Alopecia Areata Associated With Autoimmune Comorbidity

Lara C. Pullen, PhD

May 22, 2013

Many individuals with alopecia areata (AA) have comorbid conditions, according to a retrospective cross-sectional study. The authors compared the prevalence of comorbid conditions in patients with AA with the prevalence of comorbid conditions in patients in the Psoriasis and Psoriatic Arthritis Follow-up Study. The association between AA and comorbid conditions was consistent with findings from previous studies.

Kathie P. Huang, MD, from the Clinical Research Program, Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and colleagues report their results in an article published online May 22 in JAMA Dermatology.

"Our descriptive study aimed to characterize the comorbid conditions associated with AA in the Boston patient population seen at the Partners institutions during an 11-year period. The [Automated Retrieval Console] program, which harnessed properties of artificial intelligence and systematic natural language processing, allowed us to select a group of 2115 patients with AA. These patients were initially screened on the basis of their [International Classification of Diseases, Ninth Revision] codes, and their diagnosis was confirmed by using our innovative program, which created a model based on manual review of records," the authors explain.

The study had the advantage of including a large, heterogeneous population. Patients with AA had a significantly increased incidence of atopy (38.2%), contact dermatitis (35.9%), gastroesophageal reflux disease (17.3%), and vitiligo (2.8%). The authors suggest that the connection between atopic disease and AA may be driven by changes in the integrity of the epidermal barrier resulting from filaggrin mutations.

"We found a high prevalence of autoimmune diseases in our AA cohort compared with previous studies," the authors write. Specifically, they found that 35.0% of patients with AA were positive for thyroid peroxidase antibodies, an autoimmune marker.

"We found high psychiatric comorbidity among our patients with AA at 25.5%; this category included depression and anxiety, consistent with findings of previous studies that surveyed the most common psychiatric disorders in adult patients with AA," they note. They also found an association between AA and hyperlipidemia and hypertension.

"The first practice gap is the need to understand whether this increase is real or just linked to advances in diagnostic methods or differences in the study population and methods," writes Anatonella Tosti, MD, from the Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida, in an accompanying comment. "The second practice gap is the need for dermatologists to include in their review of systems for AA questions about autoimmune disorders, mood or depression, and bowel symptoms.... The third and most important practice gap for physicians is establishing the costs and benefits of ordering extensive laboratory and diagnostic tests to screen patients with AA for possible associated autoimmune diseases."

One coauthor reported serving as a consultant for Abbott, the Centers for Disease Control and Prevention, Novartis, and Janssen, and receiving a grant from Amgen for an unrelated project. The questionnaire used was licensed to Pfizer and Merck for clinical trials. The other authors and Dr. Tosti have disclosed no relevant financial relationships.

JAMA Dermatol. Published online May 22, 2013. Article abstract, Comment extract


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