Alopecia areata and the Bowel

Increased Risk of IBS in Patients with AA

Alopecia areata is an autoimmune disease. It occurs in about 2 % of the population and in all age groups and races.  An increasing amount of data is emerging looking at the role of “gut health” in many autoimmune disease. The fact that fecal transplants was propsed to benefit AA in limited studies further highlights the role of the bowel. 

In 2017, Conic and colleagues set out to retrospectively review the clinical features of patients with alopecia areata that were seen at the Cleveland Clinic over the period 2005 to 2014.  In total, data from 504 patients was tabulated and as a comparison group 172 patients with seborrheic dermatitis were also reviewed. 

The key bowel diseases that were studied were celiac disease, inflammatory bowel disease and irritable bowel syndrome. Interestingly, the incidence of irritable bowel syndrome was increased in patients with AA but there was no increase in inflammatory bowel disease and no increase in celiac disease. 

This study is interesting as it highlights the need to inquire about bowel symptoms in those with with AA, particularly those that related to irritable bowel syndrome (IBS). Extensive testing for celiac disease in patients with normal ferritin and hemoglobin levels is probably not advisable nor cost effective in adults. 

REFERENCE

Conic et al. Comorbidities in patients with alopecia areata. Journal American Academy Dermatology; 754-756.