Original articleComorbidities in alopecia areata: A systematic review and meta-analysis
Section snippets
Search strategy
We performed a comprehensive literature search to identify articles written in English or Korean because of the authors' language proficiency. The gray literature was also included regardless of publication status. Two main reviewers (S.L. and H.L.) searched the MEDLINE, Embase, Web of Science, and Cochrane Library databases for studies published before February 28, 2018.
Study selection
The 2 main reviewers independently evaluated the titles and abstracts of the retrieved studies. In cases of discrepancy
Study selection, identification, and data synthesis
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram is presented in Fig 1. Of the 87 included studies, 4 were cohort studies that investigated incident diseases; their characteristics and main findings are summarized in Table I.4, 5, 13, 14 Of the 83 studies that investigated prevalent diseases, 41 were case-control studies (Supplemental Table I6, 7, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43
Atopic diseases
AA was closely associated with atopic diseases, particularly atopic dermatitis and allergic rhinitis. A history of atopic disease was traditionally considered an independent factor of poor prognosis in AA. Moreover, filaggrin gene mutation was associated with severe AA and poor prognosis.96 Also, high levels of serum total IgE or Dermatophagoides farinae– and Dermatophagoides pteronyssinus–specific IgE were associated with early-onset severe AA independent of atopic history.97 Evaluating these
Conclusions
This systemic review and meta-analysis summarized the prevalent and incident diseases in patients with AA. To provide optimal evaluation and management, physicians should be aware of different comorbid conditions that may likely affect their patients. Further controlled and prospective studies with longitudinal observations are necessary to elucidate the interaction and causality between AA and its comorbidities.
References (110)
- et al.
Alopecia areata: disease characteristics, clinical evaluation, and new perspectives on pathogenesis
J Am Acad Dermatol
(2018) - et al.
Alopecia areata is associated with impaired health-related quality of life: a survey of affected adults and children, and their families
J Am Acad Dermatol
(2018) - et al.
Cardiovascular risk in patients with alopecia areata (AA): a propensity-matched retrospective analysis
J Am Acad Dermatol
(2016) - et al.
Lack of an association between alopecia areata and visceral or hematopoietic cancers
J Am Acad Dermatol
(2017) - et al.
Cancer risks among patients with alopecia areata: a population-based case-control study in Korea
J Am Acad Dermatol
(2018) - et al.
Reduced incidence of skin cancer in patients with alopecia areata: a retrospective cohort study
Cancer Epidemiol
(2016) - et al.
Comorbidities in patients with alopecia areata
J Am Acad Dermatol
(2017) - et al.
P-874 - The psychological impact of alopecia areata: a case-control study of 50 patients
Eur Psychiatry
(2012) - et al.
Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study
J Am Acad Dermatol
(2011) - et al.
History of atopy or autoimmunity increases risk of alopecia areata
J Am Acad Dermatol
(2009)
Psychosomatic factors in first-onset alopecia areata
Psychosomatics
No increased prevalence of Helicobacter pylori in patients with alopecia areata
J Am Acad Dermatol
Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989
Mayo Clin Proc
Lifetime prevalence of psychiatric disorders in patients with alopecia areata
Compr Psychiatry
Loss-of-function mutations in the filaggrin gene and alopecia areata: strong risk factor for a severe course of disease in patients comorbid for atopic disease
J Invest Dermatol
Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: a population-based cross-sectional study
J Am Acad Dermatol
Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis
J Am Acad Dermatol
A review of psychiatric disorders comorbidities in patients with alopecia areata
Int J Trichology
Alopecia areata increases the risk of stroke: a 3-year follow-up study
Sci Rep
Vote-counting methods in research synthesis
Psychol Bull
Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses
Eur J Epidemiol
Bias in meta-analysis detected by a simple, graphical test
BMJ
Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis
Biometrics
Introduction to Meta-Analysis
Follow-up study on the relationship between alopecia areata and risk of autoimmune diseases
J Dermatol
Correlation of vitamin D and vitamin D receptor expression in patients with alopecia areata: a clinical paradigm
Int J Dermatol
The association between alopecia areata and thyroid autoimmunity in Chinese adult patients: a controlled study
Biomed Res
Alopecia areata and vitamin D: is there any association?
J Am Acad Dermatol
25-Hydroxyvitamin D status in patients with alopecia areata
Postepy Dermatol Alergol
Incident alopecia areata and vitiligo in adult women with atopic dermatitis: Nurses' Health Study 2
Allergy
Vitamin D level in alopecia areata
Indian J Dermatol
Association between Helicobacter pylori infection and alopecia areata: a study in Iranian population
Middle East J Dig Dis
Severe subtype of alopecia areata is highly associated with thyroid autoimmunity
Saudi Med J
Serum vitamin D in patients with alopecia areata
Indian Dermatol Online J
Ocular findings in alopecia areata
Int J Dermatol
High prevalence of thyroid autoimmunity in patients with alopecia areata and vitiligo: a controlled study
Australas J Dermatol
Severity of depression and anxiety in patients with alopecia areata in Bandar Abbas, Iran
Dermatol Rep
Audiological abnormalities in patients with alopecia areata
J Eur Acad Dermatol Venereol
The relationship between alopecia areata and alexithymia, anxiety and depression: a case-control study
Indian J Dermatol
Identifying the relationship between thyroid disease and alopecia areata, lichen planopilaris, and frontal fibrosing alopecia
J Investig Med
Association between vitamin D levels and alopecia areata
Isr Med Assoc J
Quality of life in alopecia areata: a case-control study
Int J Trichology
Vitamin D deficiency in alopecia areata
Br J Dermatol
Prevalence of psychological disorders in patients with alopecia areata in comparison with normal subjects
ISRN Dermatol
Association of vitamin D level with alopecia areata
Iran J Derm
Insulin resistance is increased in alopecia areata patients
Cutan Ocul Toxicol
Reduced level of 25-hydroxyvitamin D in chronic/relapsing alopecia areata
Dermatoendocrinol
Is atopy and autoimmunity more prevalent in patients with alopecia areata? A comparative study
J Eur Acad Dermatol Venereol
Psychiatric comorbidities in patients with alopecia areata in Taiwan: a case-control study
Br J Dermatol
Serum cytokine levels and anxiety and depression rates in patients with alopecia areata
Eurasian J Med
Cited by (0)
Funding sources: None.
Conflicts of interest: None disclosed.
Dr Solam Lee and Dr Won-Soo Lee had full access to all data in the study and take responsibility for the integrity of data and accuracy of data analysis, as well as for the study concept and design. All the authors take responsibility for acquisition, analysis, and interpretation of the data. Dr Solam Lee takes responsibility for drafting of the manuscript. Drs Hanil Lee, Chung Hyeok Lee, and Won-Soo Lee take responsibility for critical revision of the manuscript for important intellectual content. Drs Solam Lee and Hanil Lee take responsibility for statistical analysis. Dr Won-Soo Lee was responsible for administrative, technical, and material support.
Reprints not available from the authors.