Achy, swollen joints; fever; skin rashes; fatigue—these are some of the more typical Symptoms of systemic Lupus erythematosus (SLE), a chronic, inflammatory disorder of the immune system that affects several body systems simultaneously. Approximately 1.5 million people in the United States have some form of lupus, according to the Lupus Foundation of America.
SLE is classified as an autoimmune disorder because the body’s immune system, which normally fights harmful bacteria and viruses, also targets healthy tissue, sometimes including skin, joints, kidneys, brain, heart and lungs. The condition can result in immediately serious or life-threatening problems or in chronic low-grade symptoms, such as fatigue and muscle aches, which affect the quality of life.
Lupus is an autoimmune disease that causes swelling (inflammation) and a wide variety of symptoms. Lupus affects everyone differently. Some people have only a few mild symptoms and others have many, more severe symptoms.
Symptoms usually start in early adulthood, anywhere from the teen years into the 30s. People with lupus generally experience flare-ups of symptoms followed by periods of remission. That’s why early symptoms are easy to dismiss.
Early symptoms can include:
- hair loss
- pulmonary problems
- kidney problems
- swollen joints
- gastrointestinal problems
- thyroid problems
- dry mouth and eyes
About 90 percent of people with lupus experience some level of fatigue. An afternoon nap does the trick for some people, but sleeping too much during the day can lead to insomnia at night. It may be difficult, but if you can remain active and stick to a daily routine, you may be able to keep your energy levels up.
Speak to your doctor if you’re living with debilitating fatigue. Some causes of fatigue can be treated.
One of the early symptoms of lupus is a low-grade fever for no apparent reason. Because it may hover somewhere between 98.5˚F (36.9˚C) and 101˚F (38.3˚C), you might not think to see a doctor. People with lupus may experience this type of fever off and on.
A low-grade fever could be a symptom of inflammation, infection, or imminent flare-up. If you have recurrent, low-grade fevers, make an appointment to see your doctor.
Thinning hair is often one of the first symptoms of lupus. Hair loss is the result of inflammation of the skin and scalp. Some people with lupus lose hair by the clump. More often, hair thins out slowly. Some people also have thinning of the beard, eyebrows, eyelashes, and other body hair. Lupus can cause hair to feel brittle, break easily, and look a bit ragged, earning it the name “lupus hair.”
Lupus treatment usually results in renewed hair growth. But if you develop lesions on your scalp, hair loss in those areas may be permanent.
Skin rash or lesions
One of the most visible symptoms of lupus is a butterfly-shaped rash that appears over the bridge of the nose and on both cheeks. About 50 percent of people with lupus have this rash. It can occur suddenly or appear after exposure to sunlight. Sometimes the rash appears just before a flare-up.
Lupus can also cause non-itchy lesions in other areas of the body. Rarely, lupus can cause hives. Many people with lupus are sensitive to the sun, or even to artificial lighting. Some experience discoloration in the fingers and toes.
Inflammation of the pulmonary system is another possible symptom of lupus. The lungs become inflamed, and the swelling can extend to lung blood vessels. Even the diaphragm may be affected. These conditions can all lead to chest pain when you try to breathe in. This condition is often referred to as pleuritic chest pain.
Over time, breathing issues from lupus can shrink lung size. Ongoing chest pain and shortness of breath characterize this condition. It’s sometimes called vanishing (or shrinking lung syndrome). The diaphragmatic muscles are so weak they appear to move up in CT scan images, according to the Lupus Foundation of America.
People with lupus can develop a kidney inflammation called nephritis. Inflammation makes it harder for the kidneys to filter toxins and waste from the blood. According to the Lupus Foundation of America, nephritis usually begins within five years of the start of lupus.
- swelling in the lower legs and feet
- high blood pressure
- blood in your urine
- darker urine
- having to urinate more frequently at night
- pain in your side
Early symptoms may go unnoticed. After diagnosis, monitoring of kidney function is recommended. Untreated lupus nephritis can lead to end-stage renal disease (ESRD).
Painful, swollen joints
Inflammation can cause pain, stiffness, and visible swelling in your joints, particularly in the morning. It may be mild at first and gradually become more obvious. Like other symptoms of lupus, joint problems can come and go.
If over-the-counter (OTC) pain medications don’t help, see your doctor. There may be better treatment options. But your doctor must determine if your joint problems are caused by lupus or another condition, such as arthritis.
Some people with lupus experience occasional heartburn, acid reflux, or other gastrointestinal problems. Mild symptoms can be treated with OTC antacids. If you have frequent bouts of acid reflux or heartburn, try cutting down on the size of your meals, and avoid beverages containing caffeine. Also, don’t lie down right after a meal. If symptoms continue, see your doctor to rule out other conditions.
It’s not uncommon for people with lupus to develop autoimmune thyroid disease. The thyroid helps control your body’s metabolism. A poorly functioning thyroid can affect vital organs like your brain, heart, kidneys, and liver. It can also result in weight gain or weight loss. Other symptoms include dry skin and hair, and moodiness.
When a thyroid is underactive, the condition is known as hypothyroidism. Hyperthyroidism is caused by an overactive thyroid. Treatments to get your metabolism back on track are available.
Dry mouth, dry eyes
If you have lupus, you may experience dry mouth. Your eyes may feel gritty and dry, too. That’s because some people with lupus develop Sjogren’s disease, another autoimmune disorder. Sjogren’s causes the glands responsible for tears and saliva to malfunction, and lymphocytes can accumulate in the glands. In some cases, women with lupus and Sjogren’s may also experience dryness of the vagina and skin.
In Latin, lupus means wolf, and erythematosus means redness. Physicians who first described the disease thought that one of its characteristic rashes looked liked a wolf bite. The terms “SLE” and “lupus” are often used interchangeably, but there are several kinds of lupus, including:
- Systemic lupus erythematosus (SLE) can affect almost any organ or system in the body. In some people with systemic lupus, only the skin and joints are involved; in others, the joints, lungs, kidneys, blood or other organs and/or tissues are all affected. Any two people with systemic lupus will be unlikely to have all the same symptoms. Systemic lupus may include remission periods, during which few or no symptoms are evident, and “flares,” when the disease becomes active.
- Cutaneous lupus erythematosus, which includes discoid lupus (DLE), involves the development of lesions on the face or other sun-exposed areas. The lesions are abnormally red, hard bumps or plaques. They may include an overgrowth of scaly tissue, plugged hair follicles and abnormally widened small blood vessels. Thinning of the healing skin can be seen in active lesions as well as part of atrophic scarring. There can be a loss of color in the skin, called dyspigmentation in older lesions. If the condition involves the scalp, there may be permanent scarring and loss of hair. Lesions are usually on the face or other sun-exposed areas, but they can also occur in the mouth, nose or vagina. Many people have DLE without SLE. In approximately 10 percent of these cases, DLE later progresses to the more severe SLE. This is more likely to happen in patients with lesions both above and below the neck.
- Drug-induced lupus is caused by certain medications, the most common being: procainamide (Pronesyl), used for heart rhythm abnormalities, and hydralazine (Hydra-Zide), used for high blood pressure. Drug-induced lupus usually doesn’t affect the kidneys or central nervous system and typically improves within six months of when the drug is discontinued. There are also specific medications, such as hydrochlorothiazide and terbenifine, that can induce a specific form of cutaneous lupus, subacute cutaneous lupus.
- Neonatal lupus, a very rare condition in a small percentage of newborns whose mothers have lupus, results from the passage of autoantibodies from the mother to her baby, most commonly anti-Ro/SSA or anti-La/SSB, which can affect the skin, heart and blood of the fetus and newborn. The most common symptom of neonatal lupus is an uncomplicated rash that appears within the first several weeks of life and may persist for about six months before disappearing. Less frequently, fetuses with neonatal lupus develop a congenital heart block. However, many of these babies do well with a pacemaker at birth. If a fetal heart condition is identified early enough during pregnancy, it might be possible to treat it with steroids or immunosuppressive drugs.
In general, women are far more likely than men to develop autoimmune disorders, and SLE certainly fits that paradigm, occurring up to 10 times more frequently among adult women than among men. It is also more common in African-Americans, American Indians and Asians than in Caucasians. Although lupus can develop at any age, it is usually diagnosed in women during their childbearing years. Cutaneous lupus occurs more frequently in women, but the ratio of women to men is somewhat lower than with SLE.
If you have a parent, child or sibling with lupus, your risk of developing the disease is somewhat higher, although your health care professional probably won’t test you for the disease unless you develop symptoms. There is no known cure for SLE, but there are treatments designed to minimize symptoms and effects.
Lupus seems to result from a combination of genes and environment. Scientists think that people may inherit a predisposition to developing lupus but not lupus itself. People who inherit the predisposition to the disease may develop lupus after they come in contact with something that triggers it, such as a virus or medication.
The number and type of lupus symptoms vary widely among patients. Symptoms also tend to wax and wane, with patterns of inactive disease bracketed by lupus “flares.”
Diagnosing systemic lupus erythematosus (SLE) is not easy. Sometimes the disease announces itself decisively with a flare resembling an infection, but more often the early stages of the disease produce only vague symptoms such as aches, rashes or fatigue, which gradually worsen over time. Lupus symptoms can be easily confused with those of other diseases.
Symptoms of lupus depend on which body systems are affected. The most common symptoms include:
- arthralgia (joint pain)
- arthritis (joint warmth, swelling and redness)
- unexplained fever (over 100 degrees Fahrenheit)
- extended or severe fatigue
- skin rashes
- anemia (abnormally low red blood cell count)
- kidney damage
- alopecia (hair loss)
Less common symptoms include:
- pleurisy (chest pain when breathing deeply, caused by inflammation of the lungs’ lining)
- photosensitive rashes that appear after exposure to sunlight
- baldness on areas of the scalp
- Raynaud’s syndrome (fingers turning white or blue in the cold)
- seizures, psychosis and other neuropsychiatric problems
- mouth or nose ulcers
- pericarditis (chest pain caused by inflammation of the heart lining)
- phlebitis (blood clots)
Consult a health care professional as soon as possible if you have any of the symptoms listed above, whether singly or in combination. Multiple systemic symptoms indicate a stronger likelihood that lupus is the culprit, and a rheumatologist should evaluate you.
An evaluation for lupus consists of a thorough medical history, a physical examination and laboratory tests.
An initial diagnostic and disease activity screen usually includes a complete blood count, liver and kidney tests, blood tests for autoantibodies (increased antibodies that target healthy tissues and are an indicator of autoimmune disease), skin biopsy, urinalysis (to detect possible kidney disease), blood chemistry work-up and erythrocyte sedimentation rate (a measure of inflammation).
The antinuclear antibody (ANA) test detects autoantibodies that react against components of the nucleus, or “command center,” of your own cells. A positive test indicates a stimulated immune system, which is common in people with lupus. However, ANA is also positive in people with other conditions, such as systemic sclerosis, mixed connective tissue disease and rheumatoid arthritis. In addition, people without such disorders could have a positive ANA test. A positive ANA may also be found in people over 50.
Other autoantibody tests include anti-dsDNA, anti-Sm, anti-RNP, anti-Ro (SSA) and anti-La (SSB). Anticardiolipin or other antiphospholipid tests may indicate risk for a blood clotting disorder. In some cases, specialized diagnostic tests for the eyes, heart, lungs or brain, or a biopsy of the kidney may be performed.
Clearly, diagnosing lupus is a complex matter. If there is a reasonable likelihood that you have systemic lupus, you will need a referral to a rheumatologist.
If diagnosed at an early stage, treated promptly and monitored routinely, systemic lupus erythematosus (SLE) is rarely fatal. You should make sure that every health care professional you deal with knows you have lupus.
Whether your disease is mild or severe, you have to stay under close medical supervision. You should let your health care professionals know immediately if you suffer any injuries, get sick or plan to become pregnant because many things may cause your disease to flare.
Typical warning signs of a flare are:
- increased fatigue, malaise and muscle aches (like the flu)
- a new or higher fever
- increased pain or swelling in the joints, especially when you wake up
- development or worsening of a rash, particularly one that is made worse by the sun
- shortness of breath or pain when breathing
Keep an open dialogue with a health care professional whom you trust and can easily reach in an emergency. If you are experiencing a flare, it might be important to receive diagnostic tests, change medications or postpone certain elective procedures or surgeries.
Although a lupus pregnancy is considered high risk, many women with lupus can carry their babies safely to the end of the term if they plan the pregnancy with the help of a rheumatologist and receive care from an experienced high-risk obstetrical team. Women with lupus have a higher rate of miscarriage and premature births compared to women without the disease.
There are medications for lupus that are safe in pregnancy and important in controlling disease activity during pregnancy. Currently, more than half of women with lupus have pregnancies that are completely normal, 25 percent deliver healthy babies prematurely and less than 20 percent experience miscarriage or death of a baby. About 20 percent of pregnant women with lupus will develop preeclampsia, a form of dangerously high blood pressure that increases the risk of miscarriage, low birth-weight babies, premature births and injury to the mother.
Several over-the-counter and prescription medications are available to manage lupus symptoms including:
Monoclonal antibody. Belimumab (Benlysta) is a monoclonal antibody, a laboratory-produced molecule that mimics the disease-fighting properties of the body’s natural immune system. Approved by the U.S. Food and Drug Administration in 2011, it is the first new treatment for lupus in over half a century. Belimumab can be used to treat adults with active lupus who are also receiving standard therapy, such as corticosteroids, antimalarials, immunosuppressives and nonsteroidal anti-inflammatory drugs.
Delivered intravenously, it targets B-lymphocyte stimulator (BLyS) protein, which may reduce the number of abnormal B cells thought to be a problem in lupus. Studies showed that people treated with belimumab, along with standard therapies, experienced less disease activity. The drug also may reduce likelihood of severe flares and allow some people with active lupus to reduce their steroid doses. The most common side effects in the studies were nausea, diarrhea, fever and reactions at the intravenous infusion site.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, as well as aspirin.
Corticosteroids. These drugs, including prednisone (Deltasone), prednisolone (Prelone), hydrocortisone (Cortef) and methyl-prednisolone (Medrol), suppress the immune system and reduce inflammation. They can be taken orally, given through injection or used in cream formulations to treat skin lesions. However, they can lead to numerous side effects, including acne, weight gain, diabetes, cataracts, cardiovascular problems and heightened susceptibility to infections.
People with lupus are especially prone to weakened or damaged bones, a side effect of high-dose or long-term corticosteroid treatment. People with lupus who take corticosteroids should talk to their health care professionals about taking vitamin D, calcium or other treatments to prevent osteoporosis.
Antimalarial drugs, such as hydroxychloroquine sulfate (Plaquenil) and chloroquine (Aralen), can control a variety of lupus systems including arthritis, skin rashes, mouth ulcers, lung rashes, fatigue and fever. They promote healthy blood vessels and have an anti-inflammatory effect. Side effects of antimalarials include nausea or diarrhea and, in rare cases, damage to the retina of the eye.
A person taking antimalarial treatment should be examined by an eye doctor every six months to a year to prevent unnecessary optical damage. The beneficial effects of these treatments on symptoms are often slow at the beginning. It may take weeks or months for these medications to make an impact.
Chemotherapy. Under some circumstances, chemotherapeutic drugss like methotrexate (Folex, Trexall, Rheumatrex), mycophenolate mofetil, azathioprine (Asasan, Imuran) and cyclophosphamide (Cytoxan) may be used to control symptoms of lupus. These are immunomodulating drugs, and they have some side effects, such as nausea, diarrhea, mouth ulcers, rashes, liver toxicity and bone marrow suppression, usually leading to low white blood cell counts.
Cyclophosphamide, which may be used to suppress the immune system and inflammation, can be used safely, with care, but can have significant side effects, including gastrointestinal complications, hair loss and greater risk of infection. Methotrexate can cause inflammatory damage to the lung or liver.
Other therapeutic agents. Drugs like cyclosporine, a strong immunosuppressive agent that is used primarily in organ transplant patients, may sometimes be used to control symptoms of lupus. There is a potential for kidney damage with cyclosporine.
Anticoagulant medications. To help prevent blood clots, a serious complication of lupus, medications that help thin your blood—called anticoagulants—may be prescribed. These drugs include low-dose aspirin, heparin (Calciparine, Liquaemin) and warfarin (Coumadin). If you take anticoagulants, your health care professional will monitor you to make sure your blood doesn’t become too thin.
Topical steroids and nonsteroidal T cell inhibitors. Skin lesions can also be treated with topical steroids and topical nonsteroidal T cell inhibitors such as tacrolimus or pimecrolimus.
While there is no way to prevent systemic lupus erythematosus (SLE), there are things you can do to reduce the risk and severity of lupus flares. There are also ways to reduce the potential side effects of medications used to treat the disease.
The first step is exercise. Getting low-impact, aerobic exercise regularly can reduce joint stiffness, lower stress levels and help prevent osteoporosis, weight gain and heart problems that may be caused by medications.
It is also important to determine which environmental factors may trigger your lupus flares.
Triggers may include:
- Light. Exposure to the ultraviolet sunlight (and, to a lesser extent, fluorescent and halogen lights) can lead to a skin rash and worsen other lupus symptoms. It helps to wear protective clothing and use sunscreen when outdoors. It is best to use a sunscreen that protects from both UVA and UVB light. Also remember that some UV light penetrates glass, including car windows. Try filters on windows to block UV light.
- Stress. People with lupus often link worsening symptoms or flares to stressful events such as divorce, job change or a death in the family. It is important to recognize that stress did not cause the immune imbalance of lupus and that it is OK to seek help when facing a chronic and sometimes disabling pattern of symptoms. Try not to underestimate the support you could get from family, friends, health professionals or workplace human resource services. It is equally important not to put your life on hold. Using common sense and getting plenty of rest and exercise is a good antidote to stress. Putting your life on hold and going to bed for the rest of your life is not.
- Overwork or lack of rest
- Injuries or surgery
- Pregnancy and childbirth
- Suddenly halting lupus medications
- Sensitivities or allergies to items such as hair dye, hair permanent solution, makeup and skin creams
- Certain over-the-counter medications such as cough syrup or laxatives
There are many potential lupus treatments currently being studied in clinical trials that may become mainstream therapies in the future. Examples include tocilizumab (Actemra), a drug approved for the treatment of rheumatoid arthritis that helps block the activity of interleukin-6 (IL-6), which may help reduce inflammation in people with lupus; epratuzumab, an antibody that binds to a protein called CD22 on B cells, which blood cells known to be hyperactive in many people with lupus; and stem cell transplants. In addition, there are a number of studies looking at new medications for cutaneous lupus.
Facts to Know
- Systemic lupus erythematosus (SLE) is a disease in which your body’s immune system targets healthy tissue. Normally your immune system works by creating and dispatching antibodies, cells and special chemicals that react against antigens (molecules that lie on the surface of disease-causing viruses and bacteria). In lupus, antibodies attack normal tissue; potential targets for attack include the skin, joints, kidneys, brain, heart and lungs. In fact, this occurs in all healthy people to some extent. There is nothing bizarre about the autoantibodies or the inflammation of lupus; it is simply a matter of imbalance.
- Approximately 1.5 million Americans have some form of lupus, and according to the Lupus Foundation of America, because some cases go undiagnosed, that number is probably higher. Women constitute at least 90 percent of lupus cases. Lupus is more common in African-Americans, American Indians and Asians than in Caucasians.
- There are several types of lupus that have specialized names: systemic lupus erythematosus (SLE), which can affect almost any organ system in the body; primary cutaneous lupus (the most common form is discoid lupus) involving mainly the skin; drug-induced systemic lupus erythematosus, a temporary reaction to certain drugs; and neonatal lupus, which occurs in babies born to mothers who had autoantibodies. A diagnosis of any of these types of lupus can be confusing because it can be serious and life threatening but is often mild to moderate in most people, especially with careful diagnosis and treatment.
- The diversity of symptom type and severity can make lupus difficult to diagnose. Mild cases can go undiagnosed for years, and no single lab test can detect the disease. It is important to understand that a positive antinuclear antibodies (ANA) test alone does not give a person a diagnosis of lupus.
- SLE symptoms tend to wax and wane. Patterns of inactive disease and lupus “flares” come and go. Lupus can be unpredictable; symptoms as well as the flare cycle may change at any time.
- If you have a parent, child or sibling with lupus, your risk of developing the disease is somewhat increased, but it is not usually a very high risk and is not considered enough to warrant testing in the absence of symptoms. A positive ANA is common in family members of people with lupus and does not necessarily mean they will develop lupus.
- Many women with lupus can have healthy babies with proper diagnosis and management.
- Exposure to UV light can lead to a skin rash and worsen other lupus symptoms. If you have lupus, wear protective clothing and use sunscreen (SPF 30 or greater) when outdoors, and remember that some UV light penetrates glass, including car windows. Try to use sunscreen that protects against both UVA and UVB light. Studies indicate that sunscreens that contain ecamsule (Mexoryl) in addition to SPF block of 60 or higher can be particularly effective for photosensitive patients.
- A chronic, unpredictable, waxing and waning illness is extraordinarily stressful. It may help to develop a plan for dealing with stressful situations that includes a support system of family and friends, health care professionals and community organizations. It is important to pace yourself, but it is equally important not to put your entire life on hold.
- Lupus is not preventable or curable, but symptoms can be treated and flares minimized through medications and reasonable lifestyle modifications.
- What causes lupus?The immune system of a person with lupus is unbalanced, and this leads to excess targeting of normal tissue, causing inflammation, fever, achy joints, rashes and other problems. Virtually all systemic lupus patients have autoantibodies in their blood at concentrations that can be detected by lab tests.
- What are my risks for having lupus?There is no way to predict who will get lupus and who won’t. Women of childbearing age comprise the vast majority of cases, and the disease occurs more frequently in African-Americans, American Indians and Asians than in Caucasians. Lupus seems to result from a combination of genes and environment. Experts think people may inherit a predisposition to developing lupus, but not lupus itself. People who inherit this predisposition may develop the disease after they come in contact with something that triggers it, such as a virus or medication.
- Is there anything I can do to prevent lupus?No. The disease is treatable and flares are controllable, but no one has discovered means of limiting your chances of developing the disease.
- What are the most common symptoms of lupus?The more common symptoms of lupus include joint pain, arthritis, unexplained fever, extended or severe fatigue, skin rashes, anemia and kidney damage. Other symptoms include neuropsychiatric problems, such as seizures, blood clotting problems, light sensitivity, hair loss, Raynaud’s syndrome (fingers turning white or blue in the cold) and mouth or nose ulcers.
- Is lupus curable?Lupus is not curable, but it is treatable. Your health care professional can prescribe medications to alleviate symptoms, such as pain and inflammation. You can take action as well, by eating right, exercising, avoiding sunlight and getting plenty of rest.
- Is it safe to have a baby even though I have lupus?Less than 20 percent of lupus pregnancies end in miscarriage or stillbirth and about 25 percent are premature births. Preeclampsia is a potentially life-threatening condition that seems to occur more frequently in lupus patients. The risk for these outcomes increases if you have antiphospholipid antibodies. The good news is that appropriate treatments and specialized care from a high-risk OB team can markedly increase the odds for a successful and safe pregnancy. One to 2 percent of babies born to mothers with certain autoantibodies (SSA-Ro and/or SSB-La) are born with neonatal lupus, a condition that often resolves itself within three to six months. If you have these antibodies, you may need a fetal echocardiogram during your pregnancy. In most cases, this will lead to reassurance that the baby is fine.
- What drugs are available to treat lupus?Drugs prescribed for lupus include nonsteroidal anti-inflammatory agents, such as aspirin or ibuprofen; acetaminophen; belimumab (Benlysta), a new monoclonal antibody; antimalarials such as hydroxychloroquine (Plaquenil) and chloroquine (Aralen); corticosteroids such as prednisone or methylprednisolone; immune suppressants such as azathioprine (Imuran, Asasan); methotrexate (Rheumatrex, Trexall); mycophenolate mofetil (CellCept); cytotoxic drugs such as cyclophosphamide (Cytoxan) and anticoagulants such as heparin (Calciparine, Liquaemin) and warfarin (Coumadin). Topical medications such as steroids and nonsteroidal T cell inhibitors (tacrilimus, pimecrilimus) can be helpful for skin lesions.
- How can flares be prevented or the symptoms lessened?A lupus flare can occur for no discernible reason, although some patients believe that they have experienced triggers for the flares, such as sunlight, stress, overwork, infection, injuries, surgery and immunizations.
- If some of my hair falls out, will it grow back?Generalized hair loss can be due to systemic lupus or the treatments. It is usually temporary and grows back. A severe flare may cause hair to be brittle and break off, but hair should grow normally after the flare subsides. If your hair loss occurs in patches on the scalp, find out whether advanced scarring is present: if so, hair is unlikely to grow back, but if not, it may regrow. Check with your health care professional to understand which situation is most likely to apply to you.If it is likely to be permanent hair loss, look for “alopecia” support sites. You’ll find many people dealing with hair loss due to lupus or other diseases. Consider your options: They include changing your haircut; wearing wigs, hats, scarves, turbans or hair weaves; trying hair growth products or hair replacement; or not bothering to conceal it at all. If you choose a wig, look for good quality and a color that suits your skin tone. A different hairstyle can conceal patches of hair loss, and a shorter cut can make thinning hair look fuller. Choose a style that flatters your facial shape, whether it’s the same as always or rounder due to corticosteroid treatment.
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