Alopecia areata and underlying corneal pathologies

Spanish investigators led by Barbara Burgos-Blasco, MD, PhD, reported a connection between alopecia areata and corneal abnormalities due to systemic inflammation.¹ Dr Burgos-Blasco is from the Ophthalmology Department, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid.

Some studies have reported ocular pathologies in patients with alopecia areata, which is defined as a common immune-mediated form of non-scarring hair loss of the scalp.¹ Reported ocular pathologies include mostly retinal and lenticular abnormalities²; others have reported increased prevalence rates of cataract in patients with alopecia areata, likely because of corticosteroid therapy^3-5 or the common embryonic origin of the skin and the lens from the ectoderm.⁵ The authors also explained that decreased corneal sensitivity has been reported but not thoroughly documented.⁶

Because no studies have reported corneal topographic and biomechanical findings in patients with alopecia areata, they conducted a case-control study to investigate the corneal topography parameters and biomechanics in patients with alopecia areata and compare the findings to individuals without alopecia areata.

Individuals without alopecia areata and those with severe disease underwent a general ophthalmologic examination that also included Pentacam and Corvis Scheimpflug technology examinations (Oculus Optikgeräte GmbH,). The investigators recorded the visual acuity levels, refractive errors, corneal aesthesiometry and biomechanical and topographic variables.

Severe alopecia areata was defined as extensive multifocal alopecia areata, total or universal, with more than 50% involvement of the scalp according to the Severity of Alopecia Tool scale by a dermatologist.

Study results

The study included 25 patients with alopecia areata (50 eyes; mean age, 50.6 ± 8.1 years) and 29 controls (58 eyes; mean age, 49.4 ± 8.6 years). The affected patients had decreased corneal sensitivity, increased corneal staining and more advanced cataract (P ≤ 0.004).

The authors also reported that the anterior topographic flat meridian, mean anterior keratometry and maximal keratometric point were increased in affected patients (P ≤ 0.040), and the pachymetry values were thinner (P ≤ 0.001). In addition, the keratoconic index and Belin/Ambrosio-enhanced ectasia total deviation display were increased (P ≤ 0.007).

Among the eyes of patients with severe disease, two eyes with a topographic diagnosis of keratoconus and four eyes with subclinical keratoconus were identified. In affected patients, the applanation lengths were smaller (P ≤ 0.029), and the Corvis Biomechanical Index was increased (P = 0.022).

The authors concluded, “This is the first study to thoroughly evaluate corneal parameters in alopecia areata and to depict altered topographic and biomechanical parameters in alopecia areata and how patients may present with a higher incidence of corneal ectasia. The current findings suggest that patients with severe alopecia areata should undergo a complete ophthalmologic examination and a prolonged follow-up to allow for early diagnosis of ocular diseases and prevent future ocular morbidity.”

References

1. Burgos-Blasco B, Burgos-Blasco P, Rodriguez-Quet O, et al. Alterations in corneal sensitivity, staining and biomechanics of alopecia areata patients: novel findings in a case-control study. J Clin Med. 2024;13:2426; https://doi.org/10.3390/jcm13082426

2. Orecchia G, Bianchi P, Malvezzi F, et al. Lens changes in alopecia areata. Dermatologica. 1988;176:308–309.

3. Tosti A, Colombati S, Caponeri G, et al. Ocular abnormalities occurring with alopecia areata. Dermatologica. 1985;170:69–73.

4. de Andrade FA, Giavedoni P, Keller J, et al. Ocular findings in patients with alopecia areata: Role of ultra-wide-field retinal imaging. Immunol Res. 2014;60, 356–360.

5. Pandhi D, Singal A, Gupta R, Das G. Ocular alterations in patients of alopecia areata. J Dermatol. 2009;36:262–268.

6. Camacho F, Tosti A, Randall V, Price V. Tricología: enfermedades del folículo pilosebáceo. In Manifestaciones Oculares En La Alopecia Areata; Aula Médica Ediciones: Madrid, Spain, 2013; pp. 779–782.