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Vol 10, No 4 (2024)
Review paper
Published online: 2024-12-05

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Metabolic syndrome and associated comorbidities in alopecia

Agnieszka Leszyńska1, Janusz Kubasik1, Paweł Głuszak2, Dominika Kozłowska1, Julia Linke1, Maria Wawrzyniak1, Magdalena Jałowska2
DOI: 10.5603/fd.103087
Forum Dermatologicum 2024;10(4):120-128.

Abstract

Alopecia, a prevalent condition characterized by hair loss, bears a significant psychological impact on affected individuals. The condition can be classified into two primary categories: scarring (cicatricial) and non-scarring forms. Alopecia is frequently associated with various comorbidities, particularly autoimmune disorders. This review critically examines the existing literature to elucidate the potential relationship between different types of alopecia and metabolic syndrome (MetS), along with MetS-associated comorbidities. MetS is defined by a cluster of conditions, including hypertension, hyperglycaemia, abdominal obesity, and dyslipidaemia, which collectively heighten the risk for cardiovascular diseases (CVD) and diabetes. Furthermore, the shared risk factors, encompassing lifestyle habits and genetic predispositions, suggest a possible bidirectional relationship between these conditions. This underscores the importance of adopting integrated treatment approaches to address the complex interactions between alopecia and MetS. The review highlights the necessity for more comprehensive and diverse cohort studies to enhance our understanding of the interplay between alopecia and MetS.

Keywords: alopeciametabolic syndromecomorbiditiesautoimmune disordershypertensiondyslipidaemiahyperglycaemia

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References

  1. Darwin E, Hirt PA, Fertig R, et al. Alopecia areata: review of epidemiology, clinical features, pathogenesis, and new treatment options. Int J Trichology. 2018; 10(2): 51–60.
    CrossRefPubMed
  2. Toussi A, Barton VR, Le ST, et al. Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: a systematic review. J Am Acad Dermatol. 2021; 85(1): 162–175.
    CrossRefPubMed
  3. Botega AA, Amorim CV, Teixeira F, et al. Scarring versus non-scarring alopecia: an interobserver histopathological reproducibility study. Skin Appendage Disord. 2023; 9(1): 34–41.
    CrossRefPubMed
  4. Trüeb RM. Molecular mechanisms of androgenetic alopecia. Exp Gerontol. 2002; 37(8–9): 981–990.
    CrossRefPubMed
  5. Śliwa K, Synia D, Placek W, et al. The diagnosis and treatment of androgenetic alopecia: a review of the most current management. Forum Derm. 2023; 9(3): 99–111.
    CrossRef
  6. Morita W, Dakin SG, Snelling SJB, et al. Cytokines in tendon disease: a systematic review. Bone Joint Res. 2017; 6(12): 656–664.
    CrossRefPubMed
  7. Żeberkiewicz M, Rudnicka L, Malejczyk J. Immunology of alopecia areata. Cent Eur J Immunol. 2020; 45(3): 325–333.
    CrossRefPubMed
  8. Dobrowolski P, Prejbisz A, Kuryłowicz A, et al. Metabolic syndrome — a new definition and management guidelines. Arterial Hypertens. 2022; 26(3): 99–121.
    CrossRef
  9. Fahed G, Aoun L, Bou Zerdan M, et al. Metabolic syndrome: updates on pathophysiology and management in 2021. Int J Mol Sci. 2022; 23(2).
    CrossRefPubMed
  10. Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep. 2018; 20(2): 12.
    CrossRefPubMed
  11. Lolli F, Pallotti F, Rossi A, et al. Androgenetic alopecia: a review. Endocrine. 2017; 57(1): 9–17.
    CrossRefPubMed
  12. Norwood OT. Incidence of female androgenetic alopecia (female pattern alopecia). Dermatol Surg. 2001; 27(1): 53–54.
    CrossRef
  13. Ho CY, Wu CY, Chen JYF, et al. Clinical and genetic aspects of alopecia areata: a cutting edge review. Genes (Basel). 2023; 14(7): 1362.
    CrossRefPubMed
  14. Lie C, Liew CF, Oon HH. Alopecia and the metabolic syndrome. Clin Dermatol. 2018; 36(1): 54–61.
    CrossRefPubMed
  15. Ramos PM, Miot HA. Female pattern hair loss: a clinical and pathophysiological review. An Bras Dermatol. 2015; 90(4): 529–543.
    CrossRefPubMed
  16. Su X, Cheng Ye, Chang D. The important role of leptin in modulating the risk of dermatological diseases. Front Immunol. 2020; 11: 593564.
    CrossRefPubMed
  17. Park PJ, Cho EG. Kojyl cinnamate ester derivatives increase adiponectin expression and stimulate adiponectin-induced hair growth factors in human dermal papilla cells. Int J Mol Sci. 2019; 20(8): 1859.
    CrossRefPubMed
  18. Ter Horst R, van den Munckhof ICL, Schraa K, et al. Sex-Specific regulation of inflammation and metabolic syndrome in obesity. Arterioscler Thromb Vasc Biol. 2020; 40(7): 1787–1800.
    CrossRefPubMed
  19. Prie BE, Iosif L, Tivig I, et al. Oxidative stress in androgenetic alopecia. J Med Life. 2016; 9(1): 79–83.
    PubMed
  20. Suzuki K, Inoue M, Cho O, et al. Scalp microbiome and sebum composition in japanese male individuals with and without androgenetic alopecia. Microorganisms. 2021; 9(10): 2132.
    CrossRefPubMed
  21. Mahmud MdR, Akter S, Tamanna SK, et al. Impact of gut microbiome on skin health: gut-skin axis observed through the lenses of therapeutics and skin diseases. Gut Microbes. 2022; 14(1): 2096995.
    CrossRefPubMed
  22. Zhang J, Yao Z. Immune cell trafficking: a novel perspective on the gut-skin axis. Inflamm Regen. 2024; 44(1): 21.
    CrossRefPubMed
  23. Dharam Kumar KC, Kishan Kumar YH, Neladimmanahally V. Association of androgenetic alopecia with metabolic syndrome: a case-control study on 100 patients in a tertiary care hospital in south india. Indian J Endocrinol Metab. 2018; 22(2): 196–199.
    CrossRefPubMed
  24. Bakry OA, Shoeib MA, El Shafiee MK, et al. Androgenetic alopecia, metabolic syndrome, and insulin resistance: Is there any association? A case-control study. Indian Dermatol Online J. 2014; 5(3): 276–281.
    CrossRefPubMed
  25. Gopinath H, Upadya GM. Metabolic syndrome in androgenic alopecia. Indian J Dermatol Venereol Leprol. 2016; 82(4): 404–408.
    CrossRefPubMed
  26. Oiwoh SO, Akinboro AO, Olayemi O, et al. Androgenetic alopecia: traditional cardiovascular risk factors, metabolic syndrome, and component traits among nigerian adults. Niger J Clin Pract. 2023; 26(4): 463–469.
    CrossRefPubMed
  27. Sheikh FZ, Butt G, Hafeez R, et al. Association of early-onset androgenetic alopecia and metabolic syndrome. J Coll Physicians Surg Pak. 2021; 31(2): 123–127.
    CrossRefPubMed
  28. Chung HC, Choe SJ, Lee S, et al. Medical comorbidities and the onset of androgenetic alopecia: a population-based, case-control study. Ann Dermatol. 2018; 30(2): 251–252.
    CrossRefPubMed
  29. Qiu Y, Zhou X, Fu S, et al. Systematic review and meta-analysis of the association between metabolic syndrome and androgenetic alopecia. Acta Derm Venereol. 2022; 102: adv00645.
    CrossRefPubMed
  30. Arias-Santiago S, Gutiérrez-Salmerón MT, Castellote-Caballero L, et al. Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. J Am Acad Dermatol. 2010; 63(3): 420–429.
    CrossRefPubMed
  31. Hamed AM, Fatah MA, Shams GM. Androgenetic alopecia and metabolic syndrome: is alarin a missing link? J Clin Aesthet Dermatol. 2022; 15(7): 32–37.
    PubMed
  32. Mustafa AI, Abel Halim WA, Eman F, et al. Metabolic syndrome in androgenetic alopecia patients; Is serum regulated on activation, normal T-cell expressed and secreted the missing link? J Cosmet Dermatol. 2021; 20(7): 2270–2276.
    CrossRefPubMed
  33. Elhabak DM, Abdel Halim WA. YKL-40 a sensitive biomarker for early androgenetic alopecia and early hidden metabolic syndrome. Int J Trichology. 2020; 12(2): 49–55.
    CrossRefPubMed
  34. McKenzie PL, Maltenfort M, Bruckner AL, et al. Evaluation of the prevalence and incidence of pediatric alopecia areata using electronic health record data. JAMA Dermatol. 2022; 158(5): 547–551.
    CrossRefPubMed
  35. Harries M, Macbeth AE, Holmes S, et al. The epidemiology of alopecia areata: a population-based cohort study in UK primary care. Br J Dermatol. 2022; 186(2): 257–265.
    CrossRefPubMed
  36. Mirzoyev SA, Schrum AG, Davis MDP, et al. Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990-2009. J Invest Dermatol. 2014; 134(4): 1141–1142.
    CrossRefPubMed
  37. Arousse A, Boussofara L, Mokni S, et al. Alopecia areata in Tunisia: epidemio-clinical aspects and comorbid conditions. a prospective study of 204 cases. Int J Dermatol. 2019; 58(7): 811–815.
    CrossRefPubMed
  38. Zhou C, Li X, Wang C, et al. Alopecia areata: an update on etiopathogenesis, diagnosis, and management. Clin Rev Allergy Immunol. 2021; 61(3): 403–423.
    CrossRefPubMed
  39. Wang X, Marr AK, Breitkopf T, et al. Hair follicle mesenchyme-associated PD-L1 regulates T-cell activation induced apoptosis: a potential mechanism of immune privilege. J Invest Dermatol. 2014; 134(3): 736–745.
    CrossRefPubMed
  40. Ito T, Tokura Y. The role of cytokines and chemokines in the T-cell-mediated autoimmune process in alopecia areata. Exp Dermatol. 2014; 23(11): 787–791.
    CrossRefPubMed
  41. Betz RC, Petukhova L, Ripke S, et al. Genome-wide meta-analysis in alopecia areata resolves HLA associations and reveals two new susceptibility loci. Nat Commun. 2015; 6(1): 5966.
    CrossRefPubMed
  42. Chen CC, Li TC, Chang PC, et al. Association among cigarette smoking, metabolic syndrome, and its individual components: the metabolic syndrome study in Taiwan. Metabolism. 2008; 57(4): 544–548.
    CrossRefPubMed
  43. Liang YY, Chen J, Peng M, et al. Association between sleep duration and metabolic syndrome: linear and nonlinear Mendelian randomization analyses. J Transl Med. 2023; 21(1): 90.
    CrossRefPubMed
  44. Jurgens SM, Prieto S, Hayes JP. Inflammatory biomarkers link perceived stress with metabolic dysregulation. Brain Behav Immun Health. 2023; 34: 100696.
    CrossRefPubMed
  45. Dai YX, Yeh FY, Shen YJ, et al. Cigarette smoking, alcohol consumption, and risk of alopecia areata: a population-based cohort study in taiwan. Am J Clin Dermatol. 2020; 21(6): 901–911.
    CrossRefPubMed
  46. Seo HM, Kim TL, Kim JS. The risk of alopecia areata and other related autoimmune diseases in patients with sleep disorders: a Korean population-based retrospective cohort study. Sleep. 2018; 41(9).
    CrossRefPubMed
  47. Ly S, Manjaly P, Kamal K, et al. Comorbid conditions associated with alopecia areata: a systematic review and meta-analysis. Am J Clin Dermatol. 2023; 24(6): 875–893.
    CrossRefPubMed
  48. Abdollahimajd F, Niknezhad N, Bahreini N, et al. Metabolic syndrome in patients with alopecia areata: a case-control study. Dermatol Ther. 2021; 34(4): e14979.
    CrossRefPubMed
  49. Singdia H, Bhargava P, Nijhawan S, et al. A study of correlation of alopecia areata and metabolic syndrome in northwest indian population: a case-control study. Int J Trichology. 2023; 15(2): 63–69.
    CrossRefPubMed
  50. Nasimi M, Shakoei S, Abedini R, et al. A cross-sectional study of metabolic syndrome in patients with alopecia areata. Indian J Dermatol Venereol Leprol. 2021; 87(3): 427–429.
    CrossRefPubMed
  51. Incel-Uysal P, Akdogan N, Alli N, et al. Assessment of metabolic profile and ischemia-modified albumin level in patients with alopecia areata: a case-control study. Indian J Dermatol. 2019; 64(1): 12–18.
    CrossRefPubMed
  52. Karadag AS, Ertugrul DT, Bilgili SG, et al. Insulin resistance is increased in alopecia areata patients. Cutan Ocul Toxicol. 2013; 32(2): 102–106.
    CrossRefPubMed
  53. Huang KP, Mullangi S, Guo Ye, et al. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol. 2013; 149(7): 789–794.
    CrossRefPubMed
  54. Conic RRZ, Chu S, Tamashunas NL, et al. Prevalence of cardiac and metabolic diseases among patients with alopecia areata. J Eur Acad Dermatol Venereol. 2021; 35(2): e128–e129.
    CrossRefPubMed
  55. Andersen YMF, Nymand L, DeLozier AM, et al. Patient characteristics and disease burden of alopecia areata in the Danish Skin Cohort. BMJ Open. 2022; 12(2): e053137.
    CrossRefPubMed
  56. Lee NRi, Kim BK, Yoon NaY, et al. Differences in comorbidity profiles between early-onset and late-onset alopecia areata patients: a retrospective study of 871 korean patients. Ann Dermatol. 2014; 26(6): 722–726.
    CrossRefPubMed
  57. Conic RZ, Tamashunas NL, Damiani G, et al. Young Dermatologists Italian Network. Comorbidities in pediatric alopecia areata. J Eur Acad Dermatol Venereol. 2020; 34(12): 2898–2901.
    CrossRefPubMed
  58. Seyrafi H, Akhiani M, Abbasi H, et al. Evaluation of the profile of alopecia areata and the prevalence of thyroid function test abnormalities and serum autoantibodies in Iranian patients. BMC Dermatol. 2005; 5: 11.
    CrossRefPubMed
  59. Kasumagić-Halilović E, Prohić A, et al. Association between alopecia areata and atopy. Med Arh. 2008; 62(2): 82–84.
    PubMed
  60. Baars MP, Greebe RJ, Pop VJM. High prevalence of thyroid peroxidase antibodies in patients with alopecia areata. J Eur Acad Dermatol Venereol. 2013; 27(1): e137–e139.
    CrossRefPubMed
  61. Lee S, Lee YB, Kim BJ, et al. Screening of thyroid function and autoantibodies in patients with alopecia areata: a systematic review and meta-analysis. J Am Acad Dermatol. 2019; 80(5): 1410–1413.e4.
    CrossRefPubMed
  62. Sorrell J, Petukhova L, Reingold R, et al. Shedding light on alopecia areata in pediatrics: a retrospective analysis of comorbidities in children in the national alopecia areata registry. Pediatr Dermatol. 2017; 34(5): e271–e272.
    CrossRefPubMed
  63. Fanti PA, Baraldi C, Misciali C, et al. Cicatricial alopecia. G Ital Dermatol Venereol. 2018; 153(2): 230–242.
    CrossRefPubMed
  64. Kanti V, Röwert-Huber J, Vogt A, et al. Cicatricial alopecia. J Dtsch Dermatol Ges. 2018; 16(4): 435–461.
    CrossRefPubMed
  65. Kerkemeyer KLS, Eisman S, Bhoyrul B, et al. Frontal fibrosing alopecia. Clin Dermatol. 2021; 39(2): 183–193.
    CrossRefPubMed
  66. Akarsu S, Ozbagcivan O, Semiz F, et al. High prevalence of metabolic syndrome in patients with discoid lupus erythematosus: a cross-sectional, case-control study. J Immunol Res. 2017; 2017: 3972706.
    CrossRefPubMed
  67. Nasimi M, Lajevardi va, Mahmoudi H, et al. Metabolic syndrome in patients with oral lichen planus and lichen planopilaris: a cross-sectional study. Iran J Dermatol. 2021; 24(3): 186–192.
    CrossRef
  68. Pelet Del Toro N, Strunk A, Garg A, et al. Prevalence and treatment patterns in patients with lichen planopilaris. JAMA Dermatol. 2024; 160(8): 865–868.
    CrossRefPubMed
  69. Aguh C, McMichael A. Central centrifugal cicatricial alopecia. JAMA Dermatol. 2020; 156(9): 1036.
    CrossRefPubMed
  70. Ayandibu G, Bergfeld W. Retrospective cohort study to assess the prevalence of different factors of metabolic syndrome in central centrifugal cicatricial alopecia patients. J Am Acad Dermatol. 2018; 79(3): AB246.
    CrossRef
  71. Ali S, Collins M, Taylor SC, et al. Type 2 diabetes mellitus and central centrifugal cicatricial alopecia severity. J Am Acad Dermatol. 2022; 87(6): 1418–1419.
    CrossRefPubMed
  72. Roche FC, Harris J, Ogunleye T, et al. Association of type 2 diabetes with central centrifugal cicatricial alopecia: a follow-up study. J Am Acad Dermatol. 2022; 86(3): 661–662.
    CrossRefPubMed
  73. Colleen R. Hypertension and cicatricial hair loss: defining high value symptom clusters within reproductive aging. J Dermatol Res Ther. 2021; 7(1).
    CrossRef
  74. Arias-Santiago S, Buendía-Eisman A, Aneiros-Fernández J, et al. Lipid levels in patients with lichen planus: a case-control study. J Eur Acad Dermatol Venereol. 2011; 25(12): 1398–1401.
    CrossRefPubMed
  75. Conic RRZ, Piliang M, Bergfeld W, et al. Association of lichen planopilaris with dyslipidemia. JAMA Dermatol. 2018; 154(9): 1088–1089.
    CrossRefPubMed
  76. Whiting DA. Cicatricial alopecia: clinico-pathological findings and treatment. Clin Dermatol. 2001; 19(2): 211–225.
    CrossRefPubMed
  77. Tan E, Martinka M, Ball N, et al. Primary cicatricial alopecias: clinicopathology of 112 cases. J Am Acad Dermatol. 2004; 50(1): 25–32.
    CrossRefPubMed
  78. Powell JJ, Dawber RP, Gatter K. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Br J Dermatol. 1999; 140(2): 328–333.
    CrossRefPubMed
  79. Vañó-Galván S, Molina-Ruiz AM, Fernández-Crehuet P, et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol. 2015; 29(9): 1750–1757.
    CrossRefPubMed
  80. Miteva M. Folliculitis decalvans. In: Miteva M. ed. Hair pathology with trichoscopic correlations 1st edition. CRC Press 2021: 5.
  81. Chiarini C, Torchia D, Bianchi B, et al. Immunopathogenesis of folliculitis decalvans: clues in early lesions. Am J Clin Pathol. 2008; 130(4): 526–534.
    CrossRefPubMed
  82. Matard B, Donay JL, Resche-Rigon M, et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota. Exp Dermatol. 2020; 29(3): 295–298.
    CrossRefPubMed
  83. Lyakhovitsky A, Segal Oz, Galili E, et al. Diagnostic delay, comorbid hidradenitis suppurativa and the prognostic value of bacterial culture in folliculitis decalvans: a cohort study. J Dtsch Dermatol Ges. 2023; 21(12): 1469–1477.
    CrossRefPubMed
  84. Miguel-Gómez L, Rodrigues-Barata AR, Molina-Ruiz A, et al. Folliculitis decalvans: effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up. J Am Acad Dermatol. 2018; 79(5): 878–883.
    CrossRefPubMed
  85. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002; 287(3): 356–359.
    CrossRefPubMed
  86. Moore JX, Chaudhary N, Akinyemiju T. Metabolic syndrome prevalence by race/ethnicity and sex in the United States, national health and nutrition examination survey, 1988–2012. Prev Chronic Dis. 2017; 14: E24.
    CrossRefPubMed
  87. Edwardson CL, Gorely T, Davies MJ, et al. Association of sedentary behaviour with metabolic syndrome: a meta-analysis. PLoS One. 2012; 7(4): e34916.
    CrossRefPubMed
  88. Sun K, Liu J, Ning G. Active smoking and risk of metabolic syndrome: a meta-analysis of prospective studies. PLoS One. 2012; 7(10): e47791.
    CrossRefPubMed
  89. Kim A. Dysbiosis: a review highlighting obesity and inflammatory bowel disease. J Clin Gastroenterol. 2015; 49 Suppl 1: S20–S24.
    CrossRefPubMed
  90. Weiss GA, Hennet T. Mechanisms and consequences of intestinal dysbiosis. Cell Mol Life Sci. 2017; 74(16): 2959–2977.
    CrossRefPubMed
  91. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013; 9(1): 30.
    CrossRefPubMed

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