Person:

Huang, Kathie

The risk of skin cancer in patients with alopecia areata (AA) is unknown. While the risk of skin cancer in chronic inflammatory alopecias may be elevated, AA shares many characteristics with vitiligo, an autoimmune illness associated with decreased risk of melanoma and non-melanoma skin cancers. In this retrospective cohort study, we determined the risk of developing skin cancer among patients with AA in a validated cohort relative to matched controls at two tertiary care hospitals in Massachusetts. There was a significantly decreased risk of NMSC in AA patients than controls (OR = 0.63, 95% CI = 0.48–0.81). There was a trend towards a protective effect of AA associated with melanoma (OR = 0.65, 95% CI = 0.39–1.09). There was no difference in anatomic distribution of skin cancer between patients with AA and controls. Our study demonstrates a decreased risk of nonmelanoma skin cancer and a trend towards reduced risk of melanoma in patients with AA.

Background Alopecia areata (AA) is an autoimmune disease characterized by non-scarring hair loss. The lack of a definitive biomarker or formal diagnostic criteria for AA limits our ability to define the epidemiology of the disease. In this study, we developed and tested the Alopecia Areata Assessment Tool (ALTO) in an academic medical center to validate the ability of this questionnaire in identifying AA cases.

Methods The ALTO is a novel, self-administered questionnaire consisting of 8 closed-ended questions derived by the Delphi method. This prospective pilot study was administered during a 1-year period in outpatient dermatology clinics. Eligible patients (18 years or older with chief concern of hair loss) were recruited consecutively. No patients declined to participate. The patient’s hair loss diagnosis was determined by a board-certified dermatologist. Nine scoring algorithms were created and used to evaluate the accuracy of the ALTO in identifying AA.

Results 239 patients (59 AA cases and 180 non-AA cases) completed the ALTO and were included for analysis. Algorithm 5 demonstrated the highest sensitivity (89.8%) while algorithm 3 demonstrated the highest specificity (97.8%). Select questions were also effective in clarifying disease phenotype.

Conclusion In this study. we have successfully demonstrated that ALTO is a simple tool capable of discriminating AA from other types of hair loss. The ALTO may be useful to identify individuals with AA within large populations.

Background The cardiovascular risk of patients with alopecia areata (AA) is not well characterized, with limited studies evaluating the risk of acute myocardial infarction (AMI) and ischemic stroke.

Objective We sought to determine the risk for patients with AA to develop subsequent stroke and AMI.

Methods We conducted propensity-matched retrospective analysis between January 1, 2000, and January 1, 2010, from Brigham and Women's Hospital and Massachusetts General Hospital in Boston, MA. A comprehensive research patient data repository search was done for International Classification of Diseases, Ninth Revision code 704.01 and cases were verified using a natural language processing program. Propensity score matching was used to identify controls for AA cases based on age, race, gender, smoking status, and history of hypertension, diabetes, and hyperlipidemia.

Results We identified 1377 cases of AA matched with 4131 controls. Patients with AA had decreased odds for developing stroke (odds ratio 0.39, 95% CI 0.18-0.87) and a trend toward decreased risk of AMI (odds ratio 0.91, 95% CI 0.59-1.39).

Limitations This was a retrospective study using a clinical database.

Conclusion Patients with AA had decreased risk for stroke and AMI, although not statistically significant. Further studies are needed to confirm these findings in other AA cohorts and to elucidate a potential mechanism.