Periodontitis Associated With Risk for Alopecia Areata

A statistically significant higher rate of alopecia areata, regardless of clinical subtype, was found in patients with periodontitis.

Patients with periodontitis have a significantly increased risk for alopecia areata (AA), as reported via study findings published in the Journal of the European Academy of Dermatology and Venereology.

Researchers sought to determine whether periodontitis increases the risk for AA with use of data from the National Health Insurance Service claims database. Participants were diagnosed with periodontitis from 2002 through 2004 and were assessed up to December 2019.

After propensity score matching, 68,703 participants each were included in the periodontitis group and nonperiodontitis group.

Patients with periodontitis had a statistically significant higher rate of AA regardless of clinical subtype of AA (adjusted hazard ratio [a-HR], 1.36 [95% CI, 1.28-1.44); patchy, 1.39 [95% CI, 1.31-1.49]; and alopecia totalis/universalis, 1.49 [95% CI, 1.20-1.85]). The periodontitis group had an AA incidence of 24.19, which was significantly higher vs the 17.64 in the control group).

Children and young adults had a significantly higher risk for AA compared with older adults (a-HR, 2.01 [95% CI, 1.79-2.25] and a-HR, 2.06 [95% CI, 1.92-2.21], respectively), according to a subgroup analysis. Patients with periodontitis had a significantly higher risk for AA comorbidities, systemic lupus erythematosus (a-HR, 2.97 [95% CI, 1.54- 5.74]), rheumatoid arthritis (a-HR, 1.18 [95% CI, 1.02-1.36]), and atopic dermatitis (a-HR, 1.22 [95% CI, 1.08-1.38]).

These results suggest a possible connection between the 2 immune-inflammatory conditions of distant organ sites (oral-hair follicle axis), which may open up novel therapeutic strategies for AA

A sensitivity analysis confirmed the significant effect of periodontitis on AA, based on the matching variable, recruitment period, and matching ratio.

The mechanism by which periodontitis is a risk factor for AA could be related to the common autoimmune-inflammatory nature of the 2 disorders, noted the researchers.

Study limitations include the retrospective design and potential for misclassification bias. Also, the causality between AA and periodontitis was not assessed.

“These results suggest a possible connection between the 2 immune-inflammatory conditions of distant organ sites (oral-hair follicle axis), which may open up novel therapeutic strategies for AA,” stated the investigators. “Further prospective studies are needed to confirm the association and to elucidate the exact mechanism by which periodontitis is a risk factor for AA.”

References:

Kim J-S, Lee I-J, Lee M-G, et al. Periodontitis and risk of alopecia areata: a nationwide population-based cohort study in Korea. J Eur Acad Dermatol Venereol. Published online November 17, 2022. doi:.1111/jdv.18758