Understanding the Link Between Hair Loss and Autoimmune Disorders

1. 1. Introduction

      1. Definition of Autoimmune Disorders: It is a condition in which the body’s immune system can identify its healthy tissue as foreign particles and start producing antibodies and attacking them. It has a complicated origin with genetic, hormonal, and environmental factors all contributing to it. In the United States of America, autoimmune illnesses rank among the top killers of young and middle-aged women (under 65 years of age) earlier they are thought to be very rare but now they are impacting about 3-5% of the population and type 1 diabetes and thyroid are the most common among various autoimmune disease. It can result in the destruction of body tissue, unusual growth of organs, and also changes in organ function.
      2. Overview of Hair Loss: Hair loss is defined as the loss of hairs from a part of the body usually head region is involved. It is also termed alopecia or baldness. Hair loss affects men and women of all ages all around the world. Daily loss of about 50-100 hairs is not termed as alopecia according to the American Academy of Dermatology.
      3. Thesis Statement: The connection between hair loss and autoimmune disorders is complex and not fully understood, but research has shown a strong link between the two. Our immune system is divided into two parts, one is the innate immune system and the other is adaptive immune system, the innate immune system lacks memory and forms the first line of defence of the body whereas adaptive immunity is specific in nature and has memory. they produce a highly specialized response that improves with each encounter with a particular disease.^[1]

   2. Overview of Autoimmune Disorders

      Causes of Autoimmune Disorders:

      The exact cause of autoimmune disorders is still unknown, but several risk factors may potentiate or increase the risk of autoimmune disorders. Some of them are listed below-

      Medications: Certain types of medications have a wide range of side effects, and these side effects may together increase the chances of autoimmune disorders. So, before taking medication consult with your doctor about the major side effects of this medication and whether they can precipitate an autoimmune disorder or not.^[10]

      Having One Autoimmune Disorder: If a person is suffering from one type of autoimmune disorder, they may be at increased risk of developing another autoimmune disease in the. For example, if a person is suffering from rheumatoid arthritis, then there is a chance of him getting affected by alopecia areata which is another type of autoimmune disorder.

      Exposure to Toxins: Exposure to certain kinds of toxins will increase the chance of autoimmune disorders.^[10] Researchers at NIEHS found that exposure to some pesticides may play a key role in the development of rheumatoid arthritis in farm workers.

      Genetics: Genetics of the individual may increase the chances of him/her getting affected by the autoimmune disease. Certain disorders such as lupus as well as multiple sclerosis tend to run in families.

      Obesity: Obesity is also one of the major causes of developing an autoimmune disorder. Being overweight can increase the chances of rheumatoid arthritis and psoriatic arthritis.^[10]

      Gender: Being female is a major risk in the case of autoimmune disease because a study suggests that people who are affected by the autoimmune disorder, among them 78% are females.

      Common Autoimmune Disorders

      There are almost 100 different types of immune disorder present currently some of them are organ-specific in nature and others are non-organ-specific affecting several organs once at a time.^[1] One in fifteen people in the US has an autoimmune disease.

      1. Type 1 Diabetes: In type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas, leading to decreased insulin levels and increased blood sugar levels. The treatment of this condition is the intake of insulin injections.
      2. Multiple sclerosis: In multiple sclerosis, the immune system mostly attacks the nerve cells and which will lead to symptoms like pain, blindness, weakness, and muscle spasm.
      3. Rheumatoid arthritis: In this disease immune system produces antibodies that will bind to the lining of joints after binding to them causing inflammation and pain in the joints. If it remains untreated it may cause permanent damage to the joints. Treatment is done by using medication that can suppress the overactive immune system and give symptomatic relief.
      4. Lupus: Lupus is a type of autoimmune disorder. In this, autoimmune antibodies get developed and will bind with a tissue throughout the body. More commonly joints, blood cells, liver, and kidney get affected which prevents this tissue to perform its function. For the treatment of lupus, mostly steroidal drug is used such as prednisolone which reduces immune system function. Approximately almost 1 million peoples have lupus in the US
      5. Symptoms of autoimmune disorders: The symptoms of the autoimmune disorder may vary according to the type of disease, but they also have some common symptoms such as fatigue, joint pain, skin problems (mainly itching and inflammation), abdominal pain and digestive problems, and fever.^[11]

   3. The Connection Between Hair Loss and Autoimmune Disorders

      1. Alopecia Areata: Alopecia areata is a type of immune disease in which the immune system produces antibodies against hair follicles and attacks them, causing patchy hair loss on the scalp and ultimately hair fall.
      2. Lupus: Hair loss is very common among people who were infected with lupus. In lupus, it causes body-wide inflammation that will attack the scalp and may cause hair loss. In the most common type of lupus hair loss can occur all over the scalp, also medication used to treat lupus may result in hair fall.
      3. Thyroid Disease: Thyroid disease is linked with hair loss, both overactivity and reduced activity of the thyroid gland can cause hair loss, and the loss of hair is on the entire scalp however this condition is reversed when the thyroid problem is treated and complete hair is reversed but it will take several months.^[3]
      4. Psoriasis: Scalp psoriasis can cause temporary hair loss in some conditions but it is not an actual cause of hair loss, it happens because in psoriasis scalp itching and plaque is happened and removing plaque forcefully can results in temporary hair loss, this hair loss is prevented by using the medicated shampoo in hair to reduce itching and plaque which will finally result in stoppage of hair loss.^[4]
      5. Sjogren’s Syndrome: Sjogren’s syndrome (SS) affects about 0.5 to 2% of the adult population, and almost half of the patients remain undiagnosed. Generally, females are affected 9 times more as compared to men. This autoimmune disorder can result in telogen effluvium (a type of hair disorder) but is not always the cause of this syndrome, fortunately after the treatment of Sjogren’s syndrome hair loss is reversed.^[5]
      6. Polymyositis/Dermatomyositis: Myositis is a very rare condition in this muscle gets weak and the patient may feel pain around the muscle. Both polymyositis and dermatomyositis are types of myositis.^[6] In the case of children, it is seen that dermatomyositis is co-exist with the alopecia areata and the children suffer from heavy hair loss in a period of 3 months the complete hair falls even the eyebrows of the patients also get slightly affected, but this condition is completely reversible after taking the medication for the treatment of dermatomyositis the hair is completely reversed in one month of treatment.
      7. Rheumatoid Arthritis: Rheumatoid arthritis (RA) is an autoimmune disorder affecting a large no of the population mainly past middle age.^[7] Hair loss is very rarely caused by rheumatoid arthritis directly but other factors such as stress and medications which are used to treat rheumatoid arthritis may cause a fall in hair and hair thinning. Medicine methotrexate is most widely used to treat RA, this drug is known to cause hair thinning.

   4. Mechanisms Behind the Connection of Hair Loss and Autoimmune Disorders

      Immune System Attacking Hair Follicles: There is no research present that confirms why the immune system is attacking hair follicles however it is believed that both genetic as well as environmental factors are playing a key role in this mechanism of hair fall.^[8]

      The mechanism behind this reaction is that cells of the immune system surround the hair follicle and attack there, resulting in hair loss but not hair follicle damage, which means that hair will regrow easily.

      1. Hormonal Imbalances: Hormonal imbalance is also one of the major causes of hair fall especially the level of thyroid hormone can be crucial in deciding the life of hair, either hypothyroidism (decreased level of the thyroid hormone) or hyperthyroidism (increased level of thyroid hormone) both results in hair loss. Also, in the case of female, hair loss is more seen during the menstrual cycle which can be due to the hormonal imbalance
      2. Inflammation: There is various type of scalp inflammation are present, while all of them are not results in hair fall only a few scalps inflammation can cause hair loss such as scalp ringworm they can potentially affect hair loss and cause hair loss in patches in various parts of the scalp and even severe scalp ringworm condition can lead to the permanent hair loss at the scalp as well as eyelashes and eyebrow also. So, taking the necessary steps towards prevention and treatment of scalp inflammation can decrease the incidence of hair loss.^[9]
      3. Nutrient Deficiencies: As we know hair follicle cells are the among most rapidly growing cells in our body so that’s why they are largely affected by nutrient deficiencies such as iron, vitamin D, zinc, biotin, and vitamin B12. Iron is one of the most important among them due to the deficiency of iron a hair disorder which is known as telogen effluvium (TE) occurs. It happened due to the disruption of the normal hair growth cycle which is caused due to diverting iron stores in hair follicles to other areas of the body. Vitamin D deficiency also leads to hair loss, especially female pattern hair loss, also vitamin D supplements are found to be advantageous in promoting hair regrowth in some people with vitamin D deficiency.

A study was conducted in 2020 which involve a total of 109 people and concluded that hair loss had significantly lower blood levels of vitamin D than people without hair loss. Nearly 80% of the people with hair loss had low vitamin D levels.

1. Diagnosis and Treatment

   1. Diagnosing Autoimmune Disorders: The diagnosis of autoimmune disorders may become difficult in many cases because many autoimmune disorders have similar functions, symptoms can be vague they may come and go also there is a requirement of more than one test to identify the disease, not a single test is applicable to diagnose the disease. Tests used to diagnose immune disorders are blood tests, X-rays, MRI, biopsy, autoantibody test, complete blood count tests (CBC), erythrocytes sedimentation rate (ESR) and urinalysis.^[12]
   2. Treating Autoimmune Disorders: There is no permanent cure for autoimmune disease, the treatments are only symptomatic based.^[13] Only a few medications are used to relieve the pain of joints or muscular pain, also certain immunosuppressive medications are used but they have a disadvantage in that they are not able to differentiate between defective cells and normal cells and can suppress the immune system which results in making the patient more prone to infection.^[1] Other than medicine use of a novel class of nanoparticles coated with protein targets at the T-cells which are responsible for autoimmune disease is also an approach to treat the autoimmune disease. Research is going on, on the use of gut microbiota to treat autoimmune diseases. Currently, it has an issue that hurts patient health. In the future, it may become a safer option for treating autoimmune disorders.^[13]
   3. Managing Hair Loss: To treat hair loss associated with the autoimmune disease the physician may prescribe corticosteroids in the form of a tablet by oral route or apply them topically as an ointment or cream is the best way to reduce hair loss associated with autoimmune disease. However, FDA-approved minoxidil and finasteride are also used in combination to treat hair loss.

2. Conclusion

   The connection between hair loss and autoimmune disorders is very complex and not fully understood till now. However, several cases are seen which show a link between autoimmune disorders and hair loss. The autoimmune disorder affects hair growth and causes hair loss through various mechanisms such as inflammation, and patch formation.

   There is great importance in seeking medical professionals’ help in case of autoimmune disorder and hair loss, as physicians may underline its cause and suggest treatment according to its cause. This is helpful in the early treatment of the disease.

   In the future scientist may need to identify the actual cause of the disease by providing specific tests for a particular disease and developing medications more specific for the treatment of the disease and not affecting the normal immunity of the individuals. Another approach was that scientists must develop non-pharmacological measures to minimize the side effects associated with treatment and make treatment more cost-effective are the approaches to treat the autoimmune disorder and hair fall associated with it.

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