Original article
Comorbidities in alopecia areata: A systematic review and meta-analysis

https://doi.org/10.1016/j.jaad.2018.07.013Get rights and content

Background

Alopecia areata (AA) may be associated with various systemic diseases according to several studies.

Objective

To identify prevalent and incident diseases in patients with AA and quantify their prevalence and odds and hazard ratios compared with those in controls without AA.

Methods

A systematic review of the studies published before February 28, 2018, was performed by using the MEDLINE, Embase, Web of Science, and Cochrane Library databases. Observational studies on prevalent or incident diseases in patients with AA were included, whereas studies limited to pediatrics or providing only laboratory results or continuous data were excluded. The inverse variance method with a random-effects model was used for meta-analyses.

Results

A total of 87 studies were analyzed. Atopic diseases, metabolic syndrome, Helicobacter pylori infection, lupus erythematosus, iron deficiency anemia, thyroid diseases, psychiatric diseases, vitamin D deficiency, and audiologic and ophthalmic abnormalities were more prevalent in patients with AA. Patients with AA had a higher risk of developing autoimmune diseases.

Limitations

Some diseases were investigated by an insufficient number of studies to be meta-analyzed. Meta-analysis of incident diseases was not performed owing to the limited availability of cohort studies.

Conclusion

AA is associated with various systemic and psychiatric diseases. Physicians are encouraged to evaluate and manage potential comorbid conditions to achieve better outcomes.

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.

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  • 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.

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