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Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis

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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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Authors and Affiliations

  1. College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Sophia Ly

  2. Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA

    Sophia Ly, Priya Manjaly, Kanika Kamal, Ali Shields, Bruna Wafae, Najiba Afzal, Lara Drake, Katherine Sanchez, Samantha Gregoire, Guohai Zhou & Arash Mostaghimi

  3. Boston University School of Medicine, Boston, MA, USA

    Priya Manjaly

  4. Harvard Medical School, Boston, MA, USA

    Kanika Kamal, Bruna Wafae & Arash Mostaghimi

  5. Drexel University College of Medicine, Philadelphia, PA, USA

    Ali Shields

  6. University of California, Davis School of Medicine, Sacramento, CA, USA

    Najiba Afzal

  7. Tufts University School of Medicine, Boston, MA, USA

    Lara Drake

  8. Lake Erie College of Osteopathic Medicine, Erie, PA, USA

    Katherine Sanchez

  9. University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA

    Samantha Gregoire

  10. Countway Library of Medicine, Harvard University, Boston, MA, USA

    Carol Mita

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AM declares financial interest and a position on the advisory board of Fig. 1 Beauty, Inc., Eli Lilly and Company, Pfizer Inc., and Hims. AM receives fees as a consultant from AbbVie, Concert Pharmaceuticals, Pfizer Inc., and 3Derm Systems. AM is the founder of Lucid, Inc. and receives research funding from Incyte Corporation, Aclaris Therapeutics Inc., Eli Lilly and Company and Concert Pharmaceuticals. All other authors declare no conflict of interest.

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All authors contributed to the study design. The search strategy development and literature search were performed by S.L., C.M, and A.M. Data collection and interpretation were conducted by S.L., P.M., K.K., A.S., B.W., N.A., L.D., K.S., S.G., and A.M. Statistical analysis was performed by S.L. and G.Z. The manuscript was drafted by S.L. and critically revised by all other authors. All authors read and approved the final manuscript.

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Ly, S., Manjaly, P., Kamal, K. et al. Comorbid Conditions Associated with Alopecia Areata: A Systematic Review and Meta-analysis. Am J Clin Dermatol 24, 875–893 (2023). https://doi.org/10.1007/s40257-023-00805-4

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