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Background: There is growing evidence that patients with alopecia areata (AA) have an increased risk of developing psychiatric comorbidities. However, the relationship between AA and suicidal behaviors remains unclear., Objective: The objective of this study was to investigate the association between AA and suicidal behaviors., Methods: Participants were recruited from the National Health Insurance Research Database in Taiwan, including 10,515 patients with AA and 10,5150 matched controls, to assess the risk of suicide attempts. A Cox regression model was used for all analyses., Results: Compared with the controls, an increased risk of suicide attempts was observed in patients with AA, with an adjusted hazard ratio of 6.28 (95% confidence interval, 4.47-8.81). Suicide risk remained significantly elevated in AA patients when stratified by underlying psychiatric disorders. The mean age of initial suicidal behaviors was also lower in patients with AA., Conclusions: Patients with AA had a significantly higher incidence of suicidal attempts than controls, regardless of concurrent psychiatric illness. Further studies are needed to elucidate the pathophysiology of the association between AA and suicidality. In addition, dermatologists should be aware of the increased suicidality of patients with AA., (© 2023 S. Karger AG, Basel.)

Background: Growing evidence has revealed abnormalities in the retinal structures of patients with alopecia areata (AA). However, the relationship between AA and retinopathy remains unclear., Objective: To investigate the association between AA and retinal diseases., Methods: The study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 9909 patients with AA and 99,090 matched controls to assess the risk of retinal diseases. A Cox regression model was used for all analyses., Results: Compared with the controls, patients with AA had an adjusted hazard ratio (aHR) of 3.10 (95% confidence interval [CI] 2.26-4.26) for retinal diseases. With respect to individual retinal diseases, Patients with AA had significantly higher risks of developing retinal detachment (aHR 3.98; 95% CI 2.00-7.95), retinal vascular occlusion (aHR 2.45; 95% CI 1.22-4.92), and retinopathy (aHR 3.24; 95% CI 2.19-4.81) than controls., Limitations: This was a retrospective cohort study. Meanwhile, almost all the participating individuals were residents of Taiwan; therefore, the validity of our findings in other demographics remains unclear., Conclusion: Patients with AA had a significantly higher risk of retinal disease than controls. Further studies are needed to clarify the pathophysiology of AA and retinal diseases., Competing Interests: Conflict of interest None disclosed., (Copyright © 2021 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Alopecia areata (AA) and irritable bowel syndrome (IBS) are two distinct diseases that share a similar pathophysiology; however, the relationship between these two diseases is unknown. This study aimed to investigate the bidirectional relationship between AA and IBS., Methods: Participants were recruited from the National Health Insurance Research Database in Taiwan. We included 5446 patients with AA and 21 784 matched controls to assess the risk of IBS, and 56 429 patients with IBS and 225 716 matched controls to assess the risk of AA. The Cox proportional-hazards regression model was used to calculate the adjusted hazard ratio (aHR)., Results: After adjustment for potential confounders, patients with AA had an aHR of 5.20 [95% confidence interval (CI) 3.97-6.82] for IBS in comparison with the controls. Furthermore, compared with the controls, IBS patients had an aHR of 5.38 (95% CI 3.95-7.34) for AA., Conclusion: AA is bidirectionally associated with IBS. Further investigation is needed to elucidate the shared pathogenesis underlying these two diseases., (© 2022 Australasian College of Dermatologists.)

Hepatitis C virus (HCV) infection is associated with several cutaneous manifestations, including lichen planus and psoriasis. However, its association with other chronic inflammatory skin diseases (CISD) remains largely unknown. The aim of this study was to investigate the association between HCV infection and CISD. Participants were recruited from the National Health Insurance Research Database in Taiwan. Altogether 23 509 patients with HCV infection and 94 036 matched controls were included to assess the risk of CISD. A Cox regression model was used for the analyses. Compared with controls, patients with HCV infection had an adjusted hazard ratio (aHR) of 6.34 (95% confidence interval [CI], 5.30-7.58) for CISD after adjustment for potential confounders. Regarding individual CISD, patients with HCV infection had a significantly increased risk of developing lichen planus, psoriasis, vitiligo, alopecia areata, and cutaneous lupus erythematosus. Interferon-based antiviral therapy (IFN-based AVT) was significantly associated with a decreased risk of CISD (aHR = 0.42; 95% CI, 0.28-0.64). Patients with HCV infection had a significantly increased risk of CISD, while IFN-based AVT was associated with a decreased risk. These findings suggest monitoring of CISD in patients with HCV infection., (© 2021 Japanese Dermatological Association.)

Background: Alopecia areata (AA) is associated with multiple comorbidities and shares a similar inflammatory signature with dementia. The great negative psychosocial impact of AA may result in poor social engagement, a typical risk factor for dementia. However, little is known about the association between AA and dementia., Methods: Via the Taiwan National Health Insurance Research Database, 2,534 patients with AA ( International Classification of Diseases, 9th Revision, Clinical Modification code: 704.01) aged ≥ 45 years and 25,340 controls matched for age, sex, residence, income, dementia-related comorbidities, systemic steroid use, and annual outpatient visit were included between 1998 and 2011 for investigation of subsequent dementia from enrollment to the end of 2013. After controlling for potential confounders, stratified Cox regression analysis on each matched pair was applied to assess the dementia risk between the AA and control groups., Results: Patients with AA were more likely to develop any dementia (adjusted hazard ratio [aHR]  = 3.24; 95% CI, 2.14-4.90), Alzheimer's disease (aHR = 4.34; 95% CI, 1.45-12.97), and unspecified dementia (aHR = 3.36; 95% CI, 2.06-5.48) than the control cohort. Stratification analysis by age and sex revealed increased risks of any dementia and unspecified dementia in both age groups (ie, < 65 and ≥ 65 years) and both sex groups and increased risks of AD in male patients and in those with age at dementia onset ≥ 65 years. Sensitivity analyses after exclusion of the first year or first 3 years of observation showed consistent findings., Conclusions: Patients with AA had a higher risk of developing dementia. Further studies are needed to elucidate the underlying pathophysiology between AA and dementia risk., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Alopecia areata (AA) has long been associated with thyroid diseases; however, the temporality of their association remains unclear. This study aimed to investigate the bidirectional association between AA and thyroid diseases. In analysis 1, we included 5929 AA patients and 59,290 matched controls to assess the risk of thyroid diseases. In analysis 2, we included 35,071 patients with thyrotoxicosis, 19,227 patients with Graves' disease, 5460 patients with thyroiditis, 3352 patients with Hashimoto's thyroiditis, and their matched controls (1:10) to assess the risk of AA. Incidence of thyroid diseases and AA were the outcomes in analysis 1 and analysis 2, respectively. After adjusting the potential confounders, AA patients had an increased risk of all thyroid diseases, including toxic nodular goiter, (aHR 10.17; 95% confidence interval [CI] 5.32-19.44), nontoxic nodular goiter (aHR 5.23; 95% CI 3.76-7.28), thyrotoxicosis (aHR 7.96; 95% CI 6.01-10.54), Graves' disease (aHR 8.36; 95% CI 5.66-12.35), thyroiditis (aHR 4.04; 95% CI 2.12-7.73), and Hashimoto thyroiditis (aHR 4.35; 95% CI 1.88-10.04). On the contrary, a significantly increased risk of developing AA was observed among patients with thyrotoxicosis (aHR 9.29; 95% CI, 7.11-12.14), Graves' disease (aHR 8.66; 95% CI 6.03-12.42), and thyroiditis (aHR 6.42; 95% CI 3.15-13.11) but not in patients with Hashimoto's thyroiditis. In conclusion, our study found a bidirectional association between AA and thyroid diseases, suggesting shared biological mechanisms underlying these two diseases.

Objective: Posttraumatic stress disorder (PTSD) is known as a risk factor for various immune-related disorders; however, the association between PTSD and related autoimmune skin diseases (ASDs) remains unclear. This study aimed to investigate the association of PTSD with the risk of related ASDs., Methods: Participants were recruited from the National Health Insurance Research Database in Taiwan. We included 9801 patients with PTSD and 39,204 matched controls to assess the risk of developing ASDs. Cox regression model was used for analyses., Results: After adjusting for confounders, we found an increased risk of ASDs among the patients with PTSD (adjusted hazard ratio [aHR] = 3.00, 95% confidence interval [CI] = 2.21-4.07) compared with that among matched controls. Statistically significant associations were found between PTSD and five individual ASDs, including psoriasis (aHR = 3.81, 95% CI = 1.90-7.67), lichen planus (aHR = 31.63, 95% CI = 4.00-249.91), alopecia areata (aHR = 4.77, 95% CI = 2.47-9.20), autoimmune bullous diseases (aHR = 9.55, 95% CI = 1.98-45.99), and vitiligo (aHR = 16.06, 95% CI = 4.48-57.54)., Conclusions: Patients with PTSD had an increased risk of developing ASDs compared with the matched controls. Further studies are needed for better understanding of the underlying mechanisms., (Copyright © 2021 by the American Psychosomatic Society.)

Background: The effects of cigarette smoking and alcohol consumption on the risk of alopecia areata (AA) are unclear., Objective: The aim was to examine the association of cigarette smoking and alcohol consumption with AA., Methods: We collected participants from four rounds (2001, 2005, 2009, and 2013) of the Taiwan National Health Interview Survey. Incident AA cases were identified from the National Health Insurance database., Results: Of the 60,055 participants, 154 developed AA during the 647,902 person-years of follow-up. After controlling for confounders, current smokers had a higher risk of incident AA than never smokers [adjusted hazard ratio (aHR) 1.88; 95% confidence interval (CI) 1.22-2.88]. There was a trend toward an increased risk of AA with increasing numbers of years of smoking and cumulative pack-years of smoking among current smokers. The aHRs (95% CIs) of current smokers of > 5 and ≤ 15 cigarettes per day, > 10 and ≤ 20 years of smoking, ≤ 10, and > 10 and ≤ 20 pack-years of smoking were 2.03 (1.17-3.51), 2.25 (1.21-4.18), 1.86 (1.12-3.09), and 2.04 (1.04-4.01), respectively. Conversely, social and regular drinkers had significantly lower risks of AA than never drinkers [aHRs (95% CIs) 0.65 (0.43-0.98) and 0.49 (0.26-0.93), respectively]., Conclusion: Current smokers had an increased risk of developing AA, while alcohol consumption was associated with a decreased risk of AA.

Background: An association between alopecia areata (AA) and atopic dermatitis (AD) has been reported in previous studies. However, the temporality of this relationship remains unclear based on prior cross-sectional and case-control studies., Objective: This study aimed to investigate the bidirectional association between AA and AD., Methods: Participants were recruited from the National Health Insurance Research Database of Taiwan. In analysis 1, we included 12 022 AA patients and 48 088 matched controls to assess the association between AA and AD risks. In analysis 2, 40 307 AD patients and 161 228 matched controls were included to assess the association between AD and AA risks. A Cox regression model was used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs)., Results: Compared with controls, AA patients had a significantly increased risk of developing AD (aHR: 5.47; 95% CI: 4.76-6.28) after adjustment for potential confounders. Likewise, AD patients had a significantly increased risk of developing AA (aHR: 6.00; 95% CI: 5.04-7.14)., Conclusions: Our study demonstrated a bidirectional association between AA and AD, suggesting that these two diseases may share common pathogenic mechanisms. This finding has implications for follow-up and screening of AA patients for AD and vice versa., (© 2020 John Wiley & Sons Ltd.)

Background: The relationship between alopecia areata (AA) and sleep disorders remains uncertain. This study aims to investigate the bidirectional association between AA and sleep disorders., Methods: To assess the risk of developing sleep disorders, we recruited 5648 patients with AA and 22,592 matched controls from the National Health Insurance Research Database (NHIRD) in Taiwan. Similarly, risk of developing AA was assessed in 93,130 patients with sleep disorders (including 7310 patients with obstructive sleep apnea [OSA] and 85,820 patients with non-apnea insomnia) and 372,520 matched controls. Cox regression model was used for the analysis., Results: AA patients had a significantly increased risk of developing OSA (adjusted hazard ratio [aHR] 3.80; 95% confidence interval [CI] 2.53-5.71) and non-apnea insomnia (aHR 4.20; 95% CI 3.68-4.79). Conversely, presence of sleep disorders significantly increased the risk of AA development (aHR 4.70; 95% CI 3.99-5.54). Both OSA (aHR 3.89; 95% CI 2.46-6.16) and nonapnea insomnia (aHR 4.77; 95% CI 4.03-5.64) were associated an increased risk of developing AA., Conclusions: Patients with AA have a higher risk of developing sleep disorders compared to controls, and vice versa. Further studies are needed to investigate the shared pathogenic mechanism underlying these two conditions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Major depressive disorder (MDD) has been implicated as a risk factor for various immune-related disorders; however, the association between MDD and subsequent autoimmune skin diseases (ASDs) remains unclear. This study aimed to investigate the association of MDD with risk of subsequent ASDs., Methods: Subjects were recruited from the National Health Insurance Research Database in Taiwan. We included 222,522 patients with MDD and 890,088 matched controls to assess the risk of developing ASDs., Results: After controlling for confounders, we found an increased risk of ASDs among the patients with MDD (adjusted hazard ratio [aHR], 10.41; 95% CI, 9.62-11.42) compared to matched controls. Subgroup analyses showed that MDD patients had a significantly increased risk of developing psoriasis (aHR, 12.01; 95% CI, 10.37-13.91), lichen planus (aHR, 11.84; 95% CI, 8.90-15.75), alopecia areata (aHR, 11.61; 95% CI, 9.92-13.59), morphea (aHR, 6.03; 95% CI, 2.47-14.73), autoimmune bullous diseases (aHR, 7.67; 95% CI, 5.94-9.90), hidradenitis suppurativa (aHR, 8.45; 95% CI, 3.61-19.74), vitiligo (aHR, 7.24; 95% CI, 5.65-9.28), lupus erythematosus (aHR, 11.30; 95% CI, 9.21-13.86), systemic sclerosis (aHR, 8.07; 95% CI, 4.30-15.14), Sjogren's syndrome (aHR, 6.71; 95% CI, 5.29-8.50), and dermatomyositis (aHR, 14.44; 95% CI, 5.55-37.55)., Conclusions: Patients with MDD had an increased risk of developing ASDs as compared to the controls. Further studies are needed to better understand the underlying mechanisms., Competing Interests: Declaration of competing Interest No authors of this study have any conflicts of interest, (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Alopecia areata (AA) has long been associated with major depressive disorder (MDD). However, most evidence to date has derived from cross-sectional or case-control studies., Objective: To investigate the bidirectional association between AA and MDD among probands and unaffected siblings., Methods: Study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 2123 probands with AA, 2298 unaffected siblings, and 9192 matched controls to assess the risk of MDD. We included 16,543 probands with MDD, 17,352 unaffected siblings, and 69,408 matched controls to assess the risk of AA. The Breslow-Cox model was used to calculate the adjusted relative risk., Results: Compared with controls, AA probands and unaffected siblings had adjusted relative risks of 8.22 (95% confidence interval [CI], 6.41-10.54) and 2.55 (95% CI, 1.91-3.40), respectively, for MDD. MDD probands and unaffected siblings had adjusted relative risks for AA of 1.66 (95% CI, 1.24-2.22) and 1.64 (95% CI, 1.27-2.12), respectively., Limitation: The National Health Insurance Research Database lacked information on disease severity, body mass index, smoking habit, alcohol consumption, and stressful life events., Conclusion: Our study demonstrated a bidirectional association between AA and MDD among probands and unaffected siblings, thus suggesting shared familial mechanisms underlying AA and MDD., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Patients with severe alopecia areata (AA), including alopecia totalis (AT) and alopecia universalis (AU), are usually resistant to treatment. While tofacitinib is emerging as a promising therapy for severe AA, little is known about its efficacy and safety in Asians. Objectives: To evaluate the efficacy and safety of tofacitinib for treating severe AA. Methods: We included patients with ≥50% scalp hair loss, disease for ≥6 months, and tofacitinib therapy for ≥4 months. The efficacy, evaluated based on the percent change in severity of alopecia tool (SALT) score, and response time, defined as time from baseline to reach >50% improvement in SALT score, were assessed. Results: We included 35 patients (21 with AA, 3 with AT, and 11 with AU). There were 18 men and 17 women (median age: 39 [range: 12–68] years). After 4–24 months of treatment, 74.3% showed clinical response, with 51.4% of the patients achieving ≥50% hair regrowth. Patients with AA showed higher percent change in SALT score than patients with AT/AU (median [interquartile range]: 60.7% [0–98.2] vs. 41.1% [8.9–98.7], P = 0.047). Initial SALT score was negatively associated with the latest percent change in SALT score (P = 0.025). Duration of disease and current episode were positively associated with response time to tofacitinib (P = 0.018 and 0.026, respectively). Patients tolerated tofacitinib well without serious adverse events. Conclusion: Tofacitinib effectively promoted hair regrowth in Asian patients with severe AA. Randomized controlled trials with larger sample size are needed to confirm the long-term efficacy and safety of tofacitinib for treating severe AA. [ABSTRACT FROM AUTHOR]