Skip to main content

Advertisement

SpringerLink
Log in

Patients with alopecia areata show signs of insulin resistance

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Alopecia areata (AA) is an autoimmune disease associated with high levels of proinflammatory cytokines. Since chronic inflammation plays a major role in the pathogenesis of insulin resistance, AA can theoretically increase the risk of diabetes. We sought to investigate this theory by conducting a case–control study. Sixty patients with alopecia areata and 60 healthy volunteers (matched for age, sex, and body mass index) were evaluated. Fasting blood glucose (FBS), C-peptide, plasma insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) were measured for each individual. Plasma levels of insulin [median (interquartile range IQR): 11.22 (7.28–18.15) µIU/ml vs. 4.80 (3.20–9.00), p < 0.0001)], C-peptide [median (IQR): 2.10 (1.61–3.00) ng/ml vs. 1.40 (1.20–1.88), p < 0.0001)] and HOMA-IR [median (IQR): 2.70 (1.58–3.96) µIU/ml vs. 1.01 (0.64–1.98, p < 0.0001)] were significantly higher in patients with AA compared to controls. The differences remained significant even after controlling for age, gender, and BMI. Patients with a more severe disease (alopecia totalis/universalis) had higher levels of insulin [median (IQR): 15.80 (9.68–21.55) vs. 9.30 (5.33–14.40), p = 0.02)] and HOMA-IR [median (IQR): 3.30 (2.20–4.84) vs. 2.15 (1.29–3.52), p = 0.01] compared to those with patchy hair loss. Our data suggest that individuals with AA are at a higher risk of developing insulin resistance. This may be due to common inflammatory pathogenesis or a shared genetic background.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AA:

Alopecia areata

AT:

Alopecia totalis

AU:

Alopecia universalis

HOMA-IR:

Homeostasis model assessment for insulin resistance

IQR:

Interquartile range

References

  1. Boehncke S, Thaci D, Beschmann H, Ludwig RJ, Ackermann H, Badenhoop K, Boehncke WH (2007) Psoriasis patients show signs of insulin resistance. Br J Dermatol 157:1249–1251

    Article  CAS  PubMed  Google Scholar 

  2. Chung CP, Oeser A, Solus JF, Gebretsadik T, Shintani A, Avalos I, Sokka T, Raggi P, Pincus T, Stein CM (2008) Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum 58:2105–2112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Devaraj S, Dasu MR, Jialal I (2010) Diabetes is a proinflammatory state: a translational perspective. Expert Rev Endocrinol Metab 5:19–28

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Donath MY (2014) Targeting inflammation in the treatment of type 2 diabetes: time to start. Nat Rev Drug Discov 13:465–476

    Article  CAS  PubMed  Google Scholar 

  5. Esteghamati A, Ashraf H, Khalilzadeh O, Zandieh A, Nakhjavani M, Rashidi A, Haghazali M, Asgari F (2010) Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007). Nutr Metab 7:26

    Article  CAS  Google Scholar 

  6. Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, Gude F, García F, De Francisco A, Quintela AG (2013) Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord 13:47

    Article  PubMed  PubMed Central  Google Scholar 

  7. Goh C, Finkel M, Christos P, Sinha A (2006) Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol 20:1055–1060

    Article  CAS  PubMed  Google Scholar 

  8. Gonzalez-Gay MA, Gonzalez-Juanatey C, Vazquez-Rodriguez TR, Miranda-Filloy JA, Llorca J (2010) Insulin resistance in rheumatoid arthritis: the impact of the anti-TNF-α therapy. Ann N Y Acad Sci 1193:153–159

    Article  CAS  PubMed  Google Scholar 

  9. Huang KP, Mullangi S, Guo Y, Qureshi AA (2013) Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol 149:789–794

    Article  PubMed  Google Scholar 

  10. Hunt N, McHale S (2005) The psychological impact of alopecia. Bmj 331:951–953

    Article  PubMed  PubMed Central  Google Scholar 

  11. Huvers FC, Popa C, Netea MG, van den Hoogen FH, Tack CJ (2007) Improved insulin sensitivity by anti-TNFα antibody treatment in patients with rheumatic diseases. Ann Rheum Dis 66:558–559

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Karadag AS, Ertugrul DT, Gunes Bilgili S, Takci Z, Tutal E, Yilmaz H (2013) Insulin resistance is increased in alopecia areata patients. Cutan Ocul Toxicol 32:102–106

    Article  CAS  PubMed  Google Scholar 

  13. Karadag AS, Tutal E, Ertugrul DT (2011) Insulin resistance is increased in patients with vitiligo. Acta Dermato Venereol 91:541–544

    Article  CAS  Google Scholar 

  14. Knol MJ, Heerdink ER, Egberts AC, Geerlings MI, Gorter KJ, Numans ME, Grobbee DE, Klungel OH, Burger H (2007) Depressive symptoms in subjects with diagnosed and undiagnosed type 2 diabetes. Psychosom Med 69:300–305

    Article  PubMed  Google Scholar 

  15. Marra M, Campanati A, Testa R, Sirolla C, Bonfigli A, Franceschi C, Marchegiani F, Offidani A (2007) Effect of etanercept on insulin sensitivity in nine patients with psoriasis. Int J Immunopathol Pharmacol 20:731–736

    Article  CAS  PubMed  Google Scholar 

  16. Olefsky JM, Glass CK (2010) Macrophages, inflammation, and insulin resistance. Annu Rev Physiol 72:219–246

    Article  CAS  PubMed  Google Scholar 

  17. Rajabi F, Drake L, Senna M, Rezaei N (2018) Alopecia areata: a review of disease pathogenesis. Br J Dermatol 179:1033–1048

    Article  CAS  PubMed  Google Scholar 

  18. Reddy MPL, Wang H, Liu S, Bode B, Reed JC, Steed RD, Anderson SW, Steed L, Hopkins D, She J-X (2011) Association between type 1 diabetes and GWAS SNPs in the southeast US Caucasian population. Genes Immun 12:208

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Safavi K (1992) Prevalence of alopecia areata in the first national health and nutrition examination survey. Arch Dermatol 128:702

    Article  CAS  PubMed  Google Scholar 

  20. Stunkard AJ, Faith MS, Allison KC (2003) Depression and obesity. Biol Psychiatry 54:330–337

    Article  PubMed  Google Scholar 

  21. Tangvarasittichai S (2015) Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World J Diabetes 6:456

    Article  PubMed  PubMed Central  Google Scholar 

  22. van Asseldonk EJ, van Poppel PC, Ballak DB, Stienstra R, Netea MG, Tack CJ (2015) One week treatment with the IL-1 receptor antagonist anakinra leads to a sustained improvement in insulin sensitivity in insulin resistant patients with type 1 diabetes mellitus. Clin Immunol 160:155–162

    Article  CAS  PubMed  Google Scholar 

  23. Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27:1487–1495

    Article  Google Scholar 

  24. Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter JI (1994) Increased risk for type I (insulin-dependent) diabetes in relatives of patients with alopecia areata (AA). Am J Med Genet 51:234–239

    Article  CAS  PubMed  Google Scholar 

  25. Rajabi F, Amoli MM, Robati RM, Almasi-Nasrabadi M, Jabalameli N, Moravvej H (2019) The Association between Genetic Variation in Wnt Transcription Factor TCF7L2 (TCF4) and Alopecia Areata. Immunological Investigations. https://doi.org/10.1080/08820139.2019.1597109

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammad Shahidi-Dadras, Negin Bahraini & Fateme Rajabi

  2. Network of Dermatology Research (NDR), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Fateme Rajabi

  3. National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran

    Shima Younespour

Authors
  1. Mohammad Shahidi-Dadras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Negin Bahraini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fateme Rajabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shima Younespour
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Negin Bahraini.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Ethical standards

The Ethics Committee of Shahid Beheshti University of Medical Sciences approved this study and the study was conducted according to the latest revision of the Helsinki Declaration.

Informed consent

Written informed consent was obtained from all participants before enrolment.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shahidi-Dadras, M., Bahraini, N., Rajabi, F. et al. Patients with alopecia areata show signs of insulin resistance. Arch Dermatol Res 311, 529–533 (2019). https://doi.org/10.1007/s00403-019-01929-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-019-01929-6

Keywords

Search

Navigation