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Ly S, Manjaly P, Kamal K, Shields A, Wafae B, Afzal N, Drake L, Sanchez K, Gregoire S, Zhou G, Mita C, Mostaghimi A. Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis. Am J Clin Dermatol 2023; 24:875-893. [PMID: 37464249 DOI: 10.1007/s40257-023-00805-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a complex autoimmune condition resulting in nonscarring hair loss. In recent years, many studies have provided new evidence on comorbid diseases present in patients with AA. However, some studies have conflicting results, and analyses conducting a comprehensive approach are lacking. OBJECTIVE The aim of our study was to provide an updated systematic review and meta-analysis of medical comorbidities associated with AA. METHODS We searched PubMed, Embase, and Web of Science for case-control, cross-sectional, and cohort studies investigating medical comorbidities in AA published from inception through 1 February 2023. RESULTS We screened 3428 abstracts and titles and reviewed 345 full text articles for eligibility. Ultimately, 102 studies were analyzed, comprising 680,823 patients with AA and 72,011,041 healthy controls. Almost all included studies (100 of 102 studies) were of satisfactory to high quality (Newcastle-Ottawa scale score ≥ 4). Among patients with AA, comorbidities with the highest odds ratios (OR) compared with healthy controls and data available from more than one study included vitamin D deficiency (OR 10.13, 95% CI 4.24-24.20), systemic lupus erythematous (OR 5.53, 95% CI 3.31-9.23), vitiligo (OR 5.30, 95% CI 1.86-15.10), metabolic syndrome (OR 5.03, 95% CI 4.18-6.06), and Hashimoto's thyroiditis (OR 4.31, 95% CI 2.51-7.40). AA may be a protective factor for certain disorders, for which the AA group had lower odds compared with healthy controls, such as irritable bowel syndrome (OR 0.38, 95% CI 0.14-0.99) and colorectal cancer (OR 0.61, 95% CI 0.42-0.89). CONCLUSION These findings corroborate and contextualize the risks across comorbidities for patients with AA. Further work should be done to identify the underlying pathophysiology and understand appropriate screening criteria.
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Affiliation(s)
- Sophia Ly
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Ali Shields
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Bruna Wafae
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Najiba Afzal
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Lara Drake
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Katherine Sanchez
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Samantha Gregoire
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA
| | - Guohai Zhou
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Carol Mita
- Countway Library of Medicine, Harvard University, Boston, MA, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
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Tehranchinia Z, Abdollahimajd F, Haghighatkhah H, Talebi A, Yarahmadi A, Zoghi G. The frequency of fatty liver in patients with alopecia areata: A case-control study. J Cosmet Dermatol 2023; 22:2579-2583. [PMID: 37017934 DOI: 10.1111/jocd.15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/03/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Alopecia areata (AA) is an immune-mediated nonscarring hair loss disorder with multiple subtypes, including alopecia universalis (AU). Previous studies have shown a link between serum lipid profile and alopecia. We aimed to investigate the frequency of fatty liver in patients with AU and patchy alopecia areata (PAA) compared to a control group. METHODS This case-control study included patients with AU and PAA referred to a dermatology clinic from September 23, 2019 to September 23, 2020. A group of individuals without hair loss disorders attending the same clinic were selected as controls. Participants' general information, including age, sex, weight, height, and waist circumference (WC), was recorded. Body mass index (BMI) was calculated for all participants. Also, hyperlipidemia and statin use were noted and liver enzymes were evaluated. For AU and PAA patients, disease duration and the Severity of Alopecia Tool (SALT) score were also recorded. Then, all subjects underwent ultrasound to assess fatty liver and its grade. RESULTS Overall, 32 patients were included in each group. All three groups were comparable in age, sex, weight, height, BMI, WC, hyperlipidemia, abnormal liver enzymes, and statin use. Disease duration and SALT score were significantly higher in the AU than in the PAA group (p = 0.009 and p < 0.001, respectively). The frequency of fatty liver was the highest in AU patients (40.6%), followed by 34.4% in PAA patients, and 21.9% in controls (p = 0.263). This was also the case for grade-1 fatty liver, while grade-2 was more common in PAA patients, and grade-3 was only observed in one patient from the AU group (p = 0.496). CONCLUSIONS Fatty liver was more frequent in AU and PAA patients than controls, without statistically significant differences. There might be an association between fatty liver and AA, particularly the AU subtype.
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Affiliation(s)
- Zohreh Tehranchinia
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Abdollahimajd
- Department of Dermatology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Haghighatkhah
- Radiology Department of Diagnosis Imaging, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Talebi
- Colorectal Research Center, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Yarahmadi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Singdia H, Bhargava P, Nijhawan S, Mathur DK. A Study of Correlation of Alopecia Areata and Metabolic Syndrome in Northwest Indian Population: A Case-Control Study. Int J Trichology 2023; 15:63-69. [PMID: 37701557 PMCID: PMC10495065 DOI: 10.4103/ijt.ijt_89_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 09/14/2023] Open
Abstract
Context Alopecia areata (AA) is the most common cause of inflammatory, nonscarring hair loss, involving hair-bearing areas of the body. The etiology of AA still remains uncertain; however, genetic, environmental, and autoimmunity play a role. Newer theories such as oxidative theory, HPA axis activation, and finally, the role of increased inflammatory cytokines such as interleukin 1 (IL1), tumor necrosis factor-alpha, interferon-gamma, IL-2 IL-4, and MIF are suggested to contribute to both AA and metabolic syndrome (MS). Aims Assessment of the degree of association of MS (NCEP ATP III criteria) in clinically diagnosed cases of AA and compare to that of controls. Materials and Methods Similar age/sex-matched AA patients and controls (106 in each group) were taken. Anthropometric measurements, blood-sugar estimation, lipid-profile estimation in venous blood sample, and blood-pressure measurement were done. Results Prevalence of MS was almost similar among cases of AA 9/106 (8.47%) as well as healthy controls 8/106 (7.54%), and the difference was not statistically significant (P = 1). Among all components of MS, waist circumference (WC) (central obesity) was the most common parameter (100% cases). In controls, high systolic blood pressure (SBP) was the most common parameter (77.78% controls). AA is associated with a higher level of SBP, diastolic blood pressure (DBP), WC although nonsignificant, and low level of high-density lipoprotein cholesterol which was the only significant association. Conclusion Insignificant correlation between occurrence of MS and evidence of insulin resistance (IR) in AA was observed in this study population. However, some of the observations in the present study may raise awareness in susceptible individuals that lifestyle changes and regular screening in AA can reduce the risk of cardiovascular diseases and other co-existing autoimmune inflammatory condition-IR, dyslipidemia, and hypertension.
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Affiliation(s)
- Heena Singdia
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Puneet Bhargava
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Shivi Nijhawan
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Deepak Kumar Mathur
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
- Department of Skin and V.D., SMS Medical College; Department of Skin and V.D., SMS Medical College and Hospital, Jaipur, Rajasthan, India
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Lipocalin-2 and insulin as new biomarkers of alopecia areata. PLoS One 2022; 17:e0268086. [PMID: 35639706 PMCID: PMC9154110 DOI: 10.1371/journal.pone.0268086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
Lipocalin-2 and visfatin are proinflammatory adipokines involved in the regulation of glucose homeostasis. Their role has been described in numerous inflammatory skin diseases such as atopic dermatitis and psoriasis. Recently, an increased prevalence of metabolic abnormalities has been reported in patients with alopecia areata. The aim of the study is to determine the serum levels of lipocalin-2 and visfatin in patients with alopecia areata in comparison with healthy controls. Moreover, the serum levels of total cholesterol, low-density lipoprotein cholesterol (LDL-cholesterol), high-density lipoprotein cholesterol (HDL-cholesterol), triglycerides, fasting glucose, insulin, c-peptide, and homeostasis model assessment for insulin resistance (HOMA-IR) were evaluated. Fifty-two patients with alopecia areata and 17 control subjects were enrolled in the study. The serum levels of lipocalin-2 [mean ± standard deviation, SD: 224.55 ± 53.58 ng/ml vs. 188.64 ± 44.75, p = 0.01], insulin [median (interquartile range, IQR): 6.85 (4.7–9.8) μIU/ml vs. 4.5 (3.5–6.6), p<0.05], c-peptide [median (IQR): 1.63 (1.23–2.36) ng/ml vs. 1.37 (1.1–1.58), p<0.05)], and HOMA-IR [median (IQR): 1.44 (0.98–2.15) vs. 0.92 (0.79–1.44), p<0.05) were significantly higher in patients with alopecia areata compared to the controls. The serum concentration of insulin and HOMA-IR correlated with the number of hair loss episodes (r = 0.300, p<0.05 and r = 0.322, p<0.05, respectively). Moreover, a positive correlation occurred between insulin, HOMA-IR, c-peptide and BMI (r = 0.436, p <0.05; r = 0.384, p<0.05 and r = 0.450, p<0.05, respectively). In conclusion, lipocalin-2 and insulin may serve as biomarkers for alopecia areata. Further studies are needed to evaluate the role of insulin as a prognostic factor in alopecia areata.
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Ting HC, Ma SH, Tai YH, Dai YX, Chang YT, Chen TJ, Chen MH. Association between alopecia areata and retinal diseases: A nationwide population-based cohort study. J Am Acad Dermatol 2021; 87:771-778. [PMID: 34794815 DOI: 10.1016/j.jaad.2021.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing evidence has revealed abnormalities in the retinal structures of patients with alopecia areata (AA). However, the relationship between AA and retinopathy remains unclear. OBJECTIVE To investigate the association between AA and retinal diseases. METHODS The study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 9909 patients with AA and 99,090 matched controls to assess the risk of retinal diseases. A Cox regression model was used for all analyses. RESULTS Compared with the controls, patients with AA had an adjusted hazard ratio (aHR) of 3.10 (95% confidence interval [CI] 2.26-4.26) for retinal diseases. With respect to individual retinal diseases, Patients with AA had significantly higher risks of developing retinal detachment (aHR 3.98; 95% CI 2.00-7.95), retinal vascular occlusion (aHR 2.45; 95% CI 1.22-4.92), and retinopathy (aHR 3.24; 95% CI 2.19-4.81) than controls. LIMITATIONS This was a retrospective cohort study. Meanwhile, almost all the participating individuals were residents of Taiwan; therefore, the validity of our findings in other demographics remains unclear. CONCLUSION Patients with AA had a significantly higher risk of retinal disease than controls. Further studies are needed to clarify the pathophysiology of AA and retinal diseases.
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Affiliation(s)
- Hui-Chu Ting
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Hsiang Ma
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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Adiponectin as a novel biomarker of disease severity in alopecia areata. Sci Rep 2021; 11:13809. [PMID: 34226603 PMCID: PMC8257783 DOI: 10.1038/s41598-021-92853-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
The frequent coexistence of obesity and metabolic syndrome in patients with alopecia areata may indicate the common pathogenetic pathway in these conditions with an important role of adipokines. The aim of the study was to evaluate the serum level of adiponectin, resistin and leptin in patients with alopecia areata in comparison to healthy controls. The study included 65 patients with alopecia areata and 71 healthy controls. The concentration of adipokines was determined with the enzyme-linked immunosorbent assay. The mean concentrations of adiponectin and resistin were significantly lower in the sera of patients with alopecia areata when compared to healthy controls (7966 \documentclass[12pt]{minimal}
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\begin{document}$$\pm$$\end{document}± 8.69 ng/ml; p = 0.0176, respectively). A negative correlation between the serum level of adiponectin and severity of alopecia tool (SALT) score was observed (r = − 0.26; p < 0.05). The concentration of adiponectin was significantly lower in patients with alopecia universalis than in patients with patchy alopecia areata (4951 \documentclass[12pt]{minimal}
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\begin{document}$$\pm$$\end{document}± 4085 ng/ml; p = 0.0135). No significant difference in the serum concentration of leptin was observed between patients with alopecia areata and healthy controls. The negative correlation between the serum level of adiponectin and hair loss severity indicates that adiponectin may be considered a marker of hair loss severity in alopecia areata. Further studies are needed to evaluate the role of resistin in patients with alopecia areata and its decreased level irregardless of severity or activity of the disease.
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Abdollahimajd F, Niknezhad N, Bahreini N, Younespour S, Namazi N. Metabolic syndrome in patients with Alopecia Areata: A case-control study. Dermatol Ther 2021; 34:e14979. [PMID: 33991033 DOI: 10.1111/dth.14979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/19/2021] [Accepted: 05/12/2021] [Indexed: 12/14/2022]
Abstract
The aim of this study was to evaluate metabolic syndrome prevalence in patients with Alopecia Areata compared to controls. Sixty eligible patients with Alopecia Areata and 60 healthy subjects frequency matched for age and sex attending to our referral dermatology clinics from 2015 to 2017 were enrolled. Prevalence of metabolic syndrome and its components were compared between the two groups. Metabolic syndrome was only seen in seven patients (11.67%) and four controls (6.67%) without a significant difference (P = .34). The clinical presentations of AA included patch type (38.33%), ophiasis (6.67%), alopecia totalis (16.67%), and alopecia universalis (38.33%). Presence of metabolic syndrome was significantly associated with abdominal circumference (OR: 1.10, 95% CI for OR: 1.02to 1.19). Although there was no significant association between Alopecia Areata and metabolic syndrome, some components of metabolic syndrome were more prevalent in these patients. It may be concluded Alopecia Areata patients are at a higher risk of developing metabolic syndrome in the future. Further studies with larger sample sizes are needed.
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Affiliation(s)
- Fahimeh Abdollahimajd
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Research Development Unit, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Niknezhad
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Bahreini
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Younespour
- Dentistry Research institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Namazi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nasimi M, Shakoei S, Abedini R, Ghandi N, Faghihi Z. A cross-sectional study of metabolic syndrome in patients with alopecia areata. Indian J Dermatol Venereol Leprol 2021; 87:427-429. [PMID: 33666049 DOI: 10.25259/ijdvl_726_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 05/01/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Maryam Nasimi
- Department of dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoura Shakoei
- Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Department of dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Department of dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Faghihi
- Department of dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Serarslan G, Özcan O, Okyay E, Ünlü B, Karadağ M. Role of adiponectin and leptin in patients with alopecia areata with scalp hair loss. Ir J Med Sci 2020; 190:1015-1020. [PMID: 33083959 DOI: 10.1007/s11845-020-02410-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND/AIMS Alopecia areata (AA) is considered an organ-specific autoimmune disease of hair follicles. Adipose tissue plays a role in lipid metabolism and glucose metabolism and secretes adipokines such as leptin and adiponectin. Dysregulation in the adipokine balance may be associated with metabolic syndrome. We aimed to determine serum adipokine levels in AA patients and compare them with healthy controls, and to determine whether there was metabolic syndrome and insulin resistance in the AA patients. METHODS A total of 70 participants were included in the study. Patients were divided into two subgroups: patients with scalp hair loss were in subgroup 1 (AA1). Patients with beard and eyebrow hair loss were in subgroup 2 (AA2). Serum adiponectin, leptin, TNF-α, insulin, fasting glucose, TG, and HDL were analyzed. RESULTS Thirty-six (25 male, 11 female) patients with AA and 34 (18 male, 16 female) healthy subjects were included in the study. Metabolic syndrome was detected in three of the AA patients and in two of the healthy subjects. Serum leptin, adiponectin, TNF-α, TG, HDL, and insulin levels and HOMA-IR scores were not statistically significant in patients compared with control subjects, except fasting glucose levels (p = 0.035). However, serum leptin and adiponectin levels were significantly higher in AA1 (n = 25) subgroup compared with the control group (p = 0.029, p = 0.026 respectively). There was a statistically significant increase in the fasting glucose level, while there were no differences in other parameters between the AA2 (n = 11) subgroup and the control group. CONCLUSIONS To our knowledge, this is the first report indicating that adiponectin and leptin probably has a role in the pathogenesis of AA with scalp hair involvement.
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Affiliation(s)
- Gamze Serarslan
- Tayfur Ata Sökmen Medical Faculty, Department of Dermatology, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey.
| | - Oğuzhan Özcan
- Tayfur Ata Sökmen Medical Faculty, Department of Biochemistry, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Ebru Okyay
- Tayfur Ata Sökmen Medical Faculty, Department of Dermatology, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Bahar Ünlü
- Tayfur Ata Sökmen Medical Faculty, Department of Biochemistry, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
| | - Mehmet Karadağ
- Tayfur Ata Sökmen Medical Faculty, Department of Biostatistics, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
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Briganti S, Flori E, Mastrofrancesco A, Ottaviani M. Acne as an altered dermato‐endocrine response problem. Exp Dermatol 2020; 29:833-839. [DOI: 10.1111/exd.14168] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Stefania Briganti
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Enrica Flori
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Arianna Mastrofrancesco
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research San Gallicano Dermatological Institute IRCCS Rome Italy
| | - Monica Ottaviani
- Cutaneous Physiopathology and Integrated Center of Metabolomics Research San Gallicano Dermatological Institute IRCCS Rome Italy
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Shahidi-Dadras M, Bahraini N, Rajabi F, Younespour S. Patients with alopecia areata show signs of insulin resistance. Arch Dermatol Res 2019; 311:529-533. [PMID: 31089876 DOI: 10.1007/s00403-019-01929-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease associated with high levels of proinflammatory cytokines. Since chronic inflammation plays a major role in the pathogenesis of insulin resistance, AA can theoretically increase the risk of diabetes. We sought to investigate this theory by conducting a case-control study. Sixty patients with alopecia areata and 60 healthy volunteers (matched for age, sex, and body mass index) were evaluated. Fasting blood glucose (FBS), C-peptide, plasma insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) were measured for each individual. Plasma levels of insulin [median (interquartile range IQR): 11.22 (7.28-18.15) µIU/ml vs. 4.80 (3.20-9.00), p < 0.0001)], C-peptide [median (IQR): 2.10 (1.61-3.00) ng/ml vs. 1.40 (1.20-1.88), p < 0.0001)] and HOMA-IR [median (IQR): 2.70 (1.58-3.96) µIU/ml vs. 1.01 (0.64-1.98, p < 0.0001)] were significantly higher in patients with AA compared to controls. The differences remained significant even after controlling for age, gender, and BMI. Patients with a more severe disease (alopecia totalis/universalis) had higher levels of insulin [median (IQR): 15.80 (9.68-21.55) vs. 9.30 (5.33-14.40), p = 0.02)] and HOMA-IR [median (IQR): 3.30 (2.20-4.84) vs. 2.15 (1.29-3.52), p = 0.01] compared to those with patchy hair loss. Our data suggest that individuals with AA are at a higher risk of developing insulin resistance. This may be due to common inflammatory pathogenesis or a shared genetic background.
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Affiliation(s)
| | - Negin Bahraini
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fateme Rajabi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Network of Dermatology Research (NDR), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Shima Younespour
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
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12
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ATAŞ H, GÖNÜL M, ÖZTÜRK Y, KAVUTÇU M. Ischemic modified albumin as a new biomarker in predicting oxidative stress in alopecia areata. Turk J Med Sci 2019; 49:129-138. [PMID: 30762322 PMCID: PMC7350867 DOI: 10.3906/sag-1708-35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background/aim Results show that oxidative stress is a pathophysiologic factor for alopecia areata (AA); however, the markers used can be confounding. Thus, we aimed to investigate the role of oxidative stress in the pathogenesis of AA through an evaluation of ischemia-modified albumin (IMA); other markers of the oxidant/antioxidant system, such as SOD, CAT, GSH-ST, and MDA; and contributing clinical risk factors. Materials and methods The usefulness of IMA as a new marker for oxidative stress was compared with that of other markers and evaluated in patients with AA. Results The mean serum level of IMA was of higher statistical significance in AA patients than in the control group (IMA: 0.57 ± 0.01 vs. 0.52 ± 0.02 ΔABSU, P < 0.0001). IMA (P = 0.03, OR = 25.8, 95% CI = 1.4–482.7) was found to be an independent predictor of oxidative stress in patients with AA. Increased severity of AA was found as an independent risk factor for IMA. Conclusion Long-lasting disease, male sex, >1 site of involvement of disease, and increased severity of disease were correlated with increased oxidation. Presence of AA, male sex, and severe disease were determined to be independent risk factors for antioxidant and oxidant systems. IMA has great potential as a biomarker of oxidative stress in AA when compared to other studied biomarkers.
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Affiliation(s)
- Hatice ATAŞ
- Department of Dermatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Müzeyyen GÖNÜL
- Department of Dermatology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, AnkaraTurkey
| | - Yasin ÖZTÜRK
- Department of Biochemistry, Faculty of Science, Gazi University, AnkaraTurkey
| | - Mustafa KAVUTÇU
- Department of Biochemistry, Faculty of Science, Gazi University, AnkaraTurkey
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13
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Lee S, Lee H, Lee CH, Lee WS. Comorbidities in alopecia areata: A systematic review and meta-analysis. J Am Acad Dermatol 2019; 80:466-477.e16. [DOI: 10.1016/j.jaad.2018.07.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/01/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023]
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14
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Incel-Uysal P, Akdogan N, Alli N, Oktem A, Candar T, Topcuoglu C, Turhan T. Assessment of Metabolic Profile and Ischemia-modified Albumin Level in Patients with Alopecia Areata: A Case-Control Study. Indian J Dermatol 2019; 64:12-18. [PMID: 30745629 PMCID: PMC6340238 DOI: 10.4103/ijd.ijd_238_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Alopecia areata (AA) is an autoimmune-mediated hair follicle disorder. In the literature, there is no study evaluating metabolic syndrome and levels of ischemia-modified albumin (IMA) which is proposed as an oxidative stress biomarker in patients with AA. Aims: The aim was to investigate the presence of metabolic syndrome and the levels of IMA, small dense low-density lipoprotein (sd-LDL), and visfatin levels in AA patients. Settings and Design: A hospital-based cross-sectional study was undertaken among AA patients and controls. Subjects and Methods: Thirty-five patients with AA and 35 sex-, age-, and body mass index-matched healthy controls were enrolled. Clinical and laboratory parameters of metabolic syndrome were examined in all participants. Furthermore, IMA, sd-LDL, and visfatin levels were assessed and analyzed with regard to disease pattern, severity and extent, severity of alopecia tool score, duration, and recurrence. Results: The median IMA and adjusted IMA levels were significantly increased compared with controls (P<0.05 and P=0.002, respectively). Patients with pull test positivity displayed higher levels of adjusted IMA levels (P<0.05). In AA group, there was a positive correlation between adjusted IMA and waist circumference (r=0.443, P=0.008), adjusted IMA and triglyceride levels (r=0.535, P=0.001), and adjusted IMA and sd-LDL levels (r=0.46, P<0.05). We observed no statistically significant difference in fasting blood glucose and lipid profile, sd-LDL, and visfatin levels of the patients and healthy controls. Conclusions: AA patients and controls have similar metabolic profile. Raised levels of adjusted IMA levels may be associated with antioxidant/oxidant imbalance and with risk of cardiovascular disease.
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Affiliation(s)
- Pinar Incel-Uysal
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Neslihan Akdogan
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Nuran Alli
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ayse Oktem
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Tuba Candar
- Department of Medical Biochemistry, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Canan Topcuoglu
- Department of Medical Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Turan Turhan
- Department of Medical Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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15
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Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol 2015; 8:397-403. [PMID: 26244028 PMCID: PMC4521674 DOI: 10.2147/ccid.s53985] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Alopecia areata (AA) is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure. Objective The objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA. Methods and selection criteria A search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA’s incidence, prevalence, distribution, disability-adjusted life years (DALYs), quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data. Results The lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions. Conclusion AA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease.
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Affiliation(s)
| | - Mariya Miteva
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Insulin resistance and skin diseases. ScientificWorldJournal 2015; 2015:479354. [PMID: 25977937 PMCID: PMC4419263 DOI: 10.1155/2015/479354] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/17/2015] [Indexed: 12/16/2022] Open
Abstract
In medical practice, almost every clinician may encounter patients with skin disease. However, it is not always easy for physicians of all specialties to face the daily task of determining the nature and clinical implication of dermatologic manifestations. Are they confined to the skin, representing a pure dermatologic event? Or are they also markers of internal conditions relating to the patient's overall health? In this review, we will discuss the principal cutaneous conditions which have been linked to metabolic alterations. Particularly, since insulin has an important role in homeostasis and physiology of the skin, we will focus on the relationships between insulin resistance (IR) and skin diseases, analyzing strongly IR-associated conditions such as acanthosis nigricans, acne, and psoriasis, without neglecting emerging and potential scenarios as the ones represented by hidradenitis suppurativa, androgenetic alopecia, and hirsutism.
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Trieu N, Eslick GD. Alopecia and its association with coronary heart disease and cardiovascular risk factors: a meta-analysis. Int J Cardiol 2014; 176:687-95. [PMID: 25150481 DOI: 10.1016/j.ijcard.2014.07.079] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/24/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alopecia has been associated with an increased risk of coronary heart disease as well as the following risk factors for cardiovascular disease: hyperinsulinaemia, insulin resistance, metabolic syndrome, dyslipidaemia, and hypertension. We performed a meta-analysis to quantitatively determine the level of risk of coronary heart disease and risk factors in individuals with alopecia. METHODS A systematic literature search was conducted using several databases. We calculated pooled odds ratios and 95% confidence intervals using a random effects model. RESULTS In total, 31 studies comprising 29,254 participants with alopecia were eligible for the meta-analysis and showed that alopecia is associated with an increased risk of coronary heart disease (OR 1.22, 95% CI: 1.07-1.39), hyperinsulinaemia (OR 1.97, 95% CI: 1.20-3.21), insulin resistance (OR 4.88, 95% CI: 2.05-11.64), and metabolic syndrome (OR 4.49, 95% CI: 2.36-8.53). Individuals with alopecia were also shown to be more likely compared to those without alopecia to have higher serum cholesterol levels (OR 1.60, 95% CI: 1.17-2.21), higher serum triglyceride levels (OR 2.07, 95% CI: 1.32-3.25), higher systolic blood pressures (OR 1.73, 95% CI: 1.29-2.33), and higher diastolic blood pressures (OR 1.59, 95% CI: 1.16-2.18). CONCLUSIONS Alopecia is associated with an increased risk of coronary heart disease, and there appears to be a dose-response relationship with degree of baldness whereby the greater the severity of alopecia, the greater the risk of coronary heart disease. Alopecia is also associated with an increased risk of hypertension, hyperinsulinaemia, insulin resistance, metabolic syndrome, and having elevated serum total cholesterol and triglyceride levels.
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Affiliation(s)
- Nelson Trieu
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
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