Alopecia areata patients have higher rates of inflammatory and autoimmune diseases—including atopic dermatitis, allergic rhinitis, asthma, and psoriasis—compared to individuals without the condition, according to recent findings, in addition to having higher rates of mental health conditions.¹

This data was the result of a study examining associations with alopecia and autoimmune and inflammatory disease, conducted due to the lack of large-scale research on the diseases and mental health struggles experienced by those with the skin condition and representative of the entire US population specifically.

The research was authored by Oladayo Jagun, MD, MPH, from Pfizer Inc. in New York. Jagun and colleagues sought to expand upon the existing body of research connecting autoimmune conditions and mental health issues with alopecia areata.²

“This study aimed to assess the incidence rates (IRs) and prevalence of AA and AA clinical subtypes in the United States, as well as examine the autoimmune and inflammatory diseases and mental health condition burden in patients with AA compared with a matched cohort of patients without AA using a national administrative claims database,” Jagun and colleagues wrote.

Background and Findings

To conduct this research, the investigators utilized the Optum Clinformatics Data Mart database to identify patients aged 12 years or older who were enrolled between October 1, 2016, and September 30, 2020, and had been diagnosed with alopecia areata using 2 or more diagnosis codes for the condition.

For each patient with the skin disease, 3 individuals without alopecia were matched in terms of age, sex, and race. The presence of autoimmune and inflammatory diseases, as well as mental health conditions, was assessed by the research team at the baseline and up to 2 years following the index date.

The study included a total of 8,784 patients with alopecia areata, of whom 599 were shown to have the clinical subtypes alopecia totalis (AT) or alopecia universalis (AU), along with 26,352 matched patients without alopecia areata.

The investigators found that the incidence rate of alopecia was shown to be 17.5 per 100,000 person-years (PY), with AT/AU having an incidence rate of 1.1 per 100,000 PY, and non-AT/AU having a rate of 16.3 per 100,000 PY. Additionally, they noted that prevalence of alopecia was 54.9 per 100,000 persons, with AT/AU accounting for 3.8 and non-AT/AU for 51.2 cases per 100,000 persons.

The research team’s findings showed that those diagnosed with alopecia exhibited a higher occurrence of autoimmune and inflammatory diseases when compared to a matched group without the skin condition.

Specifically, the team found that the prevalence of conditions such as allergic rhinitis (24.0% compared to 14.5%), atopic dermatitis (8.3% compared to 1.8%), asthma (12.8% compared to 8.8%), and psoriasis (5.0% compared to 1.6%) was shown to be substantially higher among individuals with alopecia compared to those without.

Furthermore, the proportions of anxiety (30.7% compared to 21.6%) and major depressive disorder (17.5% compared to 14.0%) were found to be greater in alopecia patients versus to those without the condition.

Additionally, the investigators observed that people with the clinical subtypes of alopecia areata, alopecia totalis and alopecia universalis, generally were shown to display a higher prevalence of autoimmune and inflammatory diseases in addition to mental health conditions when compared to individuals with non-AT/AU alopecia.

“Awareness of these associations could help physicians better assist patients with AA through appropriate comorbidity screenings and treatment management, potentially prior to progression to more extensive clinical subtypes of AA or the development of mental health conditions related to AA diagnosis,” they wrote. “Future research is needed to examine these associations and potential causal relationships between AA and these comorbidities.”

References

1. ^{George, P, Jagun, O, Liu, Q, Wentworth, C, Napatalung, L, Wolk, R, et al. Prevalence of autoimmune and inflammatory diseases and mental health conditions among an alopecia areata cohort from a US administrative claims database. J Dermatol. 2023; 00: 1– 8. https://doi.org/10.1111/1346-8138.16839.}
2. ^{Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011; 65: 949– 56.}