoimmune conditions can also help narrow down the diagnosis.

• Biopsies: Small amounts of the affected areas can be surgically removed to look at under the microscope. This allows the healthcare professional to check for inflammation and to see which specific hair structures are being affected.

Different types of healthcare professionals may diagnose and treat autoimmune conditions. Oftentimes, the specialist in charge depends on which part of the body is affected. For example:

• Dermatologists treat skin, hair, and nail problems, including autoimmune hair loss.

• Rheumatologists treat autoimmune disorders, such as rheumatoid arthritis and lupus.

• Endocrinologists treat hormone disorders, including autoimmune hypothyroidism.

In many cases, a healthcare team will come together to help people with autoimmune disease.

What treatment options are available for hair loss due to autoimmune disease?

When autoimmune disease causes hair loss, the goal isn’t just to reverse the hair loss. It’s to treat the cause itself. You might think of treating autoimmune conditions like fixing a leaky faucet. You can clean up the mess with a bunch of towels, but after a while, there will be another puddle on the floor. Fixing the leaky faucet is a better long-term fix. And how to fix the leaky faucet depends on the cause.

FDA-approved medications to treat alopecia areata are immunosuppressive medications. These include: baricitinib (Olumiant) and ritlecitinib (Litfulo). These medications can increase the risk of infections. So healthcare professionals might try other “off-label” treatments first, which have less potential for side effects. 

Off-label medications aren’t FDA approved, but studies have shown that they’re reasonably safe and effective options. Other autoimmune hair loss treatments can include:

• Steroids (topical, oral, or injectable)

• Minoxidil (Rogaine)

• Anthralin (Zithranol)

• Methotrexate

• Dupilumab (Dupixent)

• Tofacitinib (Xeljanz)

When it comes to hair loss caused by autoimmune conditions that affect several parts of the body, the trick is to treat the underlying condition. In other words, if your hair loss is due to lupus, treatment for lupus can help. Some conditions respond better to treatment than others, so ask a healthcare professional what to expect from treatment. 

When should you get care for hair loss?

It’s normal to lose about 50 to 100 hairs a day. You know your body best, so if you think there’s something off, it’s a good idea to get medical attention. Talk with a healthcare professional about hair loss if:

• You’re losing more hair than usual.

• You notice patchy bald spots.

• You experience other symptoms (like rashes, changes in your weight, or joint pain).

What causes autoimmune disease?

This is the million-dollar question. Experts don’t know exactly what causes autoimmune disease. But they do know they’re related to two things: genetic risk factors (genes) and the environment. 

Some genes increase the chances of developing autoimmune disease one day. This explains why people with first-degree relatives who have autoimmune diseases are more likely to develop those conditions than other people. 

Your environment (what you are exposed to) also plays a role. Something (like an infection) might get the immune system’s attention. The immune system wakes up to get rid of what doesn’t belong, but sometimes it gets confused. It starts attacking your own body instead, causing the autoimmune condition. 

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Written by:

Tracy Norfleet, MD, FACP

Dr. Tracy Norfleet is a board-certified Internal Medicine physician, health expert, and physician leader with over 20 years of experience practicing adult medicine. Dual-certified by the American Board of Obesity Medicine and the American Board of Lifestyle Medicine, Dr. Tracy possesses a wealth of knowledge and expertise in both traditional medical practices and innovative lifestyle interventions for chronic disease management and reversal.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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