FOOD INTOLERANCE NETWORK
SYMPTOM DISCUSSION
Alopecia areata (patchy baldness) and
the gluten connection
Alopecia is
loss of hair. Three types are distinguished:
• alopecia areata (patchy baldness)
• alopecia totalis (complete loss
of hair on the scalp)
• alopecia univeralis
(complete loss of hair on the entire body)
A reader
wrote: "Around the age of about 10 months, my daughter went completely
bald from Alopecia Areata (she lost all hair on her head, eyebrows and eye lashes),
but fortunately the hair started to grow back around 19 or 20 months. However,
we are very disappointed to discover the alopecia appears to be returning as a
bald patch has recently appeared on the top of her head. Are you aware of any
foods or additives which may have triggered this condition?"
The
connection between alopecia areata and coeliac disease (CD) is not yet well
known by western medicine, but a number of failsafers have reported recovery
due to a gluten- free diet (GF), see medical articles and reader stories below.
What the medical journals say
1. First report of the association
between CD and alopecia areata (from
Corazza
GR and others, Gastroenterology, Celiac disease and alopecia areata: report of
a new association,1995 ;109(4):1333-7.
Abstract: Celiac disease is frequently
associated with other autoimmune disorders but has never been reported in
association with alopecia areata. In a routine clinical practice, 3 patients
with such an association were observed. In one of the patients, celiac disease
was diagnosed after the occurrence of malabsorption symptoms. In the youngest
patient, a 14-year-old boy, gluten-free diet resulted in complete regrowth of
scalp and body hair. A prospective screening program for celiac disease using antigliadin and antiendomysial
antibodies was therefore set up in 256 consecutive outpatients with alopecia
areata. Three patients, all completely asymptomatic for intestinal diseases,
were found to be positive and underwent biopsy. Histological analysis showed a
flat intestinal mucosa consistent with the diagnosis of celiac disease. The
results show that alopecia areata may constitute the only clinical
manifestation of celiac disease and that the association between these two
conditions is a real one because the observed frequency of association is much
greater than can be expected by chance. It is suggested that antigliadin and antiendomysial
antibodies should be included in the work-up of patients with alopecia areata.
2. Down Syndrome, alopecia areata and coeliac disease - a report from
Storm W,
Celiac disease and alopecia areata in a child with Down's syndrome, J Intellect
Disabil Res, 2000;44 ( Pt
5):621-3.
Abstract: According to recent reports in the
literature, there seems to be an association between alopecia areata and celiac
disease. The present author describes a 9-year-old girl with Down's syndrome,
and alopecia areata, and documented celiac disease, who displayed a normal
growth of hair after a gluten-free diet. Given the high prevalence of these two
diseases in patients with Down's syndrome, the present author recommends both
serological screening for celiac disease in every individual with Down's
syndrome, and in particular, the inclusion of such screening in any diagnostic
work-up for alopecia areata.
3. Two case histories from
Fessatou
S and others, Coeliac disease and alopecia areata in childhood, J Paediatr Child Health, 2003;39(2):152-4.
Abstract: Coeliac disease is a genetic, immunologically mediated small bowel enteropathy that
causes malabsorption. The immune inflammatory response to gluten frequently
causes damage to many other tissues of the body. We report the association of
coeliac disease and alopecia areata in two children, a 13-year-old girl and a
29-month-old girl. Both of our patients had immunoglobulin A (IgA) class endomysial antibodies, IgA and immunoglobulin G (IgG) antigliadin antibodies and subtotal villous atrophy on
jejunal biopsy. Administration of a gluten-free diet to our patients resulted
in complete hair growth and improved the gastrointestinal symptoms.
4. Five alopecia areata cases from
Abstract: BACKGROUND: An association between
alopecia areata (AA) and coeliac disease has recently been reported. AIM: The
aim of this paper was to evaluate the possible effect of a gluten-free diet
(GFD) on the new growth of hair in 5 alopecic patients with CD. METHODS: CD was
diagnosed in 5 patients with AA (universalis in 3 cases and patchy in 2 cases).
The diagnosis of CD was based on serological and histological standard
criteria. RESULTS: In all patients the GFD resolved CD clinically,
serologically and histologically but had no effect on
the course of alopecia. CONCLUSION: AA and CD, when associated, present
different responses to a GFD and have an independent course.
5.
An alopecia areata case in
Viola F and
others, Reappearance of alopecia areata in a coeliac patient during an
unintentional challenge with gluten [Article in Italian], Minerva Gastroenterol Dietol, 1999 ;45(4):283-5.
Abstract: A patient with coeliac disease
presenting alopecia areas as the only symptom is described. Alopecia
disappeared completely after a few months of strict gluten free diet and
reappeared after an unintentional prolonged introduction of gluten. After a severe gluten free diet, a new and persistent hair growth
in the alopecia areas was observed. The possibility a direct relationship in
some cases, between coeliac disease and alopecia areata is confirmed.
6. Dermatitis herpetiformis and
alopecia may both be skin manifestations of coeliac disease
Collins P
and others, Recognition and management of the cutaneous manifestations of
celiac disease: a guide for dermatologists, Am J Clin
Dermatol, 2003;4(1):13-20.
Abstract: In celiac disease, the ingestion of
gluten-containing cereals, such as wheat, rye, and barley, results in
small-bowel mucosal inflammation and villous atrophy with crypt hyperplasia.
The prevalence of the condition may be as high as 1% in the adult population.
The disease can also embrace various extraintestinal
manifestations, of which dermatitis herpetiformis is the best known. Earlier,
dermatitis herpetiformis was considered a skin disease occurring often
concomitantly with celiac disease. At present, a body of evidence shows that
dermatitis herpetiformis is a cutaneous manifestation of celiac disease, and
affects approximately 25% of patients with celiac disease. Both conditions can
appear in the same family and are closely linked to HLA class II locus in
chromosome 6; 90% of patients have HLA DQ2 and, almost all the remainder, HLA
DQ8. All patients with dermatitis herpetiformis have at least some-degree of
mucosal inflammation or lesion consistent with celiac disease. The etiology of celiac disease in not fully understood, but
tissue transglutaminase seems to be the predominant autoantigen both in the intestine and the skin. Serum
antibodies against tissue transglutaminase can be
used in the serologic screening and follow-up of dietary compliance of patients
with celiac disease. Gluten-free diet is essential in the treatment of both
conditions, and oral dapsone is usually needed in newly detected dermatitis
herpetiformis in order to alleviate symptoms. Oral mucosal lesions, alopecia
areata, and vitiligo probably occur more frequently in patients with dermatitis
herpetiformis than in the general population. By contrast, the reported
association of celiac disease with psoriasis seems to be coincidental.
Reader
Stories
[547] Patchy baldness and the
gluten connection – reader’s stories (April 2007)
Allergy clinic didn't know
about connection: I recently had my appointment with
the Allergy Clinic and they didn't know anything about the connection that your
website mentions between gluten intolerance and alopecia. I first had alopecia
back in 1995 very badly and I do remember my diet being very poor and high in
wheat and gluten products, I have only been told that it was probably caused by
stress but am interested to learn more. I have had small patches ever since,
and my general intake of wheat has been much lower than in 1995. I am now doing
the elimination diet for the second time and it has been going better. I failed
the wheat challenge on the 3rd night and am interested in the connection with
alopecia to gluten as I still have some joint, lethargy and lack of focus
issues.
Discovered the cause of
alopecia areata by accident: I
suffered from alopecia areata on and off for many
years without having any clue about what caused it. It was very embarrassing
and difficult for my self confidence. I only stumbled across the answer by
accident after I found out about bread preservative 282 - that was where my
journey started. I was staying with people who ate preserved bread so it was
easier for me to eat rice cakes instead, and I noticed my alopecia improving. I
have been gluten free now for three years and have had no more problems with
alopecia.
Led to
diagnosis of coeliac disease: Your mention of alopecia areata and gluten in "Fed Up" led to my being
diagnosed with coeliac disease. No one else seemed to know
anything about it, so I really wanted to say thank you. It has led to a huge
improvement in my quality of life.
Another association besides
stress: The information on your website about alopecia areata and gluten is the first bit of useful advice I have
received suggesting that alopecia could have another association besides
stress.
We welcome more reader reports on
this topic
Coeliac
disease is a serious condition, see www.coeliac.org
The information given is not intended
as medical advice. Always consult with your doctor for underlying illness.
Before beginning dietary investigation, consult a dietician with an interest in
food intolerance. You can find a supportive dietitan
through the Dietitians Association of
© Sue Dengate update January 2007
