A case study published in the Dermatology Practical & Conceptual journal has suggested medical professionals should consider Alopecia Areata a potential warning sign of other autoimmune disorders.
Alopecia Areata presents as patchy hair loss to the scalp, though in its more severe phenotypes it can also cause baldness to the entire head and/or body.
All forms are known to be autoimmune in nature and it is well-established that people with any autoimmune disorder are more likely to develop others.
The study letter references a particular need to check for potential thyroid issues as Alopecia Areata may be a marker for issues such as autoimmune thyroiditis.
In this letter, published online on 31st July 2019, its authors, from the Dermatology Unit in the Department of Health Sciences of Magna Graecia University in Catanzaro, Italy, recount their experience with two identical 15 year old female twins (pictured).
Both developed Alopecia Ophiasis - a form of Alopecia Areata that causes a 'snaking' band of hairloss around the hairline. The first twin's alopecia started at 4 years old; she then underwent treatment using systemic and topical corticosteroids from 14 years of age. The second twin presented with Alopecia Areata at age 14. Each twin's hair loss is also accompanied by what the investigators refer to as "occasional itch".
Following consultations and blood work, the researchers then diagnosed them both with autoimmune thyroiditis, with both showing "very high" autoantibody levels.
The case study letter advises, "treatment with oral betamethasone 2 mg/day was started for both twins for 1 month when they were 14 years old. It was then reduced to 2 mg twice a week in association with vasodilatory and antiseptic lotions of the scalp for 2 months. This therapy led to a partial remission of dermatological manifestations in both patients. An endocrinological consultation was also recommended to better evaluate thyroid malfunctioning."
The Italian team's personal observations led them to a conclusion which is essentially a warning to their peers that Alopecia Areata may be a biomarker for thyroid issues. They write:
"Several studies have revealed a high prevalence of thyroid disorders in patients with AA. Screening for autoimmune thyroiditis and thyroid function should be done in all patients with these cutaneous disorders for the early identification of this disease...
Based on the literature data, which suggest a common activation of different immune patterns, and on the data obtained by our clinical case, we can say that AA should be considered a warning manifestation for other distinct diseases such as ones that affect the thyroid. In this unusual case, a genetic study to support the relationship between AA and autoimmunity may be useful."
As they mention, this case study's findings back those of larger scale research that has also established links between Alopecia Areata and autoimmune-based thyroid problems. These include Grave's disease and Hashimoto's thyroiditis.
Korean studies from 2017 found that, in a nationwide review, patients with Alopecia Areata were more likely to develop Graves’ disease or Hashimoto thyroiditis than those who did not. Additionally, people with the most severe forms of Alopecia Totalis or Alopecia Universalis, had a notably increased risk of developing either of these thyroid conditions.
Additional American research, released in October 2017, also suggested that specifically children should be screened for thyroid disorders if they present with Alopecia Areata.
Hair regrowth from the scalp-only form of Alopecia Areata will generally occur naturally within 12 months, though this is not usually the case for the more extensive forms. In either case, whether you intend to undergo Alopecia Areata treatment or not, it is worthwhile alerting your GP to the fact that you have developed this condition due to its potential ramifications on other areas of your health.
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