Can some people experience a seasonal cycle in the extent of their alopecia areata?

Alopecia areata (AA) is a chronic-relapsing non-scarring hair loss condition believed to stem from autoimmune origins. Certain forms of the disease, such as ophiasis, subtotalis, and sub-universalis alopecia, can present a persistent relapsing course in some affected individuals. Through research and studies, a fascinating phenomenon has been observed, whereby patients experience seasonal cyclic fluctuations in the extent of their alopecia areata. Intriguingly, even horses may experience seasonal alopecia areata. This article explores the concept of seasonal alopecia areata, focusing on various factors that might contribute to its pattern.

Clinical observations from past research, including a study by R. D’Ovidio and F. D’Ovidio conducted in Italy, have shown that severe forms of alopecia areata may experience recurrent, more frequent relapses in February-March and fewer in July-August, a pattern suggesting a seasonal influence on disease behavior. This pattern was consistent irrespective of the coexistence of atopic diseases, indicating a broader influence of climate, rather than solely immunological factors, on disease relapses.

The seasonal cyclicality in alopecia areata might be attributed to various environmental factors. One possible explanation is that prolonged sun exposure during summer months may induce non-specific immunosuppression, reducing disease flare-ups. Alternatively, this could also be the result of a reduction in potential triggering factors such as allergen exposure, infections, and stress. The research also points towards the possibility that autoantigens, such as growth and differentiation markers of the hair follicle cells, are less expressed during summer months, thus reducing the chance of an immune response leading to hair loss.

Expanding upon these insights, more recent research from Philadelphia, Pennsylvania, has quantified the relationship between specific climate variables and AA flare frequency in children with AA. The study found significant correlations between AA flare frequency and several climate factors, including UV index, precipitation, number of days with rain, number of days with sun, and air pressure. Of these, UV index showed a strong inverse correlation with AA flare frequency, suggesting that increased UV exposure, and potentially the resultant increase in vitamin D production, could alleviate disease exacerbations.

Notably, these associations appeared to be more robust in patients with atopic comorbidities such as allergies that produce a runny nose or asthma breathing problems. The implication is that the disease flare-ups in these patients might be driven, at least in part, by climate-related exacerbation of their atopic conditions. As atopic conditions often have seasonal patterns and are influenced by climate, the interplay between these conditions and alopecia areata presents a complex and fascinating area for further research.

Another study by Losol and Şentürk, investigated the effectiveness of Squaric Acid Dibutyl Ester (SADBE) in treating AA. This treatment involves applying a chemical onto the scalp skin to promote a mild immune reaction which then promotes hair growth. They found that the response to SADBE treatment in AA patients was generally better when the disease started in spring and winter. This is particularly noteworthy as it suggests that there might be a seasonal correlation with the response to SADBE treatment in AA patients. However, as the authors acknowledge, there is a need for further research to validate this observation and explore the underlying causes of this phenomenon. It could be related to variations in immune response across different seasons, environmental factors, or other unidentified factors.

Zeng et al., focused on the role of allergen desensitization in reducing the severity of AA, particularly in patients allergic to house dust mites (HDM) in South China. This study proposes an interesting connection between allergen exposure and AA severity. It highlights that there may be a seasonal pattern of hair loss in AA patients with HDM allergies, with two peaks of AA exacerbation observed in winter and summer in South China. The study hypothesizes that AA flares during the summer months might be linked to a rise in HDM allergen concentration during the same period. Research from other scientists show that house dust mite blooms occur in high humidity seasons in South China – usually seen in summer. This provides an interesting perspective on how local allergens and their seasonal dynamics might influence the course of AA.

Understanding these climate-disease dynamics has profound implications for patient care. For instance, advising patients and caregivers about the potential for increased hair loss during colder, less sunny months, and increased hair growth during the spring could help prepare them psychologically for the seasonal pattern of the disease. Moreover, documenting these seasonal patterns of AA flares in diverse geographic regions and age groups could reveal additional insights into the disease’s mechanisms. It’s also worth noting that children might be an especially interesting population to study due to their lower likelihood of using high-dose vitamin D supplements, potentially allowing UV exposure to exert a stronger influence on disease behavior.

However, it should be mentioned that these observations do not account for all the complexities of the disease. For example, the study from Philadelphia was unable to explore the relationship between the severity of atopic conditions and AA flare-ups due to data limitations. Furthermore, the study from Italy indicated that the seasonal cyclicality was less prominent in cases of disease onset in childhood and in the presence of AA that runs in the family (suggesting a stronger genetic component to the AA in a person might reduce the impact of the environment on the AA extent).

In conclusion, the correlation between climate factors and alopecia areata flare-ups provides valuable insights into the complex dynamics of this chronic-relapsing condition. The finding that more severe forms of the disease may relapse more uniformly throughout the year warrants further investigation, as this could aid in the development of tailored therapeutic strategies for patients. Indeed, while our understanding of seasonal alopecia areata is still evolving, these insights already offer potential to improve patient prognosis and quality of life.

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