Alopesi areata ile çölyak hastalığı birlikteliği

Amaç: Alopesi areata ani gelişen, saç, sakal, kirpik, kaş veya tüm vücut kıllarını tutabilen, skar yapmayan, lokal veya diffüz kıl kaybıyla giden, T hücre aracılı otoimmün bir hastalıktır. Alopesi areata birçok otoimmün hastalıkla birlik- te görülebilir. Sık görülenler atopi, otoimmün tiroidit ve vitiligodur. Alopesi areata çölyak hastalığı ilişkisini araştı- ran yayınlar az sayıdadır, sonuçları çelişkilidir ve birçoğu anektodal olgu sunumu şeklinde olup büyük çaplı araştır- ma azdır. Yöntem ve Gereçler: Bu araştırmada, 1 Haziran 2007-31 Mayıs 2008 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi 1. Dermatoloji Kliniği’nde alopesi areata tanısı alan 103 olgu çalışmaya alındı. Eşlik eden has- talıklar ve aile öyküsünü de içeren geniş bir anamnez alınarak, olgular detaylı bir dermatolojik muayeneden geçiril- di. Olguların periferik kan örnekleri antiendomisyal ve antitransglutaminaz antikorlar(IgA ve IgG) için ELİSA yön- temiyle değerlendirildi. Bulgular: Olguların 66’sı erkek, 37’si kadın olup, yaş ortalamaları 28,92±10.6 idi. 97’’si yama tipi alopesi areata olan olguların, 3’ü alopesi universalis, 3’ü ophiazis olarak değerlendirildi. 24 olguda atopi, 2 olguda vitiligo, 1 olguda di- yabet, 1 olguda sistemik lupus eritematozus eşlik ettiği görüldü. Olguların 18’inde aile öyküsü vardı. Olguların hiç- birinde antiendomisyal ve antitransglutaminaz antikor pozitifliğine rastlanmadı. Sonuç: Bu çalışmada alopesi areata ile çölyak hastalığı arasında bir birliktelik saptanamadı ancak toplumda çölyak hastalığı prevalansının %0.6-%1.15 arasında değiştiği gözönüne alındığında, iki hastalık arasındaki ilişkinin netleşebilmesi için daha geniş gruplarda ya- pılacak yeni çalışmalara gerek vardır. .

The association between alopecia areata and celiac disease

Aim: Alopecia areata is a T-cell mediated autoimmune disease characterized by sudden localised loss of scalp, beard, eyebrows or total body hairs. Alopecia areata is often associated with other autoimmune diseases such as atopy, autoimmune thyroiditis, vitiligo. There are few large sampled studies and case reports related to alopecia areata and celiac disease in the literature. The purpose of this study was to determine the association between alopecia areata and celiac disease. Material and Methods: The sample of the study was 103 alopecia areata patients diagnosed in the Ankara Numune Hospital, 1.Dermatology Clinic in between 1 June 2007-31 May 2008. The medical history of the patients, associated diseases and patient’s family history were taken from all patients and they were evaluated dermatologically by means of total physical examination. Peripheral blood samples of the patients were also evaluated for anti-endomysial and anti-transglutaminase antibodies by ELISA. Results: Sixty six of the patients were male and 37 of the patients were female with a mean age of 28,92 ± 10.6. The results of the study show that patchy alopecia was seen in 97 of the patients, 3 of the patients had been diagnosed with alopecia universalis and 3 of them had been dignosed with ophiasis. The following diseases were identified among the participating patients: atopy (24 patients), vitiligo (2 patients), diabetes mellitus (1 patient), and systemic lupus erythematosus (1 patient). Moreover, 18 of the patients had displayed positive family history. None of the patients had anti-endomysial and anti-transglutaminase antibodies. Conclusion: In this study, no association could be found between alopecia areata and celiac disease .But when it is considered that the prevalance of the celiac disease in the population is between 0.6% and 1.15%, larger sampled studies are needed in order to confirm the association between the alopecia areata and celiac disease .

PDF

___

1. Bolognia JL, Jorizzo JL, Rapini RP. Alopecia areata. Dermatology, 2ndedition, MOSBY Elsevier, 2008, Vol.1: 987.
2. James WD, Berger TG, Elston DM. Alopecia areata. Andrews’ Diseases of The Skin, Clinical Dermatology, 10th edition.Elsevier Inc. 2006: 749-752.
3. Paus R, Olsen EA, Messenger AG. Hair Growth Disorders, Alopecia Areata in: Fitzpatrick’s Dermatology in General Medicine, 7th Edition, 2008.Vol:1: 762-764.
4. Price VH, Hordinsky MK, Olsen EA, Roberts JL, Siegfried EC, Rafal ES, Korman NJ, Altrabulsi B, Leung HM, Garovoy MR, Caro I, Whiting DA. Subcutaneous efalizumab is not effective in the treatment of alopecia areata. J Am Acad Dermatol. 2008 Mar;58(3): 395-402.
5. Kavak A, Yeşildal N, Parlak A, Gökdemir G, Aydoğan I, Anul H, Baykal C. Alopecia areata in Turkey: demographic and clinical features. J Eur Acad Dermatol Venereol. 2008 Aug;22(8):977-981.
6. Tan E, Tay YK, Goh CL, Chin Giam Y.The pattern and profile of alopecia areata in Singapore--a study of 219 Asians.Int J Dermatol. 2002 Nov;41(11):748-753.
7. Ahmed I, Nasreen S, Bhatti RJ.Alopecia areata in children.Coll Physicians Surg Pak. 2007 Oct;17(10):587-590.
8. Kakourou T, Karachristou K, Chrousos G. A case series of alopecia areata in children: impact of personal and family history of stress and autoimmunity. J Eur Acad Dermatol Venereol. 2007 Mar;21:356-359.
9. Treem WR, Veligati LN, Rotter JI, Targan SR, Hyams JS.Ulcerative colitis and total alopecia in a mother and her son. Gastroenterology. 1993 Apr;104(4):1187-1191.
10. Wengraf DA, McDonagh AJ, Lovewell TR et al.Genetic analysis of autoimmune regulator haplotypes in alopecia areata.Tissue Antigens. 2008 Mar;71(3):206-212.
11. Collins SM, Dominguez M, Ilmarinen T, Costigan C, Irvine AD.Dermatological manifestations of autoimmune polyendocrinopathy- candidiasis-ectodermal dystrophy syndrome. Br J Dermatol. 2006 Jun;154(6):1088-1093.
12. Suzuki S, Shimoda M, Kawamura M et al. Myasthenia gravis accompanied by alopecia areata: clinical and immunogenetic aspects. Eur J Neurol. 2005 Jul;12(7):566-570.
13. Sukhjot S, Sharma VK, Kumar L, Kumar B.Atopy and alopecia areata in North Indians.Indian J Dermatol Venereol Leprol. 2001 Sep-Oct;67(5):231-233.
14. Martis J, Bhat R, Nandakishore B, Shetty JN. A clinical study of vitiligo.Indian J Dermatol Venereol Leprol. 2002 Mar- Apr;68(2):92-93.
15. Sharma VK, Dawn G, Kumar B.Profile of alopecia areata in Northern India.Int J Dermatol. 1996 Jan:22-27.
16. Yang S, Yang J et al.The genetic epidemiology of alopecia areata in China. Br J Dermatol. 2004 Jul:16-23.
17. O.Braun-Falco, G.Plewig, H.H.Wolff, W.H.C. Alopecia areata. Burgdorf Dermatology, Second Completely Revised Edition, Springer, 2000, Syf: 1100-1140.
18. Rashtak S, Pittelkow MR. Skin involvement in systemic autoimmune diseases.Curr Dir Autoimmun. 2008;10:344-358.
19. Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore--a study of 219 Asians.Int J Dermatol. 2002 Nov;41(11):748-753.
20. Fessatou S, Kostaki M, Karpathios T. Coeliac disease and alopecia areata in childhood.J Paediatr Child Health. 2003 Mar;39(2):152- 154.
21. Storm W. Celiac disease and alopecia areata in a child with Down's syndrome.J Intellect Disabil Res. 2000 Oct;44 (Pt 5):621-623.
22. Bardella MT, Marino R, Barbareschi M, Bianchi F, Faglia G, Bianchi P. Alopecia areata and coeliac disease: no effect of a glutenfree diet on hair growth.Dermatology. 2000;200(2):108-110.
23. Kaukinen K, Collin P, Mykkänen AH, Partanen J, Mäki M, Salmi J. Celiac disease and autoimmune endocrinologic disorders.Dig Dis Sci. 1999 Jul;44(7):1428-1433.
24. Corazza GR, Andreani ML, Venturo N et al. Celiac disease and alopecia areata: report of a new association. Gastroenterology. 1995 Oct;109(4):1333-1337.
25. Goh C, Finkel M, Christos PJ, Sinha AA. Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history.J Eur Acad Dermatol Venereol. 2006 Oct;20(9):1055-1060.
26. Kavak A, Yeşildal N, Parlak A ve ark. Alopecia areata in Turkey: demographic and clinical features.J Eur Acad Dermatol Venereol. 2008 Apr 1:1-5.
27. Erdem T, Akdeniz N, Altuntaş İ, Aktaş E. Thyroid hormones and thyroid antibodies in patients with alopecia areata.T Klin J Dermatol 1999;9:197-199.
28. Seyrafi H, Akhiani M et al A Evaluation of the profile of alopecia areata and the prevalence of thyroid function test abnormalities and serum autoantibodies in Iranian patients.BMC Dermatol 2005;31(5):11
29. Müller SA, Winkelman RK. Alopecia areata.Arch Dermatol 1963; 88: 290-297.
30. Ahmed I, Nasreen S, Bhatti R.Alopecia areata in children.J Coll Physicians Surg Pak. 2007 Oct;17(10):587-590.
31. Assouly P, Reygagne P, Jouanique C et al. Intravenous pulse methylprednisolone therapy for severe alopecia areata: an open study of 66 patients.Ann Dermatol Venereol. 2003 Mar;130(3):326-330.
32. Kasumagić-Halilović E, Prohić A. Association between alopecia areata and atopy. Med Arh. 2008;62(2):82-84.
33. Godkin A, Jewell D. The pathogenesis of celiac disease. Gastroenterology. Jul 1998; 115(1):206-210.
34. Tursi A, Giorgetti G et al. Prevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation.Hepatogastroenterology. 2001 Mar- Apr;48(38):462-464.
35. Neuhausen SL, Steele L, Ryan S et al. Co-occurrence of celiac disease and other autoimmune diseases in celiacs and their firstdegree relatives. J Autoimmun. 2008 Sep;31(2):160-165.
36. Leffler DA, Kelly CP. Update on the evaluation and diagnosis of celiac disease. Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):191-196.
37. Roka V, Potamianos SP, Kapsoritakis AN et al. Prevalence of coeliac disease in the adult population of central Greece.Eur J Gastroenterol Hepatol. 2007 Nov;19(11):982-987.
38. Altintas A, Pasa S, Cil T, Bayan K, Gokalp D, Ayyildiz O. Thyroid and celiac diseases autoantibodies in patients with adult chronic idiopathic thrombocytopenic purpura.Platelets. 2008 Jun;19(4):252-257.
39. Ertekin V, Selimoğlu MA, Kardaş F, Aktaş E. Prevalence of celiac disease in Turkish children.J Clin Gastroenterol. 2005 Sep;39(8):689-691.
40. Gursoy S, Guven K, Simsek T et al.The prevalence of unrecognized adult celiac disease in Central Anatolia.J Clin Gastroenterol. 2005 Jul;39(6):508-511.
41. Tatar G, Elsurer R, Simsek H et al.”Screening of tissue transglutaminase antibody in healthy blood donors for celiac disease screening in the Turkish population. ”Dig Dis Sci. 2004 Sep;49(9):1479-1484.
42. Türkiye diyabet epidemiyolojisi çalışması. www.sanofi-aventis. com.tr/l/tr/tr/ download.jsp? file=074BD922-0CFD-470E-BC53- B98E8FA2BC20.pdf