Is my hair loss due to butterfly rash in lupus?

Question

Hello doctor,

Last summer, I sat in the sun for a few hours tanning. Nothing to drink and I used two oils on me. My face and chest have been red ever since. After then, I donated my blood and they sent a letter saying about some blood cells.

I had my appointment with a rheumatologist and got blood work done and I guess it had come back stating I had lupus. Everything has cleared up on me with the redness except my so-called buffer fly rash.

What do I do?
I am starting to get annoyed also. This week I have also started to notice my hair has been thinning and I have a weird bald spot on top of my head which in fact I have not had my hair cut trimmed in over a year or two. So what would you think about that also?

Last year, I had pain in my knuckles in the winter every morning I would wake up but not come back that is the confusing part. I am starting Prednisone tonight to see if that helps and I am on Topamax and Adipex right now those are it.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your history and images. (attachment removed to protect patient identity).

Your rash seems still very florid and the alopecia is setting in. I am not sure about the medications you are taking as it does not show up on the phone app, but you need to increase your medicines. Oral steroids are needed in your case. It will stop hair fall and improve the rash. Although they do come with side effects of weight gain and increased hair over the face, they will help to stop the disease process.

I am sure you are already on Hydroxychloroquine which would continue for a long time. Topical steroids are not recommended for the face as they can cause scarring. Topical Tacrolimus creams are helpful. Lastly, I would like to know if there are any major organs involved in your case. From the history, it looks like minor organ lupus only, but the remaining workup is essential to be sure.

I hope it helps.

Thank you.