‘Order matters’: Alopecia diagnoses precede onset of psychiatric, autoimmune comorbidities

Key takeaways:

• Patients with vs. without alopecia areata were 1.3 times more likely to develop a psychiatric disorder.
• They were also 2.7 times more likely to develop an autoimmune disease.

A newly published study found that an alopecia diagnosis precedes additional psychiatric and autoimmune diagnoses in affected patients.

“The association of alopecia areata with different autoimmune and psychiatric conditions has been well established,” Arash Mostaghimi, MD, MPH, FAAD, vice chair of clinical trials and innovation, director of dermatology inpatient services and co-director of the complex medical dermatology fellowship program at Brigham and Women’s Hospital and associate professor at Harvard Medical School, told Healio. “What this study adds to the literature is the idea that many of these psychiatric comorbidities and autoimmune diseases are identified after the diagnosis of alopecia areata.”

The study included 63,384 patients with AA and 3,309,107 controls at baseline. With a mean age of 36.9 years and 50.6% were women, the matched groups included 16,512 patients with AA and 66,048 without AA.

Results showed that compared with unmatched controls, a greater proportion of those with AA had psychiatric (30.9% vs. 26.8%; P < .001) and autoimmune (16.1% vs. 8.9%; P < .0001) comorbidities at AA diagnosis.

For those without these comorbidities at diagnosis, patients with AA were more likely to develop a psychiatric disorder (adjusted HR = 1.3; 95% CI, 1.3-1.4) and an autoimmune disease (aHR = 2.7; 95% CI, 2.5-2.8) vs. those without AA.

While Mostaghimi said he and his colleagues could not confidently say AA caused the onset of these new diagnoses, he also added that “the order matters.”

“It’s not just that they are associated,” he said, “but that the alopecia areata came first.”

As a result, he recommends physicians conduct psychiatric screenings and physical examinations looking for other signs of autoimmune disorders in their patients newly diagnosed within the past few months with AA. Most importantly, Mostaghimi said clinicians must listen to their patients.

“The idea that these disorders, especially psychosocial ones, originate subsequent to the alopecia areata cements that this is not a cosmetic condition,” he said. “So, I think the most important thing to do for patients with AA is to talk to them and listen.”