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 dietitian through the Dietitians
Association of
©
Sue Dengate update January 2007
