Can Someone with AA Also Have Vitiligo, and Have Both Occur in the Same Location? Almost Never — Which is the Reason for This Report
Basic science and clinical investigations about alopecia areata take place in many countries around the world and are often a collaborative effort. The article of interest in this issue of Virtual Lunch is co-authored by hair researchers from Ireland and Israel. It was published in the International Journal of Trichology, the official Journal of the Hair Research Society of India (the only country to have a journal devoted exclusively to hair).
An Extraordinary Colocalization of Alopecia Areata and Vitiligo* is interesting not only because it affirms that there are many unanswered questions about AA, but also because it shows that a very rare clinical observation can stimulate further discussion.
Autoimmune disorders such as alopecia areata have a strong genetic component, so there is a higher chance of someone with AA being in the same gene pool as people with other autoimmune conditions. It’s also possible for a person to have more than one of these conditions — in fact, we were fortunate to have someone like that attend a BGDL event. This lovely woman, who I hope is reading this, shared with us what it was like to be black and have both AA and vitiligo, a condition characterized by white or hypopigmented skin, most often on the hands, forearms, feet and face.
While these conditions are known to occur in the same patient, it is very rare to see both conditions affect the same anatomic location on the same patient. The few prior published cases (with the first going back more than 100 years) occurred in childhood and adolescence. The authors of this article observed the colocalization in the rare case of a 60-year-old female.
It is widely believed today that both AA and vitiligo have autoimmune disease pathways, though the exact causes are unknown. The authors point out that while most earlier reports of colocalization have emphasized what’s common to both disease mechanisms, they are taking a slightly different view. They are factoring in the large inconsistencies in the reporting of how much AA and other autoimmune diseases such as vitiligo show up in the same patient.
Putting it all together, they are postulating that maybe, just maybe, the pathways are really different and that’s why colocalization of alopecia areata and vitiligo is so rare. Or that it’s merely coincidence when it does happen. Or, that contrary to much of today’s reporting, that autoimmunity is not responsible for all the cases of AA or vitiligo.
Clearly this study raises more questions than it answers, and more work remains to be done. Once again, we’re reminded that there are many pieces to the puzzle that is alopecia areata.
* Int J Trichology. 2010 Jul-Dec; 2(2): 108-109 Yuval Ramot, Elena Thomaidou,1 Alexander Mali,2 and Abraham Zlotogorski
