PCOS and the Risk of Alopecia Areata

Patients with PCOS May Have a Three Fold increased Risk for Alopecia Areata

Polycystic ovary syndrome (PCOS) is a common endocrine condition in women. In fact, up to 10-15 % of women of child-bearing age have PCOS. Women present with irregular periods, infertility, acne, hirsutism and sometimes androgentic alopecia.

There is emerging evidence that women with PCOS are at risk for some autoimmune diseases. In fact, a 2018 meta-analysis that we reviewed in the past suggested that women with PCOS have a 2 to 4 fold increased risk of autoimmune thyroid disease.

Whether women with PCOS are at increased risk for the autoimmune mediated hair loss condition alopecia areata has only recently started to be carefully explored.

In 2017, Ranasinghe and colleagues showed women with PCOS frequently had androgen excess and many women with androgen excess had a diagnosis of PCOS. In fact, the researchers noted that androgen excess/PCOS was the most common dysfunction identified in 220 patients with AA and all subtypes 42.5% (n=96) (p<0.001). It should be noted that the 2017 Ranasinghe study was not designed to evaluate the magnitude of increased risk for androgen excess or PCOS in patients with alopecia areata.

Overall, the researchers noted that androgen excess/PCOS was the most common dysfunction identified in 220 patients with AA and all subtypes 42.5% (n=96) (p<0.001).

Is the Risk of Alopecia Areata Increased in PCOS?

Researchers from Taiwan set out to evaluate whether patients with PCOS are at increased risk of having a diagnosis of alopecia areata. Their retrospective cohort study compared 10 967 patients with PCOS to 43 868 matched controls. Individuals with PCOS were found to have a 3 fold increased risk of having a diagnosis of alopecia areata (adjusted HR, 3.12; 95% CI, 1.81–5.40; P < 0.001).

Conclusion

This is an interesting study which complements the growing body of literature suggesting that a proportion of women with alopecia areata may have androgen excess and PCOS. This particular study gives us a number - suggesting that women with PCOS have a three fold increased risk of having a diagnosis of alopecia areata.

This study is important as it draws attention to these potential links. Female patients with alopecia areata need to be asked about acne, irregular periods, hirsutism, infertility just like all women with hair loss do! Women with alopecia areata age 16-45 who have regular periods and do not have acne, hirsutism or known infertility do not generally need extensive work ups. However women with alopecia areata age 16-45 who do not have regular menstrual cycles or have acne, hirsutism or infertility should have appropriate screening to rule out androgen excess and PCOS.

REFERENCE

Chang et al. Increased risk of alopecia areata among patients with polycystic ovary syndrome: A population-based cohort study. J Dermatol. 2021 Feb;48(2):242-244.

Romitti et al. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocr Connect. 2018 Oct 26;7(11):1158-1167.

Ranasinghe GC, Piliang M, Bergfeld W (2017) Androgen Excess in Alopecia Areata, an Unexpected Finding. Med J Obstet Gynecol 5(3): 1104.