Risk factors for the development of and outcomes after diagnosis of autoimmune alopecia areata in patients with inflammatory bowel diseases

Introduction The development of certain immune-mediated diseases (IMD) in patients with inflammatory bowel diseases (IBD; Crohn’s disease (CD), ulcerative colitis (UC)) has been linked to treatment of IBD. Hair loss in some patients may be due to immune-mediated alopecia areata (AA). Risk factors and outcomes of AA in patients with IBD have not been previously explored. Methods This was a retrospective, multi-center case-control study. Cases were identified as individuals who developed IBD before AA diagnosis. Controls comprised of those who were never diagnosed with AA and treated contemporaneously. We extracted demographic and IBD treatment history. Severity of Alopecia Tool (SALT) was used to stratify AA severity. AA outcomes and interventions were compared within controls. Results We identified 58 cases and 90 controls. Cases had significantly higher rate of tumor necrosis factor α antagonist (anti-TNF) use compared to controls (40.7% vs. 20.0%, p= 0.006). Both groups had similar IBD disease location, behavior, and related surgery. Majority of cases had endoscopic remission or mild disease activity at AA diagnosis. There was no difference in partial or complete improvement of AA between those who stopped or continued IBD therapy (p=0.57). Those with severe AA were significantly less likely to have complete (0% vs 33.3%, p=0.01) or any improvement (50% vs 84.9%, p=0.02) of AA compared to those with non-severe AA. Discussion Individuals with IBD who later develop AA were more likely to have been on anti-TNF at time of AA onset. Severity of AA was a significant predictor of AA resolution. Fortunately many patients had improvement in their AA despite continuation of IBD therapy.