New Studies Link Alopecia Areata to Eye Diseases

Patients with alopecia areata may have increased risk of several types of eye diseases - including retinal diseases. Three recent studies are important to reflect upon.

Ergin et al, 2015

A 2015 study set out to assess tear function and ocular surface pathologies in patients with alopecia areata. 32 patients with alopecia areata were compared to 20 age- and sex-matched healthy controls.

Dry eye disease (DED) was diagnosed in 27 (84%) of 32 alopecia areata patients and in only 3 (15%) of 20 controls, and there was a significant difference between the groups (P < 0.01).

Ting et al, 2021

A new study from Taiwan set out to examine the relationship between alopecia areata and retinal diseases. By examining information found in the National Health Insurance Research Database in Taiwan, the authors compared 9909 patients with alopecia areata to 99,090 match controls In this study, patients with alopecia areata had an approximately 3 fold greater risk of having any type of retinal disease ( adjusted hazard ratio (aHR) of 3.10 (95% confidence interval [CI] 2.26-4.26)

In terms of specific eye diseases, patients with alopecia areata had a 3.98 fold increased risk of retinal detachment, a 3.24 fold increased risk of retinopathy and a 2.45 fold increased risk of retinal vascular occlusion compared to patients without alopecia areata.

Thatiparthi A et al. 2022

Authors of a 2022 study also set out to evaluate the prevalence of various eye conditions in patients with AA. To do so, the authors analyzed electronic health records at a single academic center over a 10-year (March 2011-March 2021). In this study, there were 435 patients with AA and 35,349 healthy controls. As shown in the diagram below, a variety of eye diseases were found to be more common in patients with alopecia areata compared to controls. This included keratitis, iridocyclitis, scleral diseases, conjunctivitis, lacrimal disorders and disorders of eyelid inflammation.

Comment

These are interesting studies. Of course, we don’t fully understand why these links exist.

The authors point out that genome-wide association studies suggest that immune dysregulation in various inflammatory ocular conditions and alopecia areata likely share a variety of overlapping genetic factors, pathogenic inflammatory changes, and environmental factors.

More study is clearly needed but an important message here is that concerns raised by patients about eye symptoms need to be taken seriously and referral to eye specialists should be considered for patients with persistent and troublesome symptoms.

REFERENCE

Ting HC et al. Association between alopecia areata and retinal diseases: A nationwide population-based cohort study. J Am Acad Dermatol. 2021 Nov 1;S0190-9622(21)02735-3.

Thatiparthi A et al. Inflammatory ocular comorbidities in alopecia areata: a retrospective cohort study of a single academic center. J Am Acad Dermatol. 2022 Jun 16;S0190-9622(22)01009-X.

Ergin C et al. Ocular findings in alopecia areata.Int J Dermatol. 2015 Nov;54(11):1315-8.doi: 10.1111/ijd.12897. Epub 2015 Jul 3.