Gut Microbiota May Be Linked to Alopecia Areata

Gut health is not just a hot wellness trend.

The gastrointestinal tract has long been considered the root of good health in Asian medicine, whilst the Western world only started to show significant medical interest over the past 10 years or so.

This is despite the founder of modern medicine, the Greek physician Hippocrates who died in 370BC, famously stating "all disease begins in the gut".

Researchers in Spain recently conducted a cross-sectional study to establish whether gut microbiota played a role in the autoimmune disorder, Alopecia Areata. Specifically, they were looking for links to its most severe phenotype, Alopecia Universalis.

Whereas the mild form of Alopecia Areata presents as patchy hair loss to the scalp only, Alopecia Universalis causes complete baldness from head-to-toe.

All forms can be distressing as the hair growth cycle becomes suspended, resulting in sudden hairloss with the length of time this will remain 'stuck' being unpredictable.

There are Alopecia Areata treatments available for the scalp-only type, which will often see spontaneous hair regrowth resume within 12 months, too. However, for the more extensive iterations, including Alopecia Universalis, treatments tend to be less successful and the conditions are generally on-going. There are currently no MHRA-licensed nor FDA-approved treatments for Alopecia Areata, though many are in development.

Although the underlying mechanisms that cause all types of autoimmune alopecia are still unknown, various triggers have been identified. These include sudden shock and trauma, allergies, hormones and a genetic element is also suspected.

Possible bacterial biomarkers

A team comprising researchers from various medical institutions in Madrid, compared the gut health of 15 patients with Alopecia Universalis and 15 healthy control participants.

In the study report published in the Journal of the European Academy of Dermatology and Venereology on 16th August 2019, the methodology is explained: "Gut microbiome of the study subjects was analysed by sequencing the 16SrRNA of stool samples. We searched for bacterial biomarkers of alopecia universalis using the linear discriminant analysis effect size (LEFse) tool."

Of the 30 subjects, 46.6 per cent were women and 53.4 per cent were male and no statistically significant difference was noted in gut bacteria based on gender.

However, the team noted that an "enriched presence (LDA SCORE > 2) of Holdemania filiformis, Erysipelotrichacea, Lachnospiraceae, Parabacteroides johnsonii, Clostridiales vadin BB60 group, Bacteroides eggerthii and Parabacteroides distasonis" was seen in the participants with Alopecia Universalis.

Furthermore, they advised that a "predictive model based on the number of bacterial counts of Parabacteroides distasonis and Clostridiales vadin BB60 group correctly predicted disease status in 80% of patients..."

It was concluded that, although this study showed that Alopecia Universalis "does not seem to affect broadly gut microbiota structure" more research was needed as there were a number of bacterial biomarkers found which were associated with the disease and these may be involved in the condition's pathophysiology. Alternatively, their presence could be used to assist in diagnosing the disorder, which can affect men, women and children of any age, race or hair type.

Novartis looking to revist alopecia areata treatment research?

Pharmaceutical company, Novartis contributed to the financing of this Spanish study. This may indicate that the Swiss multinational is considering revisiting a foray into developing Alopecia Areata hair loss solutions.

In 2015 Novartis started clinical trials into its biological, interleukin-17A-blocking drug, secukinumab - which goes under the brand name Cosentyx - to determine whether it could be a potential treatment for Alopecia Areata.

At present - October 2019 - however, there is no mention of this trial, nor any other research into Alopecia Areata in any of its forms, in the company's pipeline reports. Should any new information come to light on this, we will publish updates here on the Belgravia blog.

In the meantime, adults concerned about sudden hair fall from the scalp should contact a dermatologist or hair loss specialist, whilst children or those with shedding in other areas of the face or body, should speak to their doctor as a first port of call.