Cure of alopecia areata after eradication of Helicobacter pylori: a new association?

Abstract

Alopecia areata is a disease of the hair follicles, with strong evidence supporting autoimmune etiology. Alopecia areata is frequently associated with immune-mediated diseases with skin manifestations such as psoriasis and lichen planus, or without skin manifestations such as autoimmune thyroiditis and idiopathic thrombocytopenic purpura. Helicobacter pylori (H. pylori) infection is present in around 50% of the world's population and has been associated with a variety of immune-mediated extra-digestive disorders including autoimmune thyroiditis, idiopathic thrombocytopenic purpura, and psoriasis. A case of a 43-year old man with an 8-mo history of alopecia areata of the scalp and beard is presented. The patient was being treated by a dermatologist and had psychiatric support, without any improvement. He had a history of dyspepsia and the urea breath test confirmed H. pylori infection. The patient went into remission from alopecia areata after H. pylori eradication. If such an association is confirmed by epidemiological studies designed for this purpose, new therapeutic options could be available for these patients, especially in areas where infection with H. pylori is highly prevalent.

Keywords: Alopecia areata; Eradication treatment; Helicobacter pylori; Molecular mimicry.

Figure 1

Photographic sequence of lesions before and after Helicobacter pylori eradication. A-C: Alopecia areata of the scalp (A and B) and beard (C) at baseline visit (week 0) before Helicobacter pylori (H. pylori) eradication. Positive ¹³C-UBT (6.95 δ¹³CO₂); D-F: Evidence of hair regrowth at week 4; G-I: Hair regrowth at week 8. Negative ¹³C-UBT (0.81 δ¹³CO₂); J-L: Hair regrowth at week 16; M-O: Hair regrowth at week 44. Negative ¹³C-UBT (0.67 δ¹³CO₂).