“Downy hair sign”—A clue to autoimmune disease in curly hair

Although ethnic variations in curl patterns have been well described, institution of curl pattern assessments in dermatologic examinations remain limited.1 Previous literature demonstrated alterations in curl patterns in African patients with autoimmune disorders, tuberculosis, and AIDS.2 However, the acquired hair textural changes associated with autoimmune hair disorders and the response to treatments remain poorly characterized. Herein, we report 3 cases with altered curl pattern following acute lupus alopecia (ALA) and alopecia areata (AA) with restoration of baseline hair texture after medical therapies.