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A recent study provides a comprehensive analysis of the incidence rates of infections, malignancies, thromboembolism, and cardiovascular events in alopecia areata patients, contributing crucial insights to optimize treatment strategies and patient management.

  • The study identified a higher incidence rate of herpes simplex infection among patients with alopecia areata compared to the matched non-alopecia areata cohort. Other adverse events, like cardiovascular disease, malignancy, and thromboembolism, showed similar rates between both groups.
  • Patients with severe forms of alopecia areata, specifically alopecia totalis or alopecia universalis, generally exhibited higher rates of adverse events than those with non-alopecia totalis/alopecia universalis alopecia areata.
  • This large-scale observational study may enhance the understanding of comorbid disease burden in patients with alopecia areata, aiding healthcare providers in patient management and treatment decisions.

According to a study published in the journal Dermatology and Therapy, alopecia areata (AA), an autoimmune disease with an immuno-inflammatory pathogenesis, may carry associated risks of adverse events such as infections, cardiovascular disease, malignancies, and thromboembolisms, due to its potential treatment with systemic corticosteroids and immunomodulators, such as Janus kinase inhibitors.

Insights From the Study

The large-scale observational study compared the incidence rates of serious infections, malignancies, major adverse cardiovascular events (MACE), and thromboembolic events in patients diagnosed with AA to a cohort without AA, matched by age, sex, and race. The analysis of data showed that patients with AA had a higher incidence rate of herpes simplex infection compared to the non-AA cohort. 

Conversely, for other outcomes, including cardiovascular disease, malignancy, and thromboembolism, overall similar rates were found between the two cohorts. However, patients with the severe subtypes alopecia totalis (AT) or alopecia universalis (AU) generally showed higher rates of these adverse events.

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Implications for Patients With Severe AA Subtypes

The study noted that patients with AT/AU generally had higher incidence rates for most baseline comorbidities and outcome events evaluated compared to those without AT/AU. This suggests that the severity of AA may influence the incidence of adverse events, likely due to increased frequency of medical visits and therefore higher chances of being diagnosed with comorbidities. Further research is needed to explore the possible mechanistic links between severe AA and associated comorbidities.

Clinical Takeaways and Future Directions

The study’s findings can assist clinicians in managing patients with AA more effectively, given the higher incidence of certain adverse events in this population, especially in patients with severe AA subtypes. Regular screening for these adverse events upon AA diagnosis may provide opportunities for early intervention and tailored management strategies. Future studies should continue to explore these observations in larger cohorts and investigate the implications of these incidence rates on long-term patient outcomes and the optimization of treatment strategies.


George, P., Jagun, O., Liu, Q., Wentworth, C., Napatalung, L., Wolk, R., Anway, S., & Zwillich, S. H. (2023). Incidence Rates of Infections, Malignancies, Thromboembolism, and Cardiovascular Events in an Alopecia Areata Cohort from a US Claims Database. Dermatology and Therapy. https://doi.org/10.1007/s13555-023-00937-9