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Differences in comorbidities between SLE patients with alopecia and those without: Patients with systemic lupus erythematosus (SLE) who have alopecia, particularly in the form of discoid lupus erythematosus (DLE), exhibit a distinct and substantial burden of systemic comorbidities compared to those without alopecia.

DLE, a form of cutaneous lupus that often presents with scarring alopecia, is associated with a higher prevalence of systemic autoimmune conditions, notably systemic lupus erythematosus itself, affecting approximately 22% of patients with DLE, indicating significant overlap Sanz-Cabanillas et al. 2026 NICE CKS.

In addition, patients with alopecia linked to cutaneous lupus show increased frequencies of cardiometabolic comorbidities such as hypertension and cardiovascular disease, with pooled odds ratios demonstrating a more than twofold increase in hypertension risk and nearly fourfold in cardiovascular disease compared to controls Sanz-Cabanillas et al. 2026. Psychiatric comorbidities including depression and anxiety are also significantly more prevalent in patients with lupus-associated alopecia Sanz-Cabanillas et al. 2026.

Endocrine comorbidities, particularly hypothyroidism, are more common in patients with cutaneous lupus and scarring alopecia, with a pooled prevalence around 12% and moderate association with disease Sanz-Cabanillas et al. 2026. In contrast, smoking does not show a significant association with discoid lupus-related alopecia Sanz-Cabanillas et al. 2026.

Fatigue in SLE patients with alopecia does not correlate directly with active disease but is strongly linked with organ damage accrual, including pulmonary fibrosis and peripheral neuropathy, as well as higher body mass index, which might be more prevalent in patients with alopecia due to systemic involvement Chapman et al. 2026 Santacruz et al. 2026.

Late-onset SLE, which may also present with alopecia, particularly shows a reduced frequency of classical mucocutaneous manifestations such as alopecia compared to earlier-onset SLE but features increased multimorbidity burden including cardiovascular disease, interstitial lung disease, and autoimmune overlap syndromes that may contribute to the complex comorbidity profile of patients with alopecia Santacruz et al. 2026.

Notably, general alopecia in SLE may relate to systemic disease activity, but alopecia closely linked with cutaneous lupus (discoid lupus) signifies a higher systemic and psychiatric comorbidity burden through overlapping autoimmune and metabolic pathways Sanz-Cabanillas et al. 2026 Chapman et al. 2026.

Therefore, SLE patients with alopecia, especially discoid lupus-related alopecia, tend to have a higher prevalence of systemic autoimmune diseases, cardiovascular and endocrine disorders, and psychiatric conditions compared to those without alopecia, reflecting a more complex multisystem disease requiring comprehensive multidisciplinary management Sanz-Cabanillas et al. 2026 NICE CKS.