Results of Blood Cells Counting, Fasting Blood Suture, Rheumatoid Factor, C Reactive Protein, Antinuclear Antibodies and Thyroid Function Tests in Patients with Alopecia Areata
Alopecia Areata (AA) is a disease with local hair loss that may be associated with other autoimmune diseases including thyroid dysfunction, diabetes mellitus, pernicious anemia, systemic lupus erythematous, etc. This study aimed at evaluating the results of some serum laboratory tests related to autoimmune disorders in patients with AA. In a descriptive-analytical study, 58 patients with AA were evaluated in Tabriz Sina Hospital during a 36-month period. Serum laboratory results (red blood cell count, white blood cell count, platelet count, C-reactive protein, hematocrit, erythrocyte sedimentation rate, hemoglobin, fasting blood sugar), thyroid tests (TSH, free T4 and T3), as well as serum antinuclear antibody (ANA) and rheumatoid factor were measured. Thirty three males and twenty five females with the mean age of 30.1±13.4 years were enrolled. Previous history of vitiligo and atopy was positive in 1.7 and 10.3% of the studied population, respectively. Laboratory findings indicative of thyroid dysfunction, diabetes mellitus, anemia, positive ANA and positive rheumatoid factor were detected in 8.6, 6.9, 8.6, 22.4 and 15.5% of the patients, respectively. Comparing with normal population, some underlying autoimmune disorders may be present in patients with AA, especially thyroid dysfunction. Therefore, screening tests might be simple and beneficial.
to cite this article:
H.H. Qadim, J. Majidi, M.S. Navasi, R. Fadaei and M. Goldust, 2013. Results of Blood Cells Counting, Fasting Blood Suture, Rheumatoid Factor, C Reactive Protein, Antinuclear Antibodies and Thyroid Function Tests in Patients with Alopecia Areata. Journal of Medical Sciences, 13: 50-55.
Received: January 28, 2013;
Accepted: March 19, 2013;
Published: May 06, 2013
Alopecia areata is a hair loss condition characterized by the rapid onset of
hair loss in a sharply defined area (Finner, 2011;
Goldust and Rezaee, 2013; Lotti et
al., 2013). Any hair-bearing surface can be affected, but the most noticeable
surface is the scalp (Goldust et al., 2013a, b;
Mohebbipour et al., 2012). The reason alopecia
areata occurs is not completely known. In some cases it is associated with other
diseases, but most of the time it is not (Goldust et
al., 2013c, d; Olszewska
et al., 2010). Research is ongoing to determine the best treatment
for this sometimes-striking disease (Sadighi et al.,
2011; Singh and Lavanya, 2010; Vafaee
et al., 2012). There are several different hypotheses as to what
causes alopecia areata (Alkhalifah et al., 2010;
Goldust et al., 2012; Milan
et al., 2011). Genetic factors seem to play an important role since
there is a higher frequency of a family history of alopecia areata in people
who are affected (Alkhalifah et al., 2010;
Golfurushan et al., 2011; Megiorni
et al., 2011). Alopecia areata appears to also have an autoimmune
factor causing the patient to develop antibodies to different hair follicle
structures (Fardiazar et al., 2012; Goldust
et al., 2011; Sadeghpour et al., 2011).
Certain chemicals that are a part of the immune system called cytokines may
play a role in alopecia areata by inhibiting hair follicle growth (Ahmed
et al., 2010; Nikanfar et al., 2012;
Sadeghpour et al., 2012). Some studies show
that emotional stress may also cause alopecia areata (Francis
and Orlow, 2009; Ganjpour Sales et al., 2012;
Vahedi et al., 2012). Considering that human
hair has an important communicative role and alopecia areata is often seen in
youths, the disease may lead to a main mental stress (Karzar
et al., 2012; Seyyednejad et al., 2012;
Shakeri et al., 2013). Therefore, finding appropriate
methods and treatments to overcome this stressful condition is of high importance.
This goal will be achieved when background causes of the disease is known (Farhoudi
et al., 2012; Nourizadeh et al., 2013;
Salehi et al., 2013a). Although different pathological
reasons have been introduced in this regard, exact determining of the background
cause is difficult (Cetin et al., 2009; Rulon
et al., 2009; Salehi et al., 2013b).
In fact, these problems root in variable extent of disease and its heterogeneous
and ill-defined nature (Chiarini et al., 2008;
Fardiazar et al., 2013; Ganjpour
Sales et al., 2013). Several researches have studied the relationship
between alopecia areata and diseases and self-immunity conditions (DallOglio
et al., 2005; Shohat, et al. 2005;
Soleimanpour et al., 2013). Thyroid gland dysfunctions
are of these cases but it seems that there are geographical differences in this
regard (Daghigh et al., 2013; Nemati
et al., 2013; Salehi et al., 2013c).
Accordingly, screening patients suffering from alopecia areata considering self-immunity
diseases and thyroid dysfunctions may be important in better patients
management and helpful in etiological studies (Qadim et
al., 2013; Seyrafi et al., 2005; Sheehan
and Islam 2009). This was neglected in East Azerbaijan. The present research
aims at studying of results of the normal serum tests and thyroid tests in these
MATERIALS AND METHODS
In this descriptive-analytical study, we studied 58 patients with alopecia
areata from April 2009 to April 2012 in skin clinic of Sina Educational Center
of Tabriz. All these patients had alopecia areata for at least 6 months before
visiting our department for treatment. These patients had reported no effect
from other therapeutic methods or they had no treatment history for more than
6 months before visiting our clinic. All patients were evaluated dermatologist
(GC). All diagnoses were made by history and physical examination. Particulars
of the referred patients including age, gender, disease duration, lesion position,
disease relapse record, vitiligo and atopy records were registered. Serum tests
including TSH, serum free T3 and T4 level, CRP, hemoglobin, hematocrit, RBC
counting, WBC counting, platelet counting, ESR, fasting blood glucose, ANA and
RF conducted at the same center were registered. Importance of examinations
and tests were described for all patients and written consent was obtained from
all the patients. The patients were referred to the related specialist for further
examinations when a slight change was observed in the tests. SPSSTM,
version 16 is the used statistical software program. The results were expressed
as Means±Standard deviation. The Chi-square test was used for statistical
analysis. The level of statistical significance was set at a value of p<0.05.
A total of 68 patients were studied, 10 patients (7 men and 3 women) were not
able to continue the study and were therefore excluded from the study. The remaining
58 patients consisted of 33 males (56.9%) and 25 females (43.1%). Their ages
ranged from 12 to 62 years (mean age 30.1±13.4). General data of the
studied subjects are summarized in Table 1. Vitiligo was positive
in 1.7% of the patients that in 1 (3%) of the males and none of the females
it was stated. Atopy was observed in 6 (10.3%) of the patients that was positive
in 3 (12%) of the females and 3 (9.1%) of the males. Relapse was stated in 23
(39.7%) of the patients that was positive in 17 (51.5%) of the male and 6(24%)
of the females (Table 1).
|| Particulars of patients with alopecia areata considering
|| Results of test in patients with alopecia areata
Also, results of laboratory serum results of these patients are summarized
in Table 2. The 8.6% of cases suffered from laboratory thyroid
dysfunctions, 3.4% of patients (all female) had laboratory hyperthyroid, 5.2%
of cases (all male) suffered from laboratory hyperthyroid and 6.9% had high
levels of blood glucose. RBC, WBC and serum platelet counting were normal in
all cases. None of the patients suffered clinically from problems including
hypothyroid or hyperthyroid and other complications in this regard (Table
In this study, we considered results of serum laboratory tests in patients
suffering from alopecia areata. Accordingly, 8.6% of the cases suffered from
laboratory thyroid dysfunction (3.4% of cases with hyperthyroid and 5.2% of
cases with hypothyroid). The study conducted by Kasumagic-Halilovic
and Prohic (2008) on seventy patients with alopecia areata, 11.4% of cases
suffered from thyroid dysfunctions (Kasumagic-Halilovic
and Prohic, 2008; Sharma et al., 1996). Revealed
that thyroid dysfunction frequency in patients suffering from alopecia areata
varied from 8 to 28% (Sharma et al., 1996). Ansar
(2003) evaluated 200 patients with alopecia areata. In their study, 8.77%
of patients suffered from thyroid dysfunction all in form of hypothyroid. In
another study, Seyrafi et al. (2005) studied 123
patients with alopecia areata in Tehran. The study revealed that 8.9% of patients
suffered from thyroid dysfunction (Seyrafi et al.,
2005). As observed, results of different studies vary in this regard. Frequency
of thyroid laboratory dysfunction in the present study is similar to other results
reported from Iran. Difference observed in definition of thyroid dysfunction
and type of the evaluations may be one of the reasons for varied results. In
a western study, prevalence of thyroid dysfunction in society has been reported
about 2% (1% hypothyroid and 1% hyperthyroid) (Brounwald,
2005). Therefore, observing thyroid dysfunctions in 8.6% patients with alopecia
areata is of high importance. Lack of complication or special sign and symptom
related to thyroid dysfunction in these subjects was a side interesting finding
in this regard. Grandolfo et al. (2008) in their
study on 63 patients with alopecia areata suggested that autoantibody related
to thyroid dysfunction in 44% of the subjects can be registered while all cases
lacked clinical symptoms. This study suggests that alopecia areata should be
regarded as organ-proof of other self-immunity diseases including alopecia areata
(Grandolfo et al., 2008). Alopecia areata should
be regarded as a criterion to further evaluations considering self-immunity
diseases specially thyroid dysfunctions (Razi et al.,
2013; Salehi et al., 2013d; Yousefi
et al., 2013). The outcomes resulted from our study confirms the
statement. In our study, laboratory symptoms indicating diabetes mellitus and
positive ANA was, respectively observed in 6.9 and 22.4% of patients. Also,
there was vitiligo and atopy records in 1.7 and 10.3% of cases, respectively.
Kakourou et al. (2007) evaluated 157 patients
with alopecia areata. In this study, 3.2% of patients suffered from self-immunity
diseases and 11.4% of them had positive records of atopy (Kakourou
et al., 2007). In the study conducted by Kasumagic-Halilovic
and Prohic (2008) all fifty patients suffering from alopecia areata had
positive records of atopy. In their study on 808 patients, Sharma
et al. (1996) reported positive record of atopy, vitiligo and mellitus
diabetes respectively in 18, 1.8 and 0.4% of cases (Kakourou
et al., 2007; Sukhjot et al., 2002).
As observed, results of different studies and also our study are almost the
same and indicate possible relation between self-immunity conditions and alopecia
areata (Azimi et al., 2013; Nejad
et al., 2013; Golforoushan et al., 2013).
Results of the recent study demonstrate that evidences of other diseases specially
self-immunity ones may be observed in patients suffering from alopecia areata.
Therefore, above-mentioned evaluations are recommended for all patients. Also,
it is suggested to conduct more controlled studies with high density sample
as well as control group.
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