Alopecia Areata Associated with Significant Comorbidities

A systematic review of alopecia areata (AA) in Clinical, Cosmetic & Investigational Dermatology highlighted the unpredictability and lack of treatment options for the condition. But it also pointed to a larger problem: more than half of patients with AA experience poor health-related quality of life (QOL). Patients with AA are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions.

Notably, a 66% to 74% lifetime prevalence of psychiatric disorders has been reported in those with AA, with a 38% to 39% lifetime prevalence of depression and a 39% to 62% prevalence of generalized anxiety disorder. Burden of disease as measured by disability-adjusted life years (DALYs) puts AA in line or ahead of conditions such as psoriasis. The World Health Organization (WHO) measured the global DALYs lost to AA in 2010 to be 1,332,800, higher than the 1,050,660 estimated for psoriasis.

The review looked at more than 50 years of study on AA through a search of PubMed, Embase, and Web of Science. Among the more interesting findings:

• An estimated 2.4 million doctor office visits in the USA are for AA, which accounts for 25% of visits for all types of alopecia.
• The course of AA is unpredictable, with spontaneous regrowth of hair occurring in 80% of patients within the first year, and sudden relapse possible at any given time.
• The scalp is involved with or without involvement of other body sites in almost all cases of AA, with the occipital scalp being the most commonly involved site.
• Treatment options for AA have limited success, no cure has been found, and no therapy has been able to prevent disease relapse. Treatment options include topical, locally injected, or systemic steroids; they also often include psychosocial support and therapy.
• No significant difference in the incidence of AA was found between males and females in two large population-based studies, with other hospital-based studies conflicting between male and female predominance.
• The DALYs for AA have been increasing linearly since 1990, when the global DALYs were under 1 million.
• In addition to autoimmune thyroid disease, it has been long suspected that there is an association between AA and other autoimmune disorders such as vitiligo, systemic lupus erythematosus, psoriasis, inflammatory bowel disease, and rheumatoid arthritis.
• Most recently, diabetes mellitus was found in 11.1% of patients with AA. Significant increases in levels of insulin were reported in patients with AA compared to controls, suggesting increased insulin resistance associated with AA.

“The estimated high prevalence of 2% globally underscores the importance of disease awareness, of unveiling the role of genomics in influencing the likelihood of developing AA, and of discovering potential molecule-oriented treatments,” the study authors concluded.