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Alopecia
areata associated with other autoimmune diseases
Strong direct and indirect evidence supports an autoimmune etiology
for alopecia areata, and the condition has been seen in patients
associated with other diseases which are autoimmune in nature.
It is not known why alopecia areata and other autoimmune diseases
might occur together in the same person. It is thought that some
possible triggers like viruses, infection, medicines, sunlight,
or other environmental factors prompt the immune system to attack
the body's own tissues. It may be that the same environmental
trigger activates more than one form of autoimmune disease. There
is also a genetically inherited factor, which makes some people
more prone to autoimmune diseases. About 1 in 5 people with alopecia
areata have a close relative who is also affected. Also, people
with alopecia areata may have a family history of other autoimmune
diseases. However, it is important to stress that most people
with alopecia areata do not have any of these other conditions.
Some of the other forms of autoimmune disease that have been found
in association with alopecia areata in the same person include:
- Vitiligo, a condition involving loss of pigment in the
skin in patches, which may affect varying areas of the body.
The relationship of alopecia areata with Vitiligo is controversial.
Some case studies indicate that it occurs more frequently
in alopecia
areata patients compared to the general population other studies
suggest there is no difference in the rate of vitiligo in
alopecia areata patients compared to the general population.
Because vitiligo
is more likely to develop on irritated skin, someone who has
both alopecia areata and vitiligo may not be able to pursue
certain
treatment options for alopecia areata involving contact sensitization.
Current data suggests that vitiligo may result from an intrinsic
biochemical defect of the entire epidermal melanin unit in
skin which elicits an inflammatory response from the body’s
immune system.
- Lupus erythematosus, a chronic autoimmune disease
in which almost any type of cell in the body can be targeted.
It is often
characterized by red, scaly lesions or patches on the face and upper portion
of the trunk.
- Discoid lupus erythematosus, a form of photosensitive
lupus characterized by pronounced erythema, scale and pigment
changes in the skin.
- Rheumatoid arthritis, a disabling and painful
inflammatory condition, which can lead to substantial loss of
mobility due to pain
and joint destruction.
- Pernicious anemia, a potentially dangerous form of anemia,
usually caused by an autoimmune process, which results in a
deficiency
of vitamin B-12.
- Scleroderma, a rare, chronic disease characterized
by excessive deposits of collagen, the main component of connective
tissue.
- Inflammatory bowel disease, a group of inflammatory
conditions of the large intestine and, in some cases, the small
intestine.
- Myasthenia gravis, a neuromuscular disease leading
to fluctuating weakness and fatigability.
- Lichen planus, a common
skin disease in which itchy, small, pink or purple spots appear
on the arms or legs. This can develop
into a scarring alopecia involving permanent loss of hair.
- Alopecia areata has
also been described in patients seropositive for the human
immunodeficiency virus. It seems that the changes
in the immune system as a result of HIV infection can trigger
the development of alopecia areata.
-
An strong disease association has been noted with
the autosomal recessive disorder autoimmune polyglandular
syndrome, a disorder often leading to insufficiency of the
adrenal cortex, the parathyroid glands, and/or the gonads.
In this condition, up to 30 percent of affected patients may
express alopecia areata.
The chances of someone with alopecia areata developing one
of these diseases is low and routine lab tests for
these diseases
are not usually indicated, though some clinics will examine
for thyroid diseases as part of their overall evaluation
and diagnosis of alopecia areata. If a patient with alopecia
areata
develops unexplained medical symptoms, the doctor would
be the best advisor to determine whether the two conditions
are related.
It should be highlighted, however, that the majority of patients
with alopecia areata are in a state of good health. It has been
estimated that only 3-5% of patients with alopecia areata have
another autoimmune or endocrine disease. Consequently, the association
between alopecia areata and other autoimmune diseases is more
the exception than the rule.
Thyroid disease and alopecia areata
Diseases of the thyroid gland are also frequently seen in association
with alopecia areata, indicating an association between the two
conditions. But even though there is an apparent correlation between
alopecia areata and thyroid disease, treating the thyroid disease
does not remedy the alopecia areata.
Studies conducted on 736 patients with alopecia areata by Muller
and Winkelmann, pointed to 59 patients having a clinical thyroid
abnormality. These 59 patients represented 14 cases of exophthalmic
goiter, 27 cases of simple goiter, 7 cases of myxedema, 6 cases
of Hashimoto's thyroiditis and 5 cases of previous thyroidectomy.
Cunliffe and associates also found the incidence of these same
diseases to be increased in patients with alopecia areata. Studies
undertaken by Bergfeld and colleagues with the aim of evaluating
the relationship between alopecia areata and diseases of the thyroid
gland found thyroid microsomal antibodies in 19 of 64 patients
(29 percent) with alopecia areata, although the incidence was
only 7.7 percent in a separate study of an East Indian population.
Neither of these studies screened all patients for thyroid function
but focused on history, physical examination, and/or the presence
of thyroglobulin or thyroid antibodies.
However, another school of thought claims that the occurrence
of clinically evident thyroid abnormalities, such as Hashimoto's
chronic lymphocyte thyroiditis, thyrotoxicosis, exophthalmic goiter,
and myxedema, does not differ significantly in alopecia areata
patients from that in historical controls. Therefore, it is difficult
to establish the exact co-relation between thyroid disease and
alopecia areata.
Diabetes and rheumatoid arthritis
There appears to be a higher incidence of diabetes mellitus and
rheumatoid arthritis in the family members of patients with alopecia
areata but not in the actual patients with alopecia areata. An
important observation shows that the frequency of type I diabetes
mellitus has been found to be increased in the relatives of patients
with alopecia areata but not in the patients themselves, suggesting
that the pre-disposition for alopecia areata may actually be protective
against the development of diabetes.
Table
of references on finding alopecia areata in association with
other autoimmune conditions
Alopecia areata has been reported in association with many other
medical conditions. Most of these complaints are immunologically
mediated or even autoimmune diseases. The presence of alopecia
areata plus other immune conditions in individuals has been taken
as indirect, circumstantial evidence that alopecia areata is also
immunologically based. Note: Most medical journal papers below
are case reports on just one or two people and statistical information
was not provided.
| PERCENTAGE WITH AA PLUS CONDITION
| ASSOCIATED CONDITION
| CITATION
|
| *
| Addison's disease
| Kern 1974
|
| *
| Celiac disease
| Corazza 1995
|
| *
| Diabetes
| Cunliffe 1968
|
| *
| Diabetes
| Taniyama 1991
|
| *
| Diabetes
| Wang 1994
|
| *
| Lichen planus
| Tan 1974
|
| *
| Lichen planus
| Brenner 1979
|
| *
| Lichen planus
| Conte 1990
|
| *
| Lichen planus
| Gruppo Italiano 1991
|
| *
| Lichen planus
| Kanwar 1993
|
| *
| Lichen planus
| Kumar 1995
|
| *
| Lichen planus
| Dhar 1996
|
| *
| Lupus Erythematosus (SLE/DLE)
| Barber 1921
|
| *
| Lupus Erythematosus (SLE/DLE)
| Muller 1963
|
| *
| Lupus Erythematosus (SLE/DLE)
| Werth 1992
|
| *
| Lupus Erythematosus (SLE/DLE)
| Kumar 1995
|
| *
| Myasthenia Gravis
| Tan 1974
|
| *
| Myasthenia Gravis
| Wakata 1995
|
| *
| Pernicious anemia
| Allison 1955
|
| *
| Pernicious anemia
| Cunliffe 1968
|
| *
| Pernicious anemia
| Kern 1974
|
| *
| Pernicious anemia
| Freidman 1981b
|
| *
| Pernicious anemia
| Wang 1994
|
| *
| Polymyalgia rheumatica
| Faergemann 1979
|
| *
| Psoriasis
| Ganor 1977
|
| *
| Psoriasis
| Kumar 1995
|
| *
| Psoriasis
| Yamamoto 1995
|
| *
| Rheumatoid arthritis
| Barber 1921
|
| *
| Rheumatoid arthritis
| Muller 1963
|
| *
| Scleroderma
| Brenner 1979
|
| *
| Sjogren syndrome
| Torok 1977
|
| Significant
| Thyroid disease
| Castel 1928
|
| 8%
| Thyroid disease
| Muller 1963
|
| 27%
| Thyroid disease
| Cunliffe 1969
|
| Not significant
| Thyroid disease
| Salamon 1971
|
| *
| Thyroid disease
| Kern 1974
|
| Not significant
| Thyroid disease
| Main 1975
|
| 24% children
| Thyroid disease
| Milgraum 1987
|
| Not significant
| Thyroid disease
| Gollinck 1992
|
| 11.8%
| Thyroid disease
| Shellow 1992
|
| 7.2%
| Thyroid disease
| Puavilai 1994
|
| *
| Ulcerative colitis
| Allen 1974
|
| *
| Ulcerative colitis
| Tan 1974
|
| *
| Ulcerative colitis
| Gruppo Italiano 1991
|
| *
| Ulcerative colitis
| Treem 1993
|
| *
| Vitiligo
| Barber 1921
|
| *
| Vitiligo
| Levy-franckel 1925
|
| *
| Vitiligo
| Brown 1929
|
| 4%
| Vitiligo
| Anderson 1950
|
| 4%
| Vitiligo
| Muller 1963
|
| *
| Vitiligo
| Cunliffe 1968
|
| *
| Vitiligo
| Cunliffe 1969
|
| 9%
| Vitiligo
| Main 1975
|
| *
| Vitiligo
| Brenner 1979
|
| *
| Vitiligo
| Wang 1994
|
| *
| Vitiligo
| Dhar 1994
|
| *
| Vitiligo
| Hara 1995
|
| *
| Vitiligo
| Cho 1995
|
Alopecia
areata associated with other autoimmune diseases references
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M, Tosti A, Gasbarrini G. Celiac disease
and alopecia areata: report of a new association. Gastroenterology.
1995 Oct;109(4):1333-7.
PMID: 7557104
- Cunliffe WJ, Hall R, Newell DJ, Stevenson CJ. Vitiligo, thyroid
disease and autoimmunity. Br J Dermatol. 1968 Mar;80(3):135-9.
PMID: 5646064
- Taniyama M, Kushima K, Ban Y, Kaihara M, Nagakura H, Sekita
S, Katagiri T, Sueki H. Simultaneous
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- Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter
JI. Increased risk for type I (insulin-dependent)
diabetes in relatives of patients with alopecia areata (AA).
Am J Med Genet. 1994 Jul 1;51(3):234-9.
PMID: 8074151
- Tan RS. Ulcerative colitis, myasthenia
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- Tan RS. Thymoma, acquired hypogammaglobulinaemia, lichen planus,
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- Conte A, Inverardi D, Loconsole F, Petruzzellis V, Rantuccio
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- Muller SA, Brunsting LA. Cataracts in alopecia areata report
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- Werth VP, White WL, Sanchez MR, Franks AG. Incidence of alopecia
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- Kumar B, Sharma VK, Sehgal S. Antismooth
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- Wakata N, Sumiyoshi S, Tagaya N, Okada S, Araki Y, Kinoshita
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- Friedmann PS. Alopecia areata and
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- Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter
JI.
Increased risk for type I (insulin-dependent) diabetes in relatives of patients
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Am J Med Genet. 1994 Jul 1;51(3):234-9.
PMID: 8074151
- Faergemann J. Lichen sclerosus et
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- Ganor S. Diseases sometimes associated
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- Salamon T, Musafija A, Milicevic M.
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8462807
- Cunliffe WJ, Hall R, Newell DJ, Stevenson CJ. Vitiligo, thyroid
disease and autoimmunity. Br J Dermatol. 1968 Mar;80(3):135-9.
PMID: 5646064
- Brenner W, Diem E, Gschnait F. Coincidence
of vitiligo, alopecia areata, onychodystrophy, localized scleroderma
and lichen planus. Dermatologica. 1979;159(4):356-60. PMID:
478074
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