As a dermatologist, I see autoimmune diseases on a regular basis. There are certain autoimmune diseases that have classic findings on the skin. This is very important to recognize because, when I see a skin problem that looks concerning for an autoimmune disease, it may be a sign that there are internal problems in the body as well.
In my last blog post about autoimmune diseases, I talked about lupus and listed some of the other diseases that may show up through skin findings. In this blog post, I will address two of the most common autoimmune diseases I see.
Alopecia areata is an autoimmune disease in which the immune system attacks the hair follicle and results in patches of on-scarring hair loss. It preferentially targets colored hairs (rather than gray hairs). Oftentimes, once the hair grows back, it is initially white with eventual recovery of color. Any hair-bearing area can be affected by this condition including eyebrows and eyelashes. Some people experience a mild form of this disease with only a small patch of hair loss. Others, however, may experience complete hair loss of the entire body called alopecia universalis.
Alopecia areata often behaves in an unpredictable way. It does tend to flare with stress. Fortunately, the hair follicles do not get permanently damaged. Alopecia areata can be associated with nail problems, most commonly pitting of the nails. I always ask people if alopecia areata runs in their family because it can be hereditary. I also ask patients if they have a history of vitiligo, thyroid problems or inflammatory bowel disease because these are conditions we know are associated with alopecia areata.
There are several treatments for alopecia areata. The most common treatment is injecting steroid medicine into the area of hair loss to quiet down the immune system in that area so that the hair follicles stop getting attacked. There are other topical medicines that can be used as well. Widespread cases sometimes require pills that quiet the immune system such oral steroids (prednisone) or cyclosporine. Rogaine can be used to stimulate hair follicle growth as well, but it’s usually used in conjunction with injections.
Vitiligo is a condition in which people lose the pigment in their skin. In this case, melanocytes (pigment-producing cells) are attacked by the immune system. Loss of pigment can occur anywhere on the skin. It may be subtle and show up as only a small white patch on the skin, and it may be very hard to see in fair-skinned people. When I see people who look like they have a patch of de-pigmented skin, I use a black light (technically called a “Wood’s lamp”) to tell if the skin actually lacks pigment completely or is just lighter than surrounding skin. If it’s truly “de-pigmented,” it will look blue under the light.
In other cases, vitiligo can be extensive and involve a large percentage of the skin. This, like many autoimmune conditions, may first start after a major stressful event – either emotional or physical. There are certainly genetic factors as well. Vitiligo can be associated with other autoimmune diseases too, especially when it is affects a large amount of skin. However, most people are healthy who have the disease. The most common associated autoimmune diseases are thyroid problems or type 1 diabetes.
Treatment of vitiligo can be difficult, particularly when it’s extensive. Steroid creams/ointments are commonly used, particularly if there are only small areas affected. If more extensive, ultraviolet light under the supervision of a dermatologist can be considered. In very extensive cases, people may choose to completely de-pigment their skin so that all of the skin is one color, which is what Michael Jackson is said to have done. In any case, it’s critical that people with vitiligo be under the care of a Board-Certified Dermatologist as we know the newest and greatest treatments for this condition.
Stay tuned for more on autoimmune diseases and your skin. For more reading, check out Dr. Hayes’ first blog post, Autoimmune Disease and Your Skin (Part 1) or Dr. Bailey’s latest post about rosacea, another autoimmune disease that affects the skin.
Do you have an autoimmune disease? How are you treating your skin to keep it healthy?
Dr. Hayes – Board Certified Dermatologist
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