Prevalence and Risk Factors Associated with the Occurrence of Autoimmune Diseases in Patients with Alopecia Areata

Abstract

Background Increased rates of autoimmune diseases (ADs) have been reported in association with alopecia areata (AA); however, the risk factors for coexisting ADs in AA patients have been poorly investigated. Objective To evaluate the prevalence and factors associated with AD comorbidities in patients with AA. Methods This case–control study included patients diagnosed with AA between January 2000 and March 2020. Individuals with AA, both with and without concomitant ADs, were statistically compared. Variables significantly associated with coexisting ADs were identified using univariate and multivariate logistic regression analyses. Multinomial logistic regression analysis was performed to identify the specific risk factors for each concomitant AD. Results Among the 615 patients with AA, comorbid ADs were found in 76 (12.4%). Autoimmune thyroid disease (AITD) exhibited the highest frequency (n = 42, 6.8%), followed by vitiligo (n = 15, 2.4%), and systemic lupus erythematosus (SLE) (n = 12, 2.0%). Logistic regression analyses revealed that female sex (odds ratio [OR] = 2.45, 95% confidence interval [CI] = 1.24–4.82; P = 0.011), nail abnormalities (OR = 2.49, 95% CI = 1.14–5.46; P = 0.023), and atopic diseases (OR = 1.98, 95% CI = 1.09–2.43; P < 0.001) were significantly associated with coexisting ADs. Regarding each concomitant AD, nail abnormalities were an associated factor for AITD (OR = 4.65, 95% CI = 1.96–7.24; P = 0.01), whereas coexisting atopic diseases were demonstrated as a predictor of vitiligo (OR = 2.48, 95% CI = 1.43–4.58; P = 0.02). Female sex (OR = 1.61, 95% CI = 1.18–4.27; P = 0.04) and family history of AD (OR = 1.85, 95% CI = 1.26–4.19; P = 0.03) were predictors of SLE. Conclusion This study suggests that female AA patients with nail abnormalities and atopic diseases have increased rates of AD comorbidities. A thorough review of systems for associated factors can help physicians screen for concomitant ADs.

Histopathological Evidence of Occipital Involvement in Male Androgenetic Alopecia

“…Accumulating evidence suggests that hair follicles in the occipital area might elicit less androgen-regulated cellular responses than hair follicles in the other scalp areas ( 22 , 23 ). Frontal hair follicles contained a significantly higher level of androgen receptors and 5α-reductase enzymes, known for converting testosterone into a more potent androgen called dihydrotestosterone, compared to occipital hair follicles for both genders ( 24 – 27 ). Scalp biopsies also demonstrated a greater amount of aromatase, the enzyme accountable for lowering androgen levels by turning into estrogens, within the occipital rather than the frontal hair follicles in both men and women ( 21 , 24 , 28 ).…”

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

“…Trichoscopy is increasingly used as a non-invasive tool for the diagnosis of hair and scalp disorders ( 6 – 8 ). Despite the presence of cutaneous signs and laboratory findings, trichoscopic abnormalities may represent the specific features of SA and help differentiate it from other causes of alopecia ( 9 – 11 ).…”

Retrospective Analysis of the Effect of Comorbid Atopic Dermatitis on the Treatment Response to Topical Immunotherapy in Pediatric Alopecia Areata Patients

“…Alopecia areata is accepted as a tissue-specific autoimmune disease that occurs with an environmental triggering factor on the basis of genetic predisposition [ 5 – 7 ]. Relationships have been reported between alopecia areata and autoimmune diseases such as autoimmune thyroid diseases, vitiligo, type 1 diabetes mellitus and celiac disease [ 8 ]. It has also been reported that atopic conditions such as atopic dermatitis, allergic rhinitis, and asthma are common comorbid diseases in alopecia areata [ 9 ].…”