Answer:

At this time, not much has been written about hair loss specific to scleroderma. However, since there are many reasons for hair loss, we will review a few in an effort to bring some understanding to this question.

Medications may cause loss of hair. Some medications commonly used in the treatment of scleroderma could possibly be the culprit in your hair loss. Cyclophosphomide, methotrexate, corticosteroids, hydroxychloroquine, calcium channel blockers and antidepressants are a few medications that can cause hair loss in some people.

Hormone imbalances such as over or underactive thyroid can cause hair loss. Psychological stress, severe chronic illness, or a severe infection are a few of the causes of a condition known as telogen effluvium. Telogen effluvium seems to come on suddenly and patients will notice a diffuse thinning of the hair on their scalps. Patients often notice that they are losing “handsful” of hair while shampooing or combing their hair. This hair loss actually occurs several weeks to several months after the precipitating stressor.

Keep in mind that it is normal to shed up to about 100 hairs a day on one’s comb, brush, in the sink or on the pillow. This is the result of the normal hair growth cycle. Hairs will grow for a few years, then rest for a few months, shed, and regrow. Telogen is the name for the resting stage of the hair growth cycle. A telogen effluvium is when some stress causes hair roots to be pushed prematurely into the resting state.

The most important issue in telogen effluvium is to determine if an underlying cause for the problem is present. Blood tests may need to be done if the cause is not obvious, such as mild iron deficiency. If the telogen effluvium is caused by a medication, the medication needs to be stopped. When the cause of the hair loss is something like giving birth, a transient illness, or other self-limited problem the induced telogen effluvium is also usually self-limited and requires no treatment.

Medscape reports the following regarding hair loss and scleroderma. Scarring alopecias cause permanent hair loss and have in common the destruction of the hair follicles. Lesions show the loss of follicle orifices. So far, a broadly accepted classification system of sarring alopecias does not exist. The list of scarring alopecias is vast because many diseases of the skin involve the bulb of the follicles and may cause permanent damage to hair follicles. These are secondary scarring alopecias: for example, systemic scleroderma or linear scleroderma en coup de sabre, dermatomyositis, sarcoidosis, and pemphigoid.

To try to determine the reason for your hair loss, your physician will look at the areas and pattern of loss, the bulb of your hair, take a history and perform a physical exam.