Pediatric Alopecia Areata Correlates With Autoimmune and Metabolic Disorders

The prevalence of comorbidities in pediatric patients with alopecia areata was determined, using a large de-identified aggregated patient database.

Children with alopecia areata (AA) are more likely to have certain autoimmune and metabolic disorders than the general pediatric population, according to results of a cross-sectional study published in the Journal of the European Academy of Dermatology and Venereology.

Although comorbidities in AA have been examined in adult populations, comorbidities that occur in pediatric AA have yet to be determined. To establish the prevalence of comorbidities in pediatric patients with AA, data from 8,310,710 patients (48.4% girls) who were ≤18 years of age from more than 360 hospitals were analyzed. Of all included patients, 3510 (0.04%) had a diagnosis of AA. Most patients with AA were 10 to18 years of age (73.8%). Girls and African Americans represented a higher percentage of the AA population than the control group.

Atopic dermatitis was the most common comorbidity in pediatric patients with AA, presenting in 17.4% of AA patients. Other autoimmune diseases observed in AA patients include vitiligo (1.4%), psoriasis (1.4%), celiac disease (0.57%), ulcerative colitis (0.14%), systemic lupus erythematosus (0.29%), juvenile idiopathic arthritis (0.14%), and juvenile rheumatoid arthritis (0.29%), all of which were more common in pediatric AA patients than control participants (P <.001).

Obesity was the most common metabolic disorder observed in patients with AA (5.7%). Other metabolic disorders found in patients with AA include hyperlipidemia (1.4%), diabetes mellitus (1.1%), and metabolic syndrome (0.3%). All were significantly more common in pediatric patients with AA than in control participants (P <.001). Other disorders in pediatric AA patients were anemia (7.7%), vitamin D deficiency (5.1%), hypothyroidism (2.6%), hypertension (0.85%), and depression (2.6%), all of which were more common in patients with AA than control participants (P <.001).

Limitations to this study include the possibility of misclassification of patients in the database used for analysis. The small sample size of patients with AA limits the statistical power of some aspects of the study.

The results of this study suggest that patients with pediatric AA have significantly higher rates of various autoimmune and metabolic disorders than pediatric patients without AA. Therefore, “Dermatologists might consider multidisciplinary management” when treating this patient population, the investigators wrote.


Conic RZ, Tamashunas NL, Damiani G, Fabbrocini G, Cantelli M. Comorbidities in pediatric alopecia areata. [published online June 12, 2020]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16727