Ophthalmologic Comorbidities in Alopecia Areata

November 2025 in “ Journal of Clinical Medicine ”

Piedad Marcela Guavita Falla, Diego Buendía‐Castaño, Ángela Hermosa‐Gelbard, Barbara Burgos‐Blasco, Patrícia Burgos‐Blasco, Sergio Vañó‐Galván, David Saceda‐Corralo

alopecia areata autoimmune mechanisms immune privilege hair follicles corticosteroids

Studysummary This review article explores the potential systemic nature of alopecia areata, highlighting the association with ocular abnormalities and suggesting that shared pathogenic pathways may lead to eye symptoms occurring at younger ages than usual. Our plain-language summary of this paper — not a Tressless recommendation.

Alopecia areata (AA) is linked to various ophthalmologic comorbidities due to shared autoimmune mechanisms and the collapse of immune privilege in both hair follicles and ocular tissues. This review emphasizes the need for dermatologists to integrate ophthalmologic evaluations into their practice for AA patients, as they are at increased risk for conditions like madarosis, blepharitis, dry eye disease, cataracts, and retinal changes. The document synthesizes evidence from numerous studies, highlighting the prevalence of these conditions in AA patients and the potential impact of treatments like corticosteroids on ocular health. Further research is needed to clarify the causal relationships between AA and these eye disorders.

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research Alopecia Areata: Pathogenesis, Diagnosis, And Therapies

21 citations , April 2025 in “MedComm”

This review explores the complex factors involved in alopecia areata, such as immune and genetic influences, and discusses advances in diagnostic and therapeutic approaches, while reporting no new clinical results.

research Alopecia Areata–Specific Patient-Reported Outcome Measures

2 citations , March 2025 in “JAMA Dermatology”

This review evaluates the quality of alopecia areata-specific patient-reported outcome measures and suggests that more high-quality validation studies are needed to enhance their reliability and validity.

research Subclinical Atherosclerosis in Alopecia Areata: Usefulness of Arterial Ultrasound for Disease Diagnosis and Analysis of Its Relationship with Cardiometabolic Parameters

3 citations , July 2024 in “Journal of Clinical Medicine”

This study found that alopecia areata patients have a higher prevalence of carotid subclinical atherosclerosis, with factors such as disease duration, systemic inflammation, and insulin resistance potentially contributing to this increased risk.

research Alterations in Corneal Sensitivity, Staining and Biomechanics of Alopecia Areata Patients: Novel Findings in a Case-Control Study

1 citations , April 2024 in “Journal of Clinical Medicine”

This study found that patients with severe alopecia areata demonstrated reduced corneal sensitivity and increased corneal staining, and exhibited altered topographic and biomechanical eye parameters compared to controls, suggesting a possible increased risk of keratoconus and the necessity for regular ophthalmological exams.

research Ocular Comorbidities and Their Relation to Clinical and Dermoscopic Features in Patients with Alopecia Areata: A Case-Control Study

1 citations , January 2024 in “Journal of the Egyptian Womenʼs Dermatologic Society”

This study found that ocular comorbidities, particularly errors of refraction, are common in patients with Alopecia Areata, but dermoscopic findings are not predictive of these ocular issues.

research Evaluation of Retinal Layers and Choroidal Structures Using Optical Coherence Tomography in Alopecia Areata

June 2023 in “Medeniyet medical journal”

This study found that while the macular, retinal nerve fiber layer, and retinal layers' thickness were similar between alopecia areata patients and controls, the choroidal thickness was significantly thicker in the alopecia areata group, suggesting potential inflammation-related changes.

research Impact and Management of Loss of Eyebrows and Eyelashes

May 2023 in “Dermatology and therapy”

This study aims to provide a practical guide for managing common causes of madarosis, highlighting the need to identify underlying causes to ensure effective treatment for eyelash and eyebrow loss.

research Ocular Manifestations Associated With Alopecia Areata

January 2023 in “Al-Azhar International Medical Journal /Al-Azhar International Medical Journal”

This piece discusses the importance of diagnosing and treating refractive errors and ocular diseases in patients with alopecia areata for better prognosis, but it presents no new findings.

research Eyebrow and Eyelash Alopecia: A Clinical Review

6 citations , October 2022 in “American journal of clinical dermatology”

This review provides an updated overview of the symptomatology, diagnosis, trichoscopy findings, and treatment options for eyebrow and eyelash alopecia, but it reports no new experimental results.

research Autoantigen Discovery in the Hair Loss Disorder, Alopecia Areata: Implications of Post-Translational Modifications

11 citations , June 2022 in “Frontiers in immunology”

This review discusses the challenges in identifying specific hair follicle antigens involved in initiating alopecia areata and highlights the need for further research to understand its etiopathogenesis, reporting no new results.

research Immune-Mediated Alopecias and Their Mechanobiological Aspects

17 citations , May 2022 in “Cells and Development”

research Isolated Hair Loss on the Eyebrow: Five Cases with Trichoscopic Features

1 citations , March 2022 in “Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia”

This study found that trichoscopy is a useful tool in differentiating between alopecia areta and trichotillomania on the eyebrows based on distinct hair and follicle features.

research Validation of the Alopecia Areata Patient Priority Outcomes Questionnaire in Adults and Adolescents with Alopecia Areata

22 citations , November 2021 in “Dermatology and Therapy”

This study found that the Alopecia Areata Patient Priority Outcomes questionnaire is a reliable and valid tool for measuring the severity and impact of hair loss in individuals with alopecia areata.

research Alopecia Areata: An Update on Etiopathogenesis, Diagnosis, and Management

290 citations , August 2021 in “Clinical Reviews in Allergy & Immunology”

JAK inhibitors show promise for treating alopecia areata, but more research is needed.

Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims

research Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims

23 citations , July 2021 in “Advances in Therapy”

This study observed that patients with alopecia areata often have comorbidities and experience significant healthcare costs, with treatments like systemic therapies being infrequently used.

Dermatologist and Patient Perceptions of Treatment Success in Alopecia Areata and Evaluation of Clinical Outcome Assessments in Japan

research Dermatologist and Patient Perceptions of Treatment Success in Alopecia Areata and Evaluation of Clinical Outcome Assessments in Japan

7 citations , January 2021 in “Dermatology and therapy”

This study confirmed that the Alopecia Areata-Investigator Global Assessment and other clinical outcome assessments are valid and relevant measures of treatment success for alopecia areata patients in Japan, aligning with previous North American findings.

research Alopecia Areata: A Review on Diagnosis, Immunological Etiopathogenesis, and Treatment Options

56 citations , January 2021 in “Clinical and Experimental Medicine”

This review highlights the challenges in treating alopecia areata, noting that current therapies often lead to relapse and have uncertain long-term effectiveness; it also points to potential future treatments such as JAK-STAT inhibitors and PRP.

research The Role of Patients in Alopecia Areata Endpoint Development: Understanding Physical Signs and Symptoms

3 citations , October 2020 in “Journal of Investigative Dermatology Symposium Proceedings”

This study found that scalp hair loss is the most bothersome symptom of alopecia areata for both adults and adolescents, highlighting the need for treatments focused on improving scalp hair growth.

Development of Clinician-Reported Outcome and Patient-Reported Outcome Measures for Eyebrow, Eyelash, and Nail Assessment in Alopecia Areata

research Development of Clinician-Reported Outcome and Patient-Reported Outcome Measures for Eyebrow, Eyelash, and Nail Assessment in Alopecia Areata

56 citations , August 2020 in “American Journal of Clinical Dermatology”

This study concluded that the ClinRO and PRO measures, along with their photoguides, offer clear and meaningful assessments for patients with alopecia areata concerning eyebrow, eyelash, and nail appearance, as well as eye irritation.

research Hair Follicle Immune Privilege and Its Collapse in Alopecia Areata

134 citations , July 2020 in “Experimental dermatology”

This review discusses immune privilege in anagen hair follicles and its collapse in alopecia areata, emphasizing the importance of restoring this function for effective management and disease relapse prevention.

research Frontiers in Alopecia Areata Pathobiology Research

55 citations , October 2019 in “The journal of allergy and clinical immunology/Journal of allergy and clinical immunology/The journal of allergy and clinical immunology”

This review discusses emerging research areas in alopecia areata pathobiology, highlighting the potential roles of unconventional immune cells and the need for more targeted therapeutic strategies, but reports no new experimental results.

research Alopecia Areata: A Multifactorial Autoimmune Condition

148 citations , December 2018 in “Journal of autoimmunity”

This review discusses genetic and environmental factors contributing to autoimmunity in alopecia areata and reports no new clinical findings, emphasizing the need for further study on its aetiology and pathophysiology.

research Comorbidities in Alopecia Areata: A Systematic Review and Meta-Analysis

100 citations , July 2018 in “Journal of The American Academy of Dermatology”

This study found that alopecia areata is linked with a higher prevalence of systemic and psychiatric diseases, suggesting that physicians should monitor for these potential comorbidities.

research Alopecia Areata: A Review of Disease Pathogenesis

191 citations , May 2018 in “British journal of dermatology/British journal of dermatology, Supplement”

This study reviewed recent theories on alopecia areata's pathogenesis, highlighting its autoimmune nature due to immune privilege disruption in hair follicles, and noted current treatments have limited efficacy with high relapse rates, underscoring the need for further research into its mechanisms for better therapies.

research Alopecia Areata Is Associated With Increased Expression of Heart Disease Biomarker Cardiac Troponin I

19 citations , January 2018 in “Acta dermato-venereologica”

In this study, the researchers observed that subjects with alopecia areata had the highest plasma level of cardiac troponin I, followed by those with androgenetic alopecia, and the lowest levels in individuals without hair loss.

research Immune Privilege Collapse And Alopecia Development: Is Stress A Factor

51 citations , December 2017 in “Skin Appendage Disorders”

This review examines the literature on autoimmune hair loss disorders, highlighting the collapse of immune privilege and the potential role of neurogenic stress in this process, but reports no new clinical results.

research Hair Follicle Immune Privilege Revisited: The Key to Alopecia Areata Management

102 citations , December 2017 in “The journal of investigative dermatology. Symposium proceedings/The Journal of investigative dermatology symposium proceedings”

This review discusses the role of immune privilege collapse in the pathogenesis of alopecia areata, emphasizing the potential for therapeutic manipulation of hair bulb immune privilege to offer new treatment options, and reports no new results.

research Alopecia Areata: Treatment Options and Efficacy

182 citations , December 2017 in “Journal of the American Academy of Dermatology”

This article reviews current and emerging treatments for alopecia areata, including Janus kinase inhibitors, highlighting variability in clinical outcomes and the lack of sustained remission.

research Health-Related Quality of Life Among Patients With Alopecia Areata: A Systematic Review

95 citations , July 2016 in “Journal of The American Academy of Dermatology”

This review concluded that patients with alopecia areata consistently show poor health-related quality of life scores, similar to those in other chronic skin diseases like atopic dermatitis and psoriasis.

research Alopecia Areata and Health-Related Quality of Life: A Systematic Review and Meta-Analysis

128 citations , February 2016 in “British Journal of Dermatology”

This study found that patients with alopecia areata experience significant impairments in health-related quality of life, notably affecting mental health, according to various quality of life assessment tools.

research Alopecia Areata Increases the Risk of Stroke: A 3-Year Follow-Up Study

25 citations , June 2015 in “Scientific Reports”

In this study, patients with alopecia areata were found to have a higher risk of stroke over a 3-year follow-up period compared to those without the condition.

research Madarosis, Milphosis, Eyelash Trichomegaly, and Dermatochalasis: Conditions Affecting the Periocular Area

10 citations , February 2015 in “Clinics in Dermatology”

This article discusses various periocular conditions like madarosis, milphosis, trichomegaly, and dermatochalasis, and highlights their potential link to underlying local and systemic diseases, but reports no new clinical findings.

research The Association of Lacrimal Gland Inflammation with Alopecia Areata

2 citations , October 2014 in “Orbit”

This study observed that lacrimal gland inflammation and alopecia areata, both autoimmune conditions, can occur together in patients.

research The Role of Hair Follicle Immune Privilege Collapse in Alopecia Areata: Status and Perspectives

79 citations , December 2013 in “Journal of Investigative Dermatology Symposium Proceedings”

This article proposes that alopecia areata may be caused by immune attacks on hair follicles after an immune privilege collapse, suggesting new therapeutic approaches targeting this immune response pattern.

research Audiological Abnormalities in Patients with Alopecia Areata

11 citations , September 2013 in “Journal of The European Academy of Dermatology and Venereology”

In this study, sensorineural hearing loss was significantly more frequent in patients with alopecia areata compared to healthy controls, suggesting a relationship between the autoimmune condition and hearing function.

research Eyelash Alopecia Areata: Case Series and Literature Review

11 citations , August 2012 in “Canadian journal of ophthalmology”

This study found that among patients with eyelash alopecia areata, 40% experienced complete regrowth of lashes, with a mean time to regrowth of 28 months.

research Long-Term Follow-Up of Previously Reported Case of Trichomegaly Associated with Alopecia Areata in a 3-Year-Old Girl

3 citations , March 2012 in “Pediatric Dermatology”

This correspondence reports on a long-term follow-up of a previously documented case of trichomegaly linked to alopecia areata in a three-year-old girl, without presenting new study results.

research Can the Hair Follicle Become a Model for Studying Selected Aspects of Human Ocular Immune Privilege?

21 citations , June 2011 in “Investigative Ophthalmology & Visual Science”

This article argues that human scalp hair follicles could serve as a surrogate model for studying immune privilege in the human eye, offering a novel approach for ocular IP research.

research Optic Neuropathy in a Child with Alopecia

1 citations , August 2010 in “Optometry and Vision Science”

This case study suggests a potential common inflammatory cause between insidious optic neuropathy and alopecia areata in a 4-year-old boy.

research Genome-Wide Association Study in Alopecia Areata Implicates Both Innate and Adaptive Immunity

717 citations , June 2010 in “Nature”

This study identified key genetic regions associated with alopecia areata, highlighting both acquired and innate immune involvement, with a novel link to the upregulation of ULBP ligands in autoimmune disease.

research Trichomegaly in a 3-Year-Old Girl with Alopecia Areata

15 citations , March 2009 in “Pediatric dermatology”

This case report documents a novel occurrence of bilateral trichomegaly with alopecia areata in a healthy 3-year-old girl, without known underlying health conditions or medication use.

research Maintenance of Hair Follicle Immune Privilege Is Linked to Prevention of NK Cell Attack

253 citations , December 2007 in “Journal of Investigative Dermatology”

This study suggests that human hair follicles may actively suppress natural killer cells, which contrasts with the observed defects in NK cell regulation in alopecia areata.

research Probing the Effects of Stress Mediators on the Human Hair Follicle

159 citations , November 2007 in “American Journal of Pathology”

In this study, researchers found that substance P triggered premature catagen development and immune changes in human scalp hair follicles, providing a possible biological link between stress and hair loss conditions like telogen effluvium and alopecia areata.

research Lymphocytes, Neuropeptides, And Genes Involved In Alopecia Areata

286 citations , August 2007 in “Journal of Clinical Investigation”

This review examines the interplay of genetics and neuroimmunology in alopecia areata, highlighting its potential to inform broader autoimmunity research, but reports no new findings.

research Cutaneous Latanoprost in the Treatment of Alopecia Areata

22 citations , April 2003 in “Eye”

Applying latanoprost on skin can stimulate hair growth with minimal side effects.