Alopecia Areata May be Correlated with Several Immune-Mediated Disorders

Alopecia areata (AA) exhibits a significant association with several immune-mediated disorders, such as autoimmune thyroiditis, gastrointestinal disorders, and atopic conditions, according to findings from a recent systematic review.

Many studies have examined possible associations between AA and other diseases, indicating a potential contribution to reduced health-related quality of life. However, many of these studies face several limitations, focusing on individual immune-mediated diseases and thereby limiting their broader applicability.2

“Many studies have established correlations between AA and other immune-related diseases, including thyroid, atopic dermatitis, gastrointestinal, rheumatological, and skin disorders,” said Piotr Krajewski, MD, PhD, University Center of General Dermatology and Oncodermatology, Wroclaw Medical University, and colleagues. “However, the variability in research methodologies prevents definitive conclusions from being drawn.”1

Investigators collected data on epidemiological studies through Medline, Web of Science, and Google Scholar; inclusion criteria included case-controlled study designs and sufficient data for both cases and controls to calculate odds ratios with a 95% confidence interval [CI]. Reviews, case reports, and letters were excluded. Pooled prevalence was assessed as mean percentage of patients with AA suffering from certain autoimmune disorders.1

Investigators collected an initial 44 articles examining autoimmune comorbidities, including 480,698 patients with AA. Significant methodological heterogeneity resulted in only 18 being considered for the meta-analysis, including 462,945 patients with AA and 11,488,192 healthy controls. Because most studies did not report all comorbidities, investigators assessed each comorbidity separately and divided them into 5 groups: atopic disorders, gastrointestinal disorders, thyroid disorders, skin disorders, and other systemic disorders.1

Atopic disorders appeared in 11 articles encompassing 77,773 patients with AA and 8,447,109 controls – these articles indicated patients with AA have a higher likelihood of developed atopic disorders (odds ratio [OR], 1.59; 95% CI, 1.56-1.62; pooled prevalence 38.65%). Specifically, individuals with AA were more likely to develop atopic dermatitis (OR, 2.63; 95% CI, 2.53-2.79; prevalence 7.31%), allergic rhinitis (OR, 1.44; 95% CI, 1.4-1.48; prevalence 17.39%), and asthma (OR, 1.34; 95% CI, 1.29-1.38; prevalence 9.56%).1

Gastrointestinal disorders were reported by 6 articles with 40,394 patients with AA and 10,763,887 controls. Patients with AA were at higher risk of inflammatory bowel disease (OR, 1.2; 95% CI, 1.04-1.38; prevalence .72%), ulcerative colitis (OR, 1.5; 95% CI, 1.3-1.73; prevalence .53%), Crohn’s disease (OR, 1.5; 95% CI, 1.25-1.81; prevalence .34%), and celiac disease (OR, 2.75l 95% CI, 2.22-3.49; prevalence .73%).1

A total of 7 articles including 265,251 patients with AA and 8,860,617 controls examined endocrinological disorders. Meta-analysis indicated patients with AA were more susceptible to thyroid disorders (OR, 1.57; 95% CI 1.51-1.64; prevalence 5.74%), autoimmune hypothyroidism (OR, 1.46; 95% CI, 1.38-1.55; prevalence .89%), and autoimmune hyperthyroidism (OR, 1.46; 95% CI, 1.36-1.56; prevalence .53%).1

Patients with AA also had a 6-fold greater probability of vitiligo compared to controls (OR, 6.61; 95% CI, 5.49-7.95; prevalence 1.31%), as well as a higher possibility of chronic spontaneous urticaria (OR, 5.12; 95% CI, 3.38-7.76; prevalence 2.77%) and psoriasis (OR, 2.26; 95% CI, 2.08-2.47; prevalence 2.4%). However, investigators noted no statistically significant correlation between AA and lichen planus.1

Patients with AA also exhibited a 3 times increased likelihood of systemic lupus erythematosus (OR, 3.28; 95% CI, 2.76-3.89; prevalence .47%), rheumatoid arthritis (OR, 1.61; 95% CI, 1.35-1.92; prevalence .9%), and type 1 diabetes mellitus (OR, 1.23; 95% CI, 1.07-1.42; prevalence 2.02%) compared to controls. Additionally, multiple sclerosis was more prevalent in patients with AA (OR, 1.32; 95% CI, .99-1.76; prevalence .34%); however, investigators noted this finding did not reach statistical significance.1

Investigators reported several limitations to these findings, noting the heterogeneity in study designs and methodologies may have created artificial variability in the results. Additionally, many included studies also lacked uniform reporting of immune-mediated comorbidities, which limited the number of eligible studies.1

Nonetheless, Krajewski and colleagues note these findings as confirming a significant association between AA and immune-mediated disorders. These data also draw attention to the intricate immunological interactions underlying these conditions.1

“These findings highlight the importance of proactive screening for additional immune-mediated disorders in patients with AA to provide a more comprehensive and holistic approach to patient care,” Krajewski and colleagues wrote. “Further research should focus on understanding the specific immunological pathways that these conditions share, paving the way for more precise and effective therapeutic strategies.”1

References

1. Krajewski PK, Jastrząb B, Szepietowski JC, Jankowska‐Konsur A, Saceda Corralo D. Immune‐mediated disorders in patients with ALOPECIA AREATA: Systematic review and meta‐analysis. International Journal of Dermatology. Published online July 2, 2025. doi:10.1111/ijd.17895

2. Mostaghimi A, Soliman AM, Li C, Barqawi YK, Grada A. Immune-Mediated and Psychiatric Comorbidities Among Patients Newly Diagnosed With Alopecia Areata. JAMA Dermatol. 2024;160(9):945-952. doi:10.1001/jamadermatol.2024.2404