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Autoimmune Disease and Your Skin (Part 2)

Autoimmune Disease and Your Skin (Part 2)

Autoimmune diseases often show up on your skin. Autoimmune diseases with skin rashes are important to recognize because it allows us to diagnose or monitor internal problems in the body as well.

In the first article about autoimmune diseases and your skin, I talked about lupus and listed some of the other diseases that may show up through skin findings. In this article, I will address two of the most common autoimmune diseases that dermatologists see.

What are the two most common autoimmune skin diseases?

  1. Alopecia areata
  2. Vitiligo 

patch of alopecia areata with early regrowth

What is alopecia areata

Alopecia areata is an autoimmune disease where your immune system attacks the hair follicle. This results in clean and clear patches of hair loss. There is no skin scarring and the hair follicles are not damaged. They just don't make hair until the process stops. 

Alopecia areata usually targets colored hairs rather than gray hairs.

The hair may grow back white instead of the original hair color at first. Any hair-bearing area can be affected by this condition including eyebrows and eyelashes.

Some people have only a rare patch and mild involvement. Others may have dramatic and/or complete hair loss of the entire scalp, face and body called alopecia universalis. 

Alopecia areata is capricious, often behaving unpredictably. Many people with alopecia areata feel that their hair loss worsens when they are under stress.

Alopecia areata may also cause nail problems.

Nail changes that you may see if you have alopecia areata are little pits on the top of the nail.

Alopecia areata can run in families

It can also be related to other autoimmune conditions, namely vitiligo, thyroid problems or inflammatory bowel disease.

What are treatments for alopecia areata.

The most commonly used treatment are cortisone injections into the skin where active hair loss is occurring. Cortisone helps to lower the immune attack at the skin site. If the hair follicles respond, the hairs to regrow.

There are other topical medicines that can be used to treat alopecia areata including Rogaine. In widespread cases, your doctor may discuss systemic pills that help lower the immune system's attack on the hair follicle growing process. These may include oral steroids (prednisone) or cyclosporine. 

autoimmune skin diseases



Skin pigment cells, called melanocytes, are the target of the autoimmune attack in vitiligo. Because of the attack, skin melanin pigment is lost. This loss of pigment can occur anywhere on the skin. It may be subtle or dramatic. 

What does vitiligo look like?

When the condition is subtle, small white patch develop on the skin. When a person's pigment skin tone is light, the white patches may even be very hard to see.  In other cases, vitiligo can be extensive and involve a large percentage of the skin. The darker a person's natural skin color is, the more dramatic the white patches of vitiligo appear.

How can doctors tell how bad vitiligo is?

Dermatologists can examine a patch of de-pigmented skin using 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.

Vitiligo and stress

Vitiligo, like many autoimmune conditions, may first start after a major stressful event – either emotional or physical. 

Is vitiligo connected to other autoimmune diseases?

Most people with vitiligo are healthy. There are, however, certainly genetic factors related to vitiligo. It is also associated with other autoimmune diseases, especially when it is affects a large amount of skin.

The most common associated autoimmune diseases are

  1. thyroid problems
  2. type 1 diabetes. 

How do you treat vitiligo?

Treatment of vitiligo can be difficult. We usually start with cortisone creams and ointments, especially 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.

Both alopecia areata and vitiligo are important autoimmune diseases because the skin changes are often disturbing to those who suffer from the conditions. It is best to seek care from an experienced Board Certified Dermatologist.