Associations between alopecia areata and multiple sclerosis: a report of two cases and review of the literature

Rossi, Alfredo; Mellai, Marta; Federico, Alessandro Di; Magri, Francesca; Caro, Gemma; Fortuna, Maria Caterina; D’Arino, Andrea; Pigliacelli, Flavia; Carlesimo, Marta

doi:10.1111/ijd.14737

Cited by 6 publications

(6 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both alopecia and MS exhibit genetic predisposition, environmental triggers, and similar pathological processes. 58 Our study further reinforces the importance of considering alopecia in patients affected by MS, with particular care when deciding which DMT to utilize or follow up with patients if any concerns regarding hair loss develop throughout treatment.…”

Section: Discussionsupporting

confidence: 67%

See 1 more Smart Citation

Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Porwal

Salter

Patel

et al. 2022

J Cent Nerv Syst Dis

View full text Add to dashboard Cite

BACKGROUND There is currently limited literature addressing the reporting of alopecia in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs). Anecdotal reports of hair thinning from patients on various DMTs prompted further investigation of a large database. OBJECTIVE To analyze total reports, source of reporting, age distribution, and sex distribution of alopecia associated with DMTs. METHODS FDA Adverse Event Reporting System (FAERS) public dashboard and OpenFDA database were analyzed for alopecia reports between January 1, 2009, and June 30, 2020, attributed to usage in MS of FDA approved DMTs. The main outcomes included total reports for each drug, age, sex distribution, and reporting source. OpenFDA data was used for statistical analyses including reporting odds ratios (ROR) and information components. RESULTS 8759 alopecia reports were identified among 44 114 adverse events in skin and subcutaneous tissue disorders (19.9%). 3701 (42.3%) with teriflunomide, 1675 (19.1%) with dimethyl fumarate, 985 (11.2%) with natalizumab, 926 (10.6%) with fingolimod, 659 (7.5%) with interferon beta-1a, 257 (2.9%) with glatiramer acetate, 243 (2.8%) with ocrelizumab, 124 (1.4%) with interferon beta-1b, 117 (1.3%) with alemtuzumab, 36 (.4%) with siponimod, 24 (.3%) with cladribine, and 12 (.1%) with rituximab. Reports were mostly made by patients (78.3%) and highest in fifth and sixth decades of life. OpenFDA analyses showed increased ROR (ROR 95% confidence interval) of alopecia in females with teriflunomide (18.00, 17.12-18.93), alemtuzumab (1.43, 1.16-1.76), dimethyl fumarate (1.26, 1.18-1.34), and ocrelizumab (1.28, 1.11-1.49). Increased ROR in males was associated with teriflunomide (24.65, 20.72-29.31). CONCLUSION We identified many reports of alopecia for DMTs in addition to teriflunomide. Within the limitations of the database, increased RORs of alopecia were observed for females treated with alemtuzumab, dimethyl fumarate, and ocrelizumab. The source of reporting was largely driven by female patients. Possible alopecia, even if transient, should be considered during patient education when starting DMTs.

show abstract

Section: Discussionsupporting

confidence: 67%

“…Lastly, alopecia areata were reported in 2 females affected by MS, aged 45 and 32. 58 Onset of alopecia occurred many years before the onset of MS in these patients. Although the descriptive analysis of alopecia in this study may be related to features of MS, current evidence does not indicate a link between MS and alopecia.…”

Section: Discussionmentioning

confidence: 94%

Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Porwal

Salter

Patel

et al. 2022

J Cent Nerv Syst Dis

View full text Add to dashboard Cite

show abstract

“…Interestingly, our patient was subsequently diagnosed with MS, which has rarely been described as a co‐morbidity of AA. In predisposed individuals, MS may be diagnosed prior to or after AA 10 . AA may also be triggered by alemtuzumab, a therapy used in MS.…”

Section: Discussionmentioning

confidence: 99%

Alopecia areata after severe allergic contact dermatitis to a permanent hair dye

et al. 2022

View full text Add to dashboard Cite

Contact allergy to diabetic devices has been well documented. However, it is typically caused by adhesive components such as acrylates or colophonium. 3 To the best of our knowledge, this is the first case of contact allergy to platinum in a CGM.Clinical trials for the Eversense E3 CGM described mild dermatologic symptoms such as redness, pain and bruising that resolved without intervention. 2,4 In the PRECISE study, transient dermatitis was noted in one patient at the transmitter site. 2 No studies or case reports to date describe persistent, non-itching subcutaneous lesions such as those found in our patient. Based on his patch test results, we strongly suspect contact allergy to platinum in the Eversense E3 CGM as the cause of his symptoms. Due to multiple components of CGMs, patch testing should be considered in a setting of dermatologic adverse events. AUTHOR CONTRIBUTIONSMichelle Xiong: Writingoriginal draft; writingreview and editing.

show abstract

“…An association between alopecia and MS has been described, involving poly autoimmunity and particularly autoimmune thyroiditis 5 . Both alopecia and MS share a genetic predisposition, environmental triggers, and similar pathological processes 13 .…”

Section: Introductionmentioning

confidence: 99%

Alemtuzumab-Induced Secondary Autoimmune Skin Disorders as Side Effects of Multiple Sclerosis Therapy: Problem That Can Be Influenced or Fate? A Narrative Overview of The Literature A Neuroprotective Role of Vitamin D?

Goischke¹

2022

MRAJ

View full text Add to dashboard Cite

At present, no cure for multiple sclerosis can be made possible with the pharmaceuticals available, nor can a gradual progression of multiple sclerosis be prevented. In the management of multiple sclerosis, it is therefore necessary to determine existing autoimmune diseases through anamnesis before starting alemtuzumab therapy with disease modifying therapy. With previously existing autoimmune diseases or as prophylaxis, comorbidities can be influenced by vitamin D supplementation. Secured pathophysiological and immunological mechanisms of vitamin D on autoimmunological processes support the daily, individually high-dose oral vitamin D intake. This add-on therapy should positively influence the quality of life of persons with multiple sclerosis in the long term. So that the patients do not reject the highly efficient multiple sclerosis therapy for fear of side effects, this therapy offer is a way of avoiding side effects of alemtuzumab administration, such as alopecia, vitiligo, and thyroid diseases, and of decisively influencing the course of MS. This increases the compliance of the persons with multiple sclerosis in therapy. The pathophysiological mechanisms of alopecia and vitiligo are shown. The immunological mechanisms of vitamin D and its influence on autoimmune diseases are described. The previous use of vitamin D in the therapy of these skin diseases is presented and oral supplementation is put up for discussion. The additional neuroprotective effect is evident. Preventing infection with oral vitamin D supplements, particularly in coronavirus disease 2019, may prevent or mitigate multiple sclerosis exacerbations.

show abstract

Associations between alopecia areata and multiple sclerosis: a report of two cases and review of the literature

Cited by 6 publications

References 22 publications

Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Alopecia in Multiple Sclerosis Patients Treated with Disease Modifying Therapies

Alopecia areata after severe allergic contact dermatitis to a permanent hair dye

Alemtuzumab-Induced Secondary Autoimmune Skin Disorders as Side Effects of Multiple Sclerosis Therapy: Problem That Can Be Influenced or Fate? A Narrative Overview of The Literature A Neuroprotective Role of Vitamin D?

Contact Info

Product

Resources

About