ALOPESİ AREATA HASTALARINDA METABOLİK SENDROMUN DEĞERLENDİRİLMESİ

AMAÇ: Alopesi areata AA hastalarında diabetes mellitus sıklığının ve insülin direncinin arttığı bildirilmiştir. Androgenetik alopeside metabolik sendrom MetS sıklığının arttığı bilinmesine rağmen, alopesi areatada bilgilerimiz kısıtlıdır. Bu çalışmanın amacı AA ile MetS arasındaki ilişkiyi araştırmaktır.GEREÇ VE YÖNTEMLER: Bu çalışma 66 AA’lı hasta ve 60 yaş-cinsiyet uyumlu kontrol içeren olgu-kontrol çalışmasıdır. Hasta ve kontrollerin demografik, klinik ve laboratuvar özellikleri karşılaştırıldı. Göreceli olasılıklar oranı OR lojistik regresyon analizi kullanılarak değerlendirildi. Korelasyon için Pearson veya Spearman testleri kullanıldı.BULGULAR: MetS, AA’sı olan 12 %18.2 ve olmayan 10 %16.7 katılımcıda tespit edildi p=0.87 . MetS için, yaş 1.3 kat çok değişkenli analizde bağımsız risk faktörü olarak bulundu Yaş: p=0.001, TRR %95 GA = 1.3 1.1-1.6 . Yaş ile MetS arasında orta derece pozitif korelasyon bulundu r=0.56, p=0.01 .SONUÇ: Çalışmamızda AA hastalarında MetS gelişmesi ile ilgili artmış bir risk saptanmadı. Alopesi areatanın sistemikten ziyade lokal tutulum yapması bu sonuçta etkili olabilir. MetS gelişme riski yaşla birlikte artmaktadır. Bizim çalışmamızda yaşta artış MetS gelişmesi açısından en önemli bağımsız faktördü. Lokal tutulumu olan, hastalık süresi kısa, yeni tanı genç hastalardan ziyade yaygın tutulumu olan, uzun hastalık süresine sahip ileri yaşta ki AA hastalarında MetS taramalarının yapılmasının genel olarak MetS’un erken tanısı ve mortalite-morbiditesinin azaltılmasında daha faydalı olacağını düşünmekteyiz

Anahtar Kelimeler:

alopesi areata, metabolik sendrom, risk faktörleri

EVALUATION OF METABOLIC SYNDROME IN PATIENTS WITH ALOPECIA AREATA

OBJECTIVE: The increase of diabetes mellitus prevelance and insulin resistance have been reported in patients with alopecia areata AA . Despite androgenetic alopecia as a potential condition for MetS, our knowledge for MetS is limited in alopecia areata AA . The aim of this study is to investigate the association between MetS and AA.MATERIAL AND METHODS: This study is a case-control study including 66 patients with AA and 60 age and gender-matched controls. Demographic, clinical and laboratory features of patients and controls were compared. Odds ratios OR were estimated using a logistic regression analysis. Pearson or Spearman test were used for correlation.RESULTS: MetS was identified in 12 18.2% subjects with AA and 10 16.7% subjects without AA p=0.87 . For metabolic syndrome, age 1.3 fold was found as independent risk factors in a multivariate analysis Age: p=0.001, OR 95% CI = 1.3 1.1-1.6 . Positive moderate correlation was found between age and presence of metabolic syndrome r=0.56, p=0.01 .CONCLUSION: The increased risk of MetS development in patients with AA was not determined in our study. Local involvement of AA rather than systemic involvement may be effective on this result. Development risk of MetS has been increasing with age. In our study, increase in age was the most significant independent risk factor for the development of MetS. We believe that screening of elders with disseminated involvement and long duration of disease rather than youngers with local involvement and short duration of disease would be more useful for early diagnosis and reduction in morbidity and mortality of MetS in AA

Keywords:

alopecia areata, metabolic syndrome, risk factors,

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1)Rigopoulos D, Larios G, Katsambas A, Skin signs of sys- temic diseases. Clin Dermatol. 2011; 29: 531-40.
2)Franks AG, Jr, Skin manifestations of internal disease. Med Clin North Am. 2009; 93: 1265-82.
3)Napolitano M, Megna M, Monfrecola G, Insulin resis- tance and skin diseases. ScientificWorldJournal. 2015; 2015
4)Alkhalifah A, Alopecia areata update. Dermatol Clin. 2013; : 93-108.
5)Muller SA, Winkelmann RK, Alopecia Areata. An Evalua- tion of 736 Patients. Arch Dermatol. 1963; 88: 290-7.
6)Karadag AS, Ertugrul DT, Bilgili SG, Takci Z, Tutal E, Yil- maz H, Insulin resistance is increased in alopecia areata pa- tients. Cutan Ocul Toxicol. 2013; 32: 102-6.
7)Kavak A, Baykal C, Ozarmagan G, Akar U, HLA in alope- cia areata. Int J Dermatol. 2000; 39: 589-92.
8)Olsen EA, Investigative guidelines for alopecia areata. Der- matol Ther. 2011; 24: 311
9)Grundy SM, Cleeman JI, Daniels SR, et al, Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scien- tific Statement. Circulation. 2005; 112: 2735-52.
10) Taniguchi CM, Emanuelli B, Kahn CR, Critical nodes in signalling pathways: insights into insulin action. Nat Rev Mol Cell Biol. 2006; 7: 85-96.
11)Buerger C, Richter B, Woth K, et al, Interleukin-1beta interferes with epidermal homeostasis through induction of insulin resistance: implications for psoriasis pathogenesis. J Invest Dermatol. 2012; 132: 2206-14.
12) Hotamisligil GS, Inflammation and metabolic disorders. Nature. 2006; 444: 860-7.
13) Acibucu F, Kayatas M, Candan F, The association of insu- lin resistance and metabolic syndrome in early androgenetic alopecia. Singapore Med J. 2010; 51: 931-6.
14) Arias-Santiago S, Gutierrez-Salmeron MT, Buendia-Eis- man A, Giron-Prieto MS, Naranjo-Sintes R, A comparative study of dyslipidaemia in men and woman with androgenic alopecia. Acta Derm Venereol. 2010; 90: 485-7.
15)Gonzalez-Gonzalez JG, Mancillas-Adame LG, Fernan- dez-Reyes M, et al, Androgenetic alopecia and insulin resis- tance in young men. Clin Endocrinol (Oxf). 2009; 71: 494-9.
16)Oguz O, Alopesi Areata. Türkderm-Deri Hastalıkları ve Frengi Arşivi Dergisi. 2014; 48: 40-4.
17) Gönül M, Gul Ü, Pişkin E, et al, Alopesi Areatalı Hasta- ların Geriye Dönük Değerlendirilmesi. Turk J Dermatol. ; 5: 43-7. ) Ishak RS, Piliang MP, Association between alopecia areata, psoriasis vulgaris, thyroid disease, and metabolic syn- drome. J Investig Dermatol Symp Proc. 2013; 16: S56-7.
18) Boniface K, Blom B, Liu YJ, de Waal Malefyt R, From interleukin-23 to T-helper 17 cells: human T-helper cell dif- ferentiation revisited. Immunol Rev. 2008; 226: 132-46.
19)Gilhar A, Paus R, Kalish RS, Lymphocytes, neuropeptides, and genes involved in alopecia areata. J Clin Invest. 2007; : 2019-27.
20)Wisse BE, The inflammatory syndrome: the role of adi- pose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol. 2004; 15: 2792-800.
21)Arca E, Musabak U, Akar A, Erbil AH, Tastan HB, Inter- feron-gamma in alopecia areata. Eur J Dermatol. 2004; 14: 6.
22)Teraki Y, Imanishi K, Shiohara T, Cytokines in alopecia areata: contrasting cytokine profiles in localized form and extensive form (alopecia universalis). Acta Derm Venereol. ; 76: 421-3. )Hoffmann R, The potential role of cytokines and T cells in alopecia areata. J Investig Dermatol Symp Proc. 1999; 4: 235-8.
23)Hoffmann R, Wenzel E, Huth A, et al, Cytokine mRNA levels in Alopecia areata before and after treatment with the contact allergen diphenylcyclopropenone. J Invest Dermatol. ; 103: 530-3.