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A new study revealed an increased risk of psychiatric and autoimmune comorbidities after an alopecia areata diagnosis.
Arash Mostaghimi, MD, MPA, MPH
Credit: Brigham and Women’s Hospital
A new study suggests individuals with alopecia areata have greater risks of developing psychiatric or autoimmune comorbidities after a diagnosis.
“This study builds on prior evaluations that demonstrated that patients with AA often have comorbid autoimmune, immune-mediated, and psychiatric disorders,” wrote investigators, led by Arash Mostaghimi, MD, MPA, MPH, from Brigham and Women’s Hospital at Harvard University. “…our analysis is one of the first studies, to our knowledge, to examine the risk of developing these comorbidities after [alopecia areata] diagnosis.”
Alopecia areata is linked to many comorbidities, with the most common ones being either autoimmune diseases or atopic conditions. For instance, patients with alopecia areata often have comorbid thyroid disease, type 1 diabetes, celiac disease, rheumatoid arthritis (RA), vitiligo, asthma, allergic rhinitis, and atopic dermatitis.
People with this condition may also develop depression or anxiety. According to the National Alopecia Areata Foundation, depression or anxiety may be comorbid or the psychiatric conditions may occur because the hair loss creates additional issues. Little is known about the timing of comorbidity development after alopecia areata is diagnosed.
Investigators sought to assess the prevalence and the new-onset incidence of psychiatric and autoimmune comorbidities in patients with alopecia areata in the US, particularly during and after their alopecia areata diagnosis. The team conducted a retrospective cohort analysis, leveraging data from Merative MarketScan Research Databases (January 1, 2007 – April 30, 2023). This database contains medical and drug claims data from > 46 million patients in the US.
The study compared participants, aged 12 – 64 years, with (n = 63,384) and without alopecia areata (n = 3,309,107). The mean age was 36.9 years and half of the sample was female (50.6%).
Some included studies matched patients with alopecia areata to controls 1:4 based on sex, age, and geographic region. After matching, the alopecia areata group had 16,512 participants and the control had 66,048 participants.
Compared with unmatched controls, patients with alopecia areata had a greater prevalence of psychiatric (30.9% vs 26.8%; P < .001) and autoimmune (16.1% vs 8.9%; P < .0001) comorbidities at their alopecia areata diagnosis. More specifically, patients with AA had significantly greater rates of anxiety (15.5% vs 12.3%), sleep disturbance (10.4% vs 8.9%), depression (9.3% vs 7.6%), atopic dermatitis (5.1% vs 2.0%), psoriasis (2.4% vs 1.2%), and RA (2.3% vs 1.3%) (P < .001).
Twelve months after an AA diagnosis, patients with AA had a greater overall incidence of any psychiatric disease (10.2% vs 6.8%; P < .001) and autoimmune comorbidity compared to controls (6.2% vs 1.5%; P < .001). This was seen in anxiety (4.0% vs 2.6%), sleep disturbance (2.6% vs 1.7%), depression (1.9% vs 1.2%), atopic dermatitis (2.2% vs 0.3%), vitiligo (1.0% vs 0.1%), and psoriasis (0.9% vs 0.2%) (P < .001).
Additionally, patients with alopecia areata had a significantly greater risk of developing a psychiatric (adjusted hazard ratio [AHR], 1.3; 95% CI, 1.3 – 1.4) or autoimmune (AHR, 2.7; 95% CI, 2.5 – 2.8) comorbidity, compared to controls. The psychiatric disorders with the greatest risk included adjustment disorder (AHR, 1.5; 95% CI, 1.3 – 1.6; P < .001), panic disorder (AHR, 1.4; 95% CI, 1.2 – 1.7; P < .001), and sexual dysfunction (95% CI, 1.4; 95% CI, 1.1 – 1.8; P = .003). Moreover, the autoimmune and immune-mediated disorders with the greatest risk were systemic lupus erythematosus (AHR, 5.7; 95% CI, 4.6-7.2; P < .001), atopic dermatitis (AHR, 4.3; 95% CI, 3.9 – 4.8; P < .001), and vitiligo (AHR, 3.8; 95% CI, 3.2 – 4.4; P < .001).
The team wrote how AA and many of these comorbidities share underlying signaling pathways. Thus, a single treatment option could potentially address multiple disorders at once.
For instance, the US Food and Drug Administration (FDA) approved the Janus kinase inhibitor baricitinib for the treatment of AA and RA and the European Medicines Agency approved this treatment option for atopic dermatitis and juvenile idiopathic arthritis. Investigators emphasized the importance of conducting long-term studies to assess the most effective treatment to improve patient health and reduce patient costs.
“Routine monitoring of patients with AA, especially those at risk of developing comorbidities, may permit earlier and more effective intervention,” investigators concluded.
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