If I have alopecia areata, what are the chances my child will have alopecia areata?

The Inheritance of Alopecia Areata

I’ve selected this question below for this week’s question of the week. It allows us to discuss the chances of children developing alopecia areata if their parents are affected.

Here is the question….

QUESTION

Our son is 19 and he has alopecia totalis for about 16 years. Now that he has reached a marriageable age, we would appreciate professional advice on an important matter. Can alopecia pass from a parent to the kids ? If he marries a girl with alopecia are the chances for the children to develop alopecia greater?

ANSWER

Thank you for the question. I’ll explain the answer to the question in greater depth in just a moment. The short answer to your question is the following:

1) Yes, alopecia areata can pass from parents to children - but it is not common. About 6 % of your son’s children would be predicated to have alopecia areata and 94 % would not. In other words, it’ s possible for your son to have a child with alopecia areata but most likely he will not.

2) Yes, if your son marries an individual who also has alopecia areata the chances their children will develop alopecia areata is greater.

Alopecia areata is an autoimmune condition. Both genetics as well as environmental factors are important. It’s not so simple as to say that if a person has the genes they develop the condition. Not at all. Even if one identical twin has the condition, there is only a 55 % chance the other twin will develop the condition. So the inheritance is complex.

There are many genes for alopecia areata, not just one. The inheritance is polygenic not autosomal dominant like some conditions. It’s not so straight ward to say that if a parent has the condition, the child will develop the condition. In fact, if a parent has the condition, there is only a small chance a child will ever develop the condition.

Let’s look further.

The Blaumeiser et al Study of 2006

In 2006, Blaumeiser and colleagues performed an incredibly detailed study. They set out to study how alopecia areata is inherited by assessing how commonly patients with alopecia areata will have other family members affected. The study included 206 patients with alopecia areata. Permission was granted from these 206 patients to contact other members of the family to enquire about alopecia areata. A total of 1029 first-degree relatives as well as 2625 second-degree relatives were assessed.

Here are the key findings of this study as it applies to your question:

1] The estimated lifetime risks for having a child with alopecia areata if a parent has alopecia was 5.7 %.

2] It does not appear that having an earlier age of onset of alopecia increases the risk that a patient will have children with alopecia areata. However, if the patient does have a child with alopecia areata, the child is also more likely to have an earlier age of onset. Age at onset in index patients and first-degree relatives was significantly correlated in the study.

3] If a patient has alopecia totals or universalis, this does not indicate that there is a higher chance his or her children will have alopecia totalis or universalis if they do develop alopecia. In fact, in the rare event that your son has a child with alopecia areata, it is more likely that it will be a more mild form than a severe form. In other words, if a patient has alopecia totalis or universalis, there is still about a 6 % chance that his or her children will have alopecia area.

REFERENCE

Blaumeiser et al. Familial Aggregation of Alopecia Areata. Journal of the American Academy of Dermatology. 2006 Apr;54(4):627-32.