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LETTER TO EDITOR
Year : 2020  |  Volume : 21  |  Issue : 1  |  Page : 77-78

Underlying celiac disease in children with alopecia areata: An association


1 Department of Pediatrics, Government Medical College, Amritsar, Punjab, India
2 Department of Ophthalmology, Civil Hospital, Amritsar, Punjab, India
3 Medical Officer, Mrs. Khushbir Kalra Memorial Hospital, Amritsar, Punjab, India

Date of Submission28-Jun-2019
Date of Decision30-Sep-2019
Date of Acceptance27-Nov-2019
Date of Web Publication24-Dec-2019

Correspondence Address:
Dr Riya Kaur Kalra
129-A, Race Course Road, Opposite Adlakha Hospital, Amritsar - 143 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_66_19

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How to cite this article:
Aggarwal S, Aggarwal S, Kalra RK. Underlying celiac disease in children with alopecia areata: An association. Indian J Paediatr Dermatol 2020;21:77-8

How to cite this URL:
Aggarwal S, Aggarwal S, Kalra RK. Underlying celiac disease in children with alopecia areata: An association. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Jan 21];21:77-8. Available from: http://www.ijpd.in/text.asp?2020/21/1/77/273836



Sir,

Celiac disease (CD) is an autoimmune disease associated with enteropathy, triggered by gluten intake, which affects both sexes and all ages.[1] Alopecia areata (AA) is another autoimmune disorder, characterized by sudden onset of patchy hair loss on the scalp and/or body.[2]

In 1995, Corazza et al. described for the first time an association between them. They described six patients where the diagnosis of AA preceded that of CD, and in at least four of them, the diagnosis of CD was made because of the presence of AA.[3]

Since then, there have been other reports of this novel association. The study by Ertekin et al. found that the prevalence of CD in children with AA was 41.7% while in healthy children in the same city was 0.87%. This indicated that the prevalence of silent CD was very high among children with AA. Hence, it can be said that AA could be the only clinical manifestation of CD in some cases.[2]

We also found a similar association in a 4½-year-old boy, who was referred to us by a dermatologist for gastrointestinal (GI) symptoms, present for the past 2 years. He consulted the said specialist for loss of hair on the anterior half of his scalp for the past 8 months without any improvement. He presented with abdominal distention after meals, intermittent diarrhea, and lack of growth (height less than the third percentile) [Figure 1]. A diagnosis of CD was suspected, which was confirmed by duodenal biopsy and serology for antiendomysial and antigliadin antibodies. We recommended gluten-free diet (GFD) with a review after 1 month, but the patient was lost to follow-up. He came 6 months later with the symptoms of common cold and a head full of hair. According to his parents, hair regrowth started once his GI symptoms subsided after the initiation of GFD.
Figure 1: Alopecia areata on the front part of the head

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Although remission and recurrence may be observed during the clinical course of AA, many patients on GFD have shown complete regrowth of hair with no further recurrence of AA at follow-up, which was similar to our finding.[4] These positive effects of GFD have been attributed to the normalization of the immune response.[1]

The estimated prevalence of CD in patients with AA ranges between 1:85 and 1:116.[1] In India, the prevalence of CD has jumped four folds since the 1960s, and now 80 lakh people are affected.[5] This emphasizes the need to screen for CD and its associated disorders, especially AA, as the latter once developed may be permanent and may lead to psychological problems in the children in later life.

To conclude, antigliadin and antiendomysial antibodies should be included in the work-up of every patient with recalcitrant AA, even if no GI symptoms are present, as that can lead to a complete cure of AA in addition to managing CD. We also suggest that GFD should be given a fair try in every patient of recalcitrant AA, even if the serology for CD is negative, as there may be hidden cases of CD in these patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parents have given their consent for the image and other clinical information to be reported in the journal. They understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rodrigo L, Beteta-Gorriti V, Alvarez N, Gómez de Castro C, de Dios A, Palacios L, et al. Cutaneous and mucosal manifestations associated with celiac disease. Nutrients 2018;10. pii: E800.  Back to cited text no. 1
    
2.
Ertekin V, Tosun MS, Erdem T. Screening of celiac disease in children with alopecia areata. Indian J Dermatol 2014;59:317.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Corazza GR, Andreani ML, Venturo N, Bernardi M, Tosti A, Gasbarrini G. Celiac disease and alopecia areata: Report of a new association. Gastroenterology 1995;109:1333-7.  Back to cited text no. 3
    
4.
Naveh Y, Rosenthal E, Ben-Arieh Y, Etzioni A. Celiac disease-associated alopecia in childhood. J Pediatr 1999;134:362-4.  Back to cited text no. 4
    
5.
The Imminent Threat of Celiac Disease in India; c2019. Available from: https://www.downtoearth.org.in/news/health/the-imminent-threat-of-celiac-disease-in-india-62818. [Last accessed on 2019 Jul 23, Last updated on 2019 Jan 15].  Back to cited text no. 5
    


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