Hair Loss and Bronze Discoloration of the Skin in Lupus Erythematosus

Figure 2

A 59-year-old female German patient developed recurrent fever, significant weight loss, and pronounced fatigue approximately 4 months after a trip to Egypt. She noticed bronze discoloration of the skin and significant hair loss (Figure). Physical examination revealed enlarged cervical and inguinal lymph nodes. Laboratory tests showed no evidence of hemochromatosis, Addison’s disease, or heavy metal poisoning. Tumor screening with computed tomography of the chest and abdomen, as well as bone marrow examination, was unremarkable. To investigate visceral leishmaniasis, blood and bone marrow samples were analyzed by serology, polymerase chain reaction, and microscopy, with no abnormal findings. Ultimately, the symptoms described above, together with newly identified photosensitivity and severe arthralgia, as well as detection of antinuclear antibodies (1:1280) and the rarely detectable anti-SP100 antibodies, led to the diagnosis of late-onset melanotic lupus erythematosus (skin biopsy, consistent with this, showed hyperpigmentation and an inflammatory infiltrate!). Weight-adjusted prednisolone therapy produced a marked improvement in symptoms, particularly the skin changes and hair loss, within a few months. This dermatological case exemplifies how variable and diagnostically misleading a newly manifesting lupus can appear—fully in line with its reputation as the ‘great imitator‘.

Dr. med. Payam Dibaj, Zentrum für Seltene Erkrankungen Göttingen (ZSEG), Klinik für Pädiatrie, Universitätsmedizin Göttingen, und Max-Planck-Institut für Multidisziplinäre Naturwissenschaften, Göttingen und Klinik der Neurologie, Ökumenisches Hainich Klinikum, Mühlhausen, [e-mail]

Prof. Dr. med. Jutta Gärtner, Zentrum für Seltene Erkrankungen Göttingen (ZSEG), Klinik für Pädiatrie und Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Dibaj P, Gärtner J: Hair loss and bronze discoloration of the skin in lupus erythematosus. Dtsch Arztebl Int 2026; 123: 77b. DOI: 10.3238/arztebl.m2025.0188