Journal Information
Vol. 101. Issue 5.
Pages 437-443 (June - July 2010)
Share
Share
Download PDF
More article options
Vol. 101. Issue 5.
Pages 437-443 (June - July 2010)
Original article
Full text access
Immunization and Bacterial Pathogens in the Oropharynx as Risk Factors for Alopecia Areata
Inmunizaciones y bacterias patógenas en la faringe como factores de riesgo para alopecia areata
Visits
6279
M.A. Morales-Sánchez
Corresponding author
marthams@prodigy.net.mx

Corresponding author.
, M.A. Domínguez-Gómez, F. Jurado-Santa Cruz, M.L. Peralta-Pedrero
Centro Dermatológico Dr. Ladislao de la Pascua, Mexico City, Mexico
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract
Introduction

Alopecia areata is an autoimmune inflammatory disease affecting the hair follicles. Researchers are currently interested in whether the presence of bacterial pathogens and/or a history of immunization can trigger an autoimmune response in patients who are genetically predisposed.

Objective

This study aimed to determine whether there is an association between the development of alopecia areata and throat carriage of bacterial pathogens or a history of immunization.

Material and methods

Sixty-five men and women with alopecia areata and 65 control patients with other skin diseases were studied at the Dr Ladislao de la Pascua Dermatology Clinic between September 2008 and February 2009. The patients ranged in age from 18 to 59 years. Patients with scalp diseases were excluded from the control group. In all cases, the patient was questioned about immunizations received in the previous 6 months, and a throat swab was cultured.

Results

A history of immunization (odds ratio [OR], 3.3; 1.6% confidence interval [CI], 1.6-6.7; P=.001), the presence of bacterial pathogens in the oropharynx (OR, 2.6; 95% CI, 1.1-6.2; P=.033), and being a carrier of Streptococcus pyogenes (OR, 2.1; 95% CI, 1.7-2.5; P=.042) were risk factors for alopecia areata. Klebsiella pneumoniae, S pyogenes, Pseudomonas aeruginosa, Streptococcus pneumoniae, Serratia marcescens and Escherichia coli were isolated from cultures.

Conclusions

This is the first study to show an association between alopecia areata and throat carriage of bacterial pathogens or history of immunization, as risk factors for development of the disease. Given the characteristics of our study population, the association appears valid for patients with less than 25% hair loss and a course of disease under 1 year.

Key words:
Alopecia areata
Immunization
Bacterial colonization
Pharynx
Streptococcus pyogenes carriage
Resumen
Introducción

La alopecia areata es una enfermedad inflamatoria autoinmune que afecta al pelo. Actualmente se estudia si las bacterias patógenas y las inmunizaciones son inductores de la respuesta autoinmune en pacientes con susceptibilidad genética.

Objetivo

El objetivo de este estudio fue determinar si las bacterias patógenas en la faringe y el antecedente de haber recibido inmunizaciones están asociados a la enfermedad.

Materiales y métodos

En el Centro Dermatológico «Dr. Ladislao de la Pascua», desde septiembre de 2008 a febrero de 2009, se estudiaron 65 pacientes con alopecia areata y 65 controles con otras dermatosis, excluyendo las del cuero cabelludo. Se incluyeron pacientes de 18 a 59 años de edad y de ambos sexos. A todos se les interrogó sobre inmunizaciones recibidas 6 meses antes y se les realizó un cultivo de exudado faríngeo.

Resultados

Haber recibido inmunizaciones, la presencia de bacterias patógenas en la faringe y ser portador de S. pyogenes se comportaron como factores de riesgo para la alopecia areata, con una razón de probabilidades de 3,3 (IC 95% 1,6-6,7; p = 0,001), 2,6 (IC 95%: 1,1-6,2; p = 0,033) y 2,1 (IC 95% 1,7-2,5; p = 0,042), respectivamente. Las bacterias aisladas fueron Klebiella penumoniae, Streptococcus pyogenes, Pseudomonas aeruginosa, Streptococcus pneumoniae, Serratia marcescens y Escherichia coli.

Conclusiones

Este es el primer estudio que apoya los hallazgos de estado de portador de bacterias patógenas en la faringe y la aplicación de inmunizaciones como factores de riesgo para desarrollar alopecia areata. Por las características de nuestra población, esta asociación es válida para los pacientes con menos del 25% de pérdida de pelo y con una evolución inferior a un año.

Palabras clave:
Alopecia areata
Inmunizaciones
Bacterias en la faringe
Estado de portador de S. pyogenes
Full text is only aviable in PDF
References
[1.]
V.A. Randall.
Is alopecia areata an autoimmune disease?.
Lancet, 9297 (2001), pp. 1922-1924
[2.]
A. Gilhar, R.S. Kalish.
Alopecia areata: a tissue specific autoimmune disease of the hair follicle.
Autoimmunity Rev, 5 (2006), pp. 64-69
[3.]
K.H. Safavi, S.A. Muller, A.N. Moshell, R.J. Melton.
Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989.
Mayo Clin Proc, 70 (1995), pp. 628-633
[4.]
A. Gilhar, R. Paus, R.S. Kalish.
Lymphocytes, neuropeptides, and genes involved in alopecia areata.
J Clin Invest, 117 (2007), pp. 2019-2027
[5.]
B.W. Colombe, C.D. Lou, V.H. Price.
The genetic basis of alopecia areata: HLA associations with patchy alopecia areata versus alopecia totalis and alopecia universalis.
J Invest Dermatol Symposium Proc, 4 (1999), pp. 216-219
[6.]
M.J. García-Hernández, S. Ruiz-Doblado, A. Rodríguez-Pichardo, F. Camacho.
Alopecia areata, stress and psychiatric disorders: a review.
J Dermatol, 26 (1999), pp. 625-632
[7.]
M. Samarkos, G. Vaiopoulos.
The role of infections in the pathogenesis of autoimmune diseases.
Curr Drug Targets Inflamm Allergy, 4 (2005), pp. 99-103
[8.]
P.A. Tsonis, B. Dwivedi.
Molecular mimicry: Structural camouflage of proteins and nucleic acids.
Biochim Biophys Acta, 1783 (2008), pp. 177-187
[9.]
K.W. Wucherpfennig.
Mechanisms for the induction of autoimmunity by infectious agents.
J Clin Invest, 108 (2001), pp. 1097-1104
[10.]
C. Jackow, D. Pharm, N. Buffer, M. Hordinsky, J. Nelson, J. Tarrand, et al.
Alopecia areata and cytomegalovirus infection in twins: Genes versus environment?.
J Am Acad Dermatol, 38 (1998), pp. 418-425
[11.]
K.J. McElwee, D. Boggess, B. Burgett, R. Bates, H.G. Bedigan, J.P. Sundberg, et al.
Murine cytomegalovirus is not associated with alopecia areata in C3H/HeJ mice.
J Invest Dermatol, 110 (1998), pp. 986-987
[12.]
A. Ofidani, P. Amerio, M.L. Bernardino, C. Feliciani, G. Bossi.
Role of cytomegalovirus replication in alopecia areata pathogenesis.
J Cutan Med Surg, 4 (2000), pp. 63-65
[13.]
T.A. Rodríguez, M. Duvic.
Onset of alopecia areata alter Epstein-Barr virus infectious mononucleosis.
J Am Acad Dermatol, 59 (2008), pp. 137-139
[14.]
Z. Jadali, O. Mansouri, F. Jadali.
There is no relationship between hepatitis C virus and alopecia areata.
Eur J Dermatol, 16 (2006), pp. 94-95
[15.]
D. Rigopoulos, A. Katsambas, A. Karalexis, G. Papatheodorou, T. Rokkas.
No increased prevalence of Helicobacter pylori in patients with alopecia areata.
J Am Acad Dermatol, 46 (2002), pp. 141
[16.]
T. Proft, J.D. Fraser.
Bacterial superantigens.
Clin Exp Immunol, 133 (2003), pp. 299-306
[17.]
S.M. Giannelli, G.R. Posse.
Prevalencia de portación asintomática del estreptococo beta hemolítico del grupo A.
Arch Argent Pediatr, 105 (2007), pp. 221-224
[18.]
R.R. Tanz, S.T. Shulman.
Chronic pharyngeal carriage of group A streptococci.
Pediatr Infect Dis J, 26 (2007), pp. 175-176
[19.]
C.A. Lloyd, S.E. Jacob, T. Menon.
Pharyngeal carriage of group A streptococci in school children in Chennai.
Indian J Med Res, 124 (2006), pp. 195-198
[20.]
B.A. Choby.
Diagnosis and treatment of streptococcal pharyngitis.
Am Fam Physician, 79 (2009), pp. 383-390
[21.]
M.E. Pichichero, J.R. Casey.
Defining and dealing with carriers of group A streptococci.
Contemporary Pediatr, 20 (2003), pp. 46-56
[22.]
G.F. Brooks, J.S. Butel, S.A. Morse.
Flora normal.
Microbiología médica de Jawetz, Melnick y Adelberg, 16 ed., pp. 218-219
[23.]
M.A. Gómez-Samano, R.A. Bourlon-Cuéllar, M.T. Bourlon, O.F. Coronel-Ayala.
Vacunación en el adulto.
Med Int Mex, 23 (2007), pp. 408-414
[24.]
E.A. Olsen, M.K. Hordinsky, V.H. Price, J.L. Roberts, J. Shapiro, D. Canfield, et al.
Alopecia areata investigational assessment guidelines-Part II.
J Am Acad Dermatol, 51 (2004), pp. 440-447
[25.]
M.J. García-Hernández, A. Rodríguez-Pichardo, F. Camacho.
Multivariate analysis in alopecia areata: risk factors and validity of clinical forms.
Arch Dermatol, 135 (1999), pp. 998-999
[26.]
D.A. Guzmán-Sánchez, G.D. Villanueva-Qintero, N.A. Alfaro, A. McMichel.
A clinical study of alopecia areata in Mexico.
Int J Dermatol, 46 (2007), pp. 1310-1312
[27.]
V.K. Sharma, G. Dawn, B. Kumar.
Profile of alopecia areata in northern India.
Int J Dermatol, 35 (1996), pp. 22-27
[28.]
A. Tosti, S. Bellavista, M. Iorizzo.
Alopecia areata: a long term follow-up study of 191 patients.
J Am Acad Dermatol, 55 (2006), pp. 438-441
[29.]
Magnúsdóttir BT, Jónsson JS, Kristinsson KG. Algengi Streptococcus pyogenes og methisillín ónæmra Staphylococcus aureus í hálsi heilbrigðra barna í Garðabæ Laeknabladid. 2008; 94:447-51.
[30.]
N. Raza, M. Usman, A. Hameed.
Chronic plaque psoriasis: streptococcus pyogenes throat carriage rate and therapeutic response to oral antibiotics in comparison with oral methotrexate.
J Coll Physicians Surg Pak, 17 (2007), pp. 717-720
[31.]
R.P. Wise, K.P. Kiminyo, M.E. Salive.
Hair loss after routine immunizations.
JAMA, 278 (1997), pp. 1176-1178
[32.]
Y. Schoenfeld, A. Aharon-Maor, Y. Sherer.
Vaccination as an additional player in the mosaic of autoimmunity.
Clin Exp Rheumatol, 18 (2000), pp. 181-184
[33.]
Y. Schoenfeld, A. Aron-Maor.
Vaccination and autoimmunity-“vaccinosis”: a dangerous liaison?.
J Autoimmunity, 14 (2000), pp. 1-10
[34.]
D.A. Geier, M.R. Geier.
A case-control study of serious autoimmune adverse events following hepatitis B immunization.
Autoimmunity, 38 (2005), pp. 295-301
[35.]
J.P. Sundberg, K.A. Silva, W. Zhang, B.A. Sundberg, K. Edwards, L.E. King, et al.
Recombinant human hepatitis B vaccine initiating alopecia areata: testing the hypothesis using the C3H/HeJ mouse model.
ESVD ACVD, 20 (2009), pp. 99-104
Copyright © 2010. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Download PDF
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?