Hair loss in Lyme disease – the last straw?
We thought we had enough problems with the discovery of chronic Lyme disease, Lyme encephalopathy, and neuropsychiatric Lyme disease. [1] Hair loss could be the last straw.
by Daniel J. Cameron, MD MPH
In a recent issue of the American Journal of Dermatopathology, Lynch and colleagues report on the case of a 21-year-old man who suffered hair loss following a tick bite to the scalp. [2] The man presented with nonscarring alopecia, a pattern of hair loss similar to alopecia-areata, also known as spot baldness.
Tick bite-induced nonscarring alopecia typically presents as patches, often described as “motheaten” or patients may have nodular, blood crusted lesions. According to the authors, symptoms include pain, pruritus or swelling. “There is usually a history of tick bite to affected areas, but lack of patient-reported tick attachment does not rule out this diagnosis.”
The patient’s nonscarring tick-borne alopecia was complicated by external trauma including hair pulling and lichen simplex chronicus, a condition of thick, leathery, brownish skin caused by chronic itching and scratching.
The nonscarring tick-borne alopecia was thought to be due to a robust host response. “Tick bite alopecia is a reported phenomenon that is thought to be caused by a robust host response to tick-injected saliva containing an anticoagulant and anti-inflammatory and immunomodulatory chemicals,” explains Lynch.
There is good news for nonscarring tick-borne alopecia. “Because few hair follicles are truly destroyed in this form of tick bite alopecia, hair regrowth is commonly observed, usually within 3 months; [3-5] however, alopecia has been reported to persist for 5 years after healing of local reaction to tick bites,” according to a series of four papers cited by Lynch. [6]
A scarring form of tick bite alopecia has also been described in Europe. “Tick-borne lymphadenopathy syndrome, classically transmitted by ticks of the genus Dermacentor and caused by Rickettsia slovaca infection, is an emerging entity typically seen in Europe,” according to Lynch. “Doxycycline remains the treatment of choice.”
[bctt tweet=”Hair loss in Lyme disease – the last straw?” username=”DrDanielCameron”]Generalized hair loss, as well, has been described in Lyme disease patients. [7] “Diffuse alopecia occurred within three months after the outbreak of disease in 3 out of 23 (13%) patients with Lyme meningitis and in 40 out of 71 (56.3%) patients with tick-borne encephalitis,” according to Cimperman from the University Medical Centre, Ljubljana, Slovenia. “The mean duration of alopecia was 2 to 3 months and alopecia was reversible in all patients.”
There are a number of causes of scarring and nonscarring alopecia including autoimmune conditions, such as lupus, diabetes and fibromyalgia. [8] Moreover, medications used to treat systemic autoimmune disease and fibromyalgia have also been associated with alopecia.
Hair loss can impair the quality of life of patients with systemic disease. “Patients in remission from their global systemic disease are often left with alopecia, which significantly impairs their self-esteem and interferes with their personal and professional lives,” according to Moghadam-Kia from the University of Pittsburgh Medical Center. “This situation is often not adequately recognized, and withdrawal from social and work functions often leads to or augments long-standing depression in the patient.”
“To the authors’ knowledge, this is the fifth report of nonscarring tick bite alopecia in the literature and the first in an adult patient,” writes Lynch. There are undoubtedly many more undocumented cases of Lyme disease patients suffering from not only generalized hair loss but from tick-borne alopecia. The authors are to be congratulated for bringing attention to an under-recognized medical condition which can greatly impact patients’ lives.
References:
1. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther, 1-33 (2014).
2. Lynch MC, Milchak MA, Parnes H, Ioffreda MD. Tick Bite Alopecia: A Report and Review. Am J Dermatopathol, 38(11), e150-e153 (2016).
3. Ross MS, Friede H. Alopecia due to tick bite. AMA Arch Derm, 71(4), 524-525 (1955).
4. Heyl T. Tick bite alopecia. Clin Exp Dermatol, 7(5), 537-542 (1982).
5. Krinsky WL. Dermatoses associated with the bites of mites and ticks (Arthropoda: Acari). Int J Dermatol, 22(2), 75-91 (1983).
6. Raoult D, Lakos A, Fenollar F, Beytout J, Brouqui P, Fournier PE. Spotless rickettsiosis caused by Rickettsia slovaca and associated with Dermacentor ticks. Clin Infect Dis, 34(10), 1331-1336 (2002).
7. Cimperman J, Maraspin V, Lotric-Furlan S, Ruzic-Sabljic E, Avsic-Zupanc T, Strle F. Diffuse reversible alopecia in patients with Lyme meningitis and tick-borne encephalitis. Wien Klin Wochenschr, 111(22-23), 976-977 (1999).
8. Moghadam-Kia S, Franks AG, Jr. Autoimmune disease and hair loss. Dermatol Clin, 31(1), 75-91 (2013).
Pj hoover
08/27/2023 (9:27 am)
Please have your patient use a tincture of Clove on their Scalp. This should help relieve the itching and heal the skin by killing any bacteria or microbes.
I use Clove on my gums for infection, put 3 drops in my water daily and use it on cuts and scrapes all the time. It is a miracle from GOD.
Mary
03/15/2021 (8:12 pm)
I came on this site because I have been losing a lot of hair. I was newly diagnosed with Lyme disease. That’s a horrible disease. I already have RSD, diabetes type 2,COPD, chronic kidney disease, and now Lyme disease. I didn’t need a new medical problem but here I am. I’ve been having a hard time. It seems like this is effecting all the other diseases. I have a horrible rash that used to itch but now I just have scabs and more scars. I thought it was just my Rsd flaring but it’s never gotten this out of control since I 1st got it. My primary took the test for Lyme and he told me I was positive and that he needs to get an appointment with the infection control Dr. Set up for me. I started taking biotin for my hair loss. I’m still losing hair but not in chunks anymore. I hurt all over. It kept me up all night. I’m 62 and in a wheelchair from botched hip replacement and the other hip I got Mrsa in it so now I don’t have a hip. I can’t walk anymore. I’m over 150 lbs too heavy. I have never weighed this much. I don’t know what I’m doing with this disease. I’m tired all the time, no ambition at all. I’m scared
Dr. Daniel Cameron
03/16/2021 (9:57 am)
I have patients with multiple medical problems where it is difficult to know if Lyme disease is a part of the story. I sometimes find treatment for a tick borne helpful, yet they still have the other conditions to address. Some of my patients have dermatology and hair issues. Occasionally I have had patients who fall into a Morgellons like pattern.
Suzie
12/06/2022 (1:58 pm)
I was bitten by a tick 7 months ago. We believe it was located and removed within several hours of the bite, and received doxycycline with a few days. However, I endured months months of intermittent sores, severe itching and increasing hair loss at the site that widened in circumference of the site to about the size a little bigger than half dollar as the months passed. I still have intermittent itching, but not as severe. My dermatologist stated the hair loss was from scratching. Although I still get mild bumps and itching at the site, I scratch very little, but get no hair regrowth. I was tested for Lyme and it was negative. However, there can be no explanation for this hair loss other than residuals from the tick bite.
Dr. Daniel Cameron
12/07/2022 (6:18 pm)
I have patients in my practice with continued irritation at the site of the bite without the disease. Ticks can leave a number of chemicals at the bite site.
Traci C Pens
10/05/2020 (5:07 pm)
Dr. Daniel Cameron bless you for putting out information on Lyme Disease. For the past 2 years my family has thought that i was crazy or on drugs. 3 of my older children do not associate with me. My marriage is on the rocks. I have not been tested however, for the 1st time in 2 years i have hope. I have searched for every symptom online to no avail until now. I too have alopecia. Exactly as stated by Patricia 11/24/17. I have a few questions and some experiences to share. I am ordering a home test for Lyme Disease, are the results of at home tests accurate? I have read that Lyme Disease or some of the Stage 3 forms of the Disease are not accepted as medical conditions by the CDC. It this true or is the information outdated? If it is true, are treatments for Lyme Disease or Chronic Lyme Disease covered by insurance such as Medicaid? And are there certain Dr.s that i would need to see for treatment as well. From my experiences my alopecia has been caused by something in my hands. This is also one indication to me that i have Lyme Disease. I would love to share my experiences with you as I agree research is needed. Thank you, this information just may have saved my life. I have also been depressed and suicidal at times through out all of this.
Dr. Daniel Cameron
10/05/2020 (7:09 pm)
There are so many causes of alopecia. I have an occasional patient with alopecia but typically have a number of other symptoms. There is also uncertainty around the existence and cause of Morgellons disease. I am aware of a doctor who takes Medicaid for a Lyme disease evaluation.
Mabel Del rio
08/12/2021 (2:21 pm)
Hi, all thank you for sharing such stories. I had the Covid and to learn I also had Lyme disease. They gave me antibiotics and send me on my way. Now I am having lots of hair loss that I can build a wig. I also am very tired and can’t stay awake and I have no kind of energy. My bones hurt especially at night when it’s time to go to bed is the worst. My blood show I had the Lyme disease but it’s not strong anymore, but why am I having so much pain in my body and so tired!! I was a hard working 80 to 90 hours per week and now I can not work at all
Dr. Daniel Cameron
08/12/2021 (8:05 pm)
I have not found a test I am comfortable with that can confirm that Lyme disease has resolved. I advise my patients who have persistent symptoms to be reevaluated.
Michelle
08/21/2022 (11:56 am)
Please read Dr Richard Horowitz books on Lyme. He is a leading resource on treatments & symptoms. They helped me. I am in my 50s and got bit in Lyme Conn. At 22. There was no knowledge in 1988. Once it’s in you passed the 6 weeks its very hard to treat.
Rhita
08/04/2020 (3:05 pm)
Hi,
I know how it feels to have once hair fall out by the bushels. 2 things helped me to stop the hair loss during my Lyme journey. # 1: it was established that I was low on Testosteron. Yes even as a woman you require Testosteron for vitality. That was mitigated by taking 7mg of DHEA daily (absolutely not more for the ladies). # 2: I washed my hair every other day then prepared a tincture of 2 table spoons of extra virgin olive Oil with 7 drops of tea tree oil and 3 drops of clove essential oil. I massaged it into the scalp and left it in over a couple of hours or over night and washed it again. Within a week my hair stopped falling out. I was ecstatic!!!! My hair is growing back too. Start with # 2. It may do the trick for you on its own.