Altered Immune System Function Leads to Increased Risk of Alopecia Areata in Down Syndrome

It’s well known that patients with Trisomy 21 (Down syndrome) are at increased risk for a variety of immune mediated and autoimmune mediated medical conditions.

Dermatological Conditions that may be more common in Down Syndrome include:

1. Dry Skin and Ichthyosis

2. Keratosis pilaris

3. Pityriasis rubra pilaris

4. Elastosis perforans serpiginosa

5. Seborrheic Dermatitis

6. Palmoplantar keratoderma

7. Psoriasis

8. Cafe au lait macules

9. Lumbosacacral dermal melanosis

10. Syringomas

11. Geographic tongue

12. Angular cheilitis

13. Vitiligo

14. Alopecia areata

15. Fungal infections

16. Folliculitis

17. Lichen nitidus

18. Hidradenitis

19. Blood disorders

Alopecia Areata In Patients with Trisomy 21

I read with interest a recent study that examined the prevalence of different immune related diagnoses in a cohort of 1299 patients with Down syndrome compared to a 2605 patient control cohort at the Mount Sinai Health System in New York, NY. The evaluation spanned about 18 years of data. Individuals with trisomy 21 had a six fold higher odds of alopecia areata compared to controls (OR 6.06, p = 0.01).

Other conditions that were increased in alopecia areata included sepsis (OR 4.79, p < 0.001), purpura and other hemorrhagic conditions (OR 2.31, p < 0.001), rosacea (OR 3.11, p < 0.001). In this particular study, there was a lower odds of a diagnosis of herpesviral infection (OR 0.42, p = 0.01), and viral warts (OR 0.51, p = 0.04).

Comment and Summary

It’s well known that the immune system functions slightly differently in patients with Trisomy 21 compared to controls. Past studies have highlighted several skin issues that are more common in patients with Trisomy 21. Alopecia areata is more common in patients with Trisomy 21 and past studies have put the number at around 10 % (compared to 2 % in the general population). This study by Gansa et al agrees with the general trend of prior data. Alopecia areata in patients with Down Syndrome tends to give more hair loss than seen in patients without Down syndrome.

REFERENCE

Gansa W et al. Dysregulation of the Immune System in a Natural History Study of 1299 Individuals with Down Syndrome. J Clin Immunol. 2024 May 22;44(6):130. doi: 10.1007/s10875-024-01725-6.