ALOPECIA areata (AA) is a prevalent autoimmune condition characterised by sudden, non-scarring hair loss on the scalp or body. Its clinical course is highly unpredictable, ranging from spontaneous remission to chronic relapsing episodes. Hair loss can vary from isolated bald patches (patchy AA) to complete scalp (alopecia totalis, AT) or body hair loss (alopecia universalis, AU). This unpredictability often causes significant psychological distress.
Comorbidity with chronic inflammatory disorders (CIDs) is frequently observed in AA, potentially influencing its prognosis and management. However, existing research on the links between AA clinical features and CID comorbidities has been limited, often involving small sample sizes or focusing on specific aspects of the disease.
A comprehensive study of 2,657 patients from Germany and Belgium assessed the relationship between CID comorbidities and AA characteristics. Over half (53.7%) of participants reported at least one CID, with atopic dermatitis (26.7%), bronchial asthma (13.4%), and rhinitis (26.7%) being the most common. Non-atopic CIDs, such as Hashimoto’s thyroiditis, vitiligo, psoriasis, and rheumatoid arthritis, were also prevalent.
Key findings revealed that AA patients with comorbid atopic dermatitis, asthma, or Hashimoto’s thyroiditis were significantly more likely to experience early-onset, severe, and prolonged AA compared to those without CIDs. Additionally, the presence of multiple atopic comorbidities increased the risk of poor outcomes. For instance, the mean age of AA onset was nearly 10 years earlier in patients with three atopic conditions (e.g., dermatitis, asthma, and rhinitis).
Although AA is traditionally seen as a Th1-mediated autoimmune disease, emerging research suggests a role for the Th2-immune axis, particularly in cases with atopic comorbidities. This axis may influence disease progression and outcomes, highlighting the importance of immune system dynamics in AA.
These findings underscore the need for heightened clinical monitoring and early intervention for AA patients with CIDs, particularly those with atopic disorders or Hashimoto’s thyroiditis. Recognising distinct comorbidity profiles could lead to more tailored and effective treatment strategies.
Katie Wright, EMJ
Reference
Friedrich A et al. Comorbid bronchial asthma, atopic dermatitis and hashimoto’s thyroiditis are risk factors for early-onset, severe and prolonged alopecia areata. Allergy. 2025;DOI:10.1111/all.16468.
