Comorbid Asthma Associated With Higher Risk for Early Onset, Severe, or Prolonged Alopecia Areata

Comorbid bronchial asthma was associated with a higher risk for early onset, severe, or prolonged alopecia areata (AA), according to research published in Allergy. Additionally, the researchers found that chronic inflammatory disease comorbidity status showed a stronger association with AA duration compared with age of onset or severity.^1,2

AA is a common autoimmune disease that is characterized by sudden, non-scarring scalp and/or body hair loss. It is unpredictable and often varies between individuals, with prior research suggesting that the disease is often associated with comorbid or co-existing chronic inflammatory diseases. Despite this evidence, there was little information on how inflammatory diseases may influence the clinical features of AA.¹

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For this study, the investigators performed an analysis of associations between comorbid chronic inflammatory diseases—including asthma, atopic dermatitis, and rhinitis—and certain clinical features of AA that are relevant to prognosis. The authors used self-reported data from 2657 Central European patients with AA who were recruited from outpatient clinics, dermatology specialists, or AA self-support groups. Early onset AA was defined as age of onset at 20 years of age or younger. Additionally, severe AA was defined as a history of complete loss of the hair from the scalp (alopecia totalis; AT), body (alopecia universalis; AU), or a combination of AT and AU.¹

According to the findings, approximately 53.7% of patients with AA reported at least 1 comorbid chronic inflammatory disease of any type. Additionally, 44.5% of patients had reported that their comorbid conditions were bronchial asthma (13.4%), atopic dermatitis (26.7%), and/or rhinitis (26.7%). Approximately 17.4% reported having at least 1 comorbid non-atopic condition, with the most frequent being Hashimoto thyroiditis (6.1%), vitiligo (4.6%), psoriasis (2.6%), and rheumatoid arthritis (1.7%).¹

“To our knowledge, this is the most comprehensive analysis of the clinical features of AA in relation to concomitant chronic inflammatory diseases. We have simultaneously assessed multiple concomitant diseases and multiple clinical features of AA in a dataset that exceeds in size most cohort-based clinical data on AA patients previously reported in the literature,” Buket Basmanav, MSc, leader of the Cure4HAIR project at the Institute of Human Genetics, said in a news release. "We consider this to be indirect support for the hypothesis that atopic diseases can trigger the onset of AA in a subgroup of patients.”²

Further, the results also demonstrated that patients with comorbid bronchial asthma, atopic dermatitis, or Hashimoto thyroiditis were more likely to report early onset, severe, and prolonged AA compared with patients who did not have comorbid chronic inflammatory conditions. Patients with comorbid bronchial asthma were also more likely to have a higher risk of early onset, severe, or prolonged AA compared with atopic dermatitis or rhinitis, whereas vitiligo and rhinitis showed an increased risk for prolonged AA.

"We found that comorbid bronchial asthma is a stronger risk factor for poor prognostic factors than comorbid atopic dermatitis or rhinitis," Annika Friedrich, PhD student at the University of Bonn at University Hospital Bonn (UKB), said in the news release. "This is the first report of a significant association between comorbid asthma and the clinical features of AA in the literature."²

The investigators also observed that the number of self-reported atopic comorbidities was much higher in early onset, severe, and prolonged AA compared with late onset, mild, and non-prolonged disease, respectively, with the odds for early onset, severe, and prolonged AA increasing by a factor of 1.179, 1.130, and 1.202 per additional atopic comorbidity, respectively. Patients with atopic dermatitis, bronchial asthma, and rhinitis, and patients with 1 or 2 comorbid atopic diseases had mean ages of onset that were about 10 and 5 years earlier, respectively, compared with patients who only had AA.¹

“Based on our results, we assume that AA patients with comorbid chronic inflammatory diseases, in particular atopic dermatitis, bronchial asthma or Hashimoto's thyroiditis, could benefit from more frequent clinical monitoring and earlier therapeutic intervention,” Regina C. Betz, PhD, professor at the Institute of Human Genetics at UKB, said in the news release.²

REFERENCES

1. Friedrich A, Schmitz M-T, Gossmann Y, et al. Comorbid Bronchial Asthma, Atopic Dermatitis and Hashimoto's Thyroiditis Are Risk Factors for Early-Onset, Severe and Prolonged Alopecia Areata. Allergy. 2025. doi:10.1111/all.16468

2. University Hospital Bonn. Inflammatory diseases influence the course of hair loss. News release. January 8, 2025. Accessed January 13, 2025. https://www.eurekalert.org/news-releases/1070013