Clinical manifestations of alopecia in autoimmune blistering diseases: A cross-sectional study

Danica Xie; Asli Bilgic; Nada Abu Alrub; Özlem Dicle; Dédée F Murrell

doi:10.1016/j.jdin.2022.08.025

Clinical manifestations of alopecia in autoimmune blistering diseases: A cross-sectional study

JAAD Int. 2022 Oct 11:10:6-13. doi: 10.1016/j.jdin.2022.08.025. eCollection 2023 Mar.

Authors

Danica Xie^{1

2}, Asli Bilgic^{1

2

3}, Nada Abu Alrub¹, Özlem Dicle³, Dédée F Murrell^{1

2}

Affiliations

¹ Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.
² Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³ Department of Dermatology and Venereology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.

Abstract

Background: Alopecia is a complication of autoimmune blistering diseases (AIBDs) that affects patients' quality of life; however, it has generally been overlooked in patients with severe disease because it is regarded as a cosmetic issue.

Objective: To study the epidemiologic data and clinical presentations of alopecia in our cohort of patients with AIBDs.

Methods: Forty-one patients with AIBDs were assessed in this cross-sectional study. An assessment tool to collate patient information, including AIBD scalp involvement, trichoscopic findings, and Severity of Alopecia Tool II scores, was used.

Results: More than 70% of patients in our cohort had at least 1 type of alopecia, with 10% presenting with a nonspecific (end-stage) scarring alopecia. Elevated Dsg1 ratios were predictive of hair loss in pemphigus vulgaris (P < .001) and increased alopecia was associated with worse disease severity in bullous pemphigoid (P = .001).

Limitations: The small sample size and lack of severe cases.

Conclusion: There is a likelihood that 1 in 10 patients with AIBDs have a scarring alopecia related to their disease. To our knowledge, this is the first study including alopecia prevalence in patients with bullous pemphigoid, which was not significantly increased despite providing clues to disease severity.

Keywords: AA, alopecia areata; AIBD, autoimmune blistering disease; BP, bullous pemphigoid,; BPDAI, Bullous Pemphigoid Disease Area Index; EBA, epidermolysis bullosa acquisita; PDAI, Pemphigus Disease Area Index; PV, pemphigus vulgaris; SALT II, Severity of Alopecia Tool II; alopecia; autoimmune blistering diseases; dermoscopy; pemphigoid; pemphigus; trichoscopy.