Kristine Kucera, PA-C, MPAS, DHS
Alopecia areata (AA) is a chronic inflammatory genetic disease related to a systemic autoimmune disorder, in which the body attacks the anagen hair follicles and suppresses them, resulting in hairless patches. A recent systematic review and meta-analysis of 87 studies conducted by Lee et al, showed that several comorbidities are associated with AA, including cardiovascular disease, atopic dermatitis, thyroid disease, lupus erythematosus, vitiligo, psoriasis, inflammatory bowel disease, and rheumatoid arthritis. A newer, cross-sectional study of 87 AA patients found that the most common diseases associated with AA were anxiety (36%), dermatitis (30%), hypothyroidism (9%), hyperlipidemia (5%), and vitamin D deficiency (4%). Allergic rhinitis, psychological problems, diabetes, hypertension, and hypothyroidism accounted for the most common comorbidities in AA patients over 18 years of age. Furthermore, the prevalence of comorbidities can be based on genetic differences including sex and age.
Patients with any degree of hair loss, regardless of the cause, require our sensitivity and a thorough clinical assessment. During a panel discussion at DERM2023 this month, I joined Dr. Adam Friedman to discuss treatments for hair loss, including the role for combination treatments. (Read more about it here.)
Oral JAK inhibitors baricitinib (Olumiant, Lilly) and ritlecitinib (Litfulo, Pfizer) can be considered for treatment of severe AA. However, their impact on comorbidities is not entirely clear. Discussion of comorbidities with the patients and problem-focused treatment or referral may be warranted.
Kristine Kucera, PA-C, MPAS, DHS, is Assistant Clinical Professor, University of Texas Southwestern, Medical Center PA Program, Dallas, TX. She is a member of the DEF Advisory Council.
https://onlinelibrary.wiley.com/doi/full/10.1002/hsr2.1444
“The most common diseases associated with AA in our study were anxiety, dermatitis, hypothyroidism, hyperlipidemia, and vitamin D deficiency, respectively. In addition, the most common diseases were hypothyroidism and hyperlipidemia in women and men, respectively. The rates of allergic rhinitis, anxiety, depression, diabetes, hypertension, and hypothyroidism were influenced by patients’ age.”
–Hamidpour, et al.