Alopecia Areata and Paraneoplastic Syndromes

Cancer, the Immune System and Alopecia Areata 

Alopecia areata is an autoimmune disease. Approximately 1.7 % of the world's population will be affected by alopecia areata. Studies have shown that the vast majority of patients with alopecia areata are extremely healthy. A higher incidence of eczema and thyroid problems is well known to exist in patients with alopecia areata.  Other autoimmune conditions can occur less frequently. 

70-80 % of the disease has a genetic basis and 20 % or so is influenced by environmental factors or 'triggers.' Most of the time, a trigger can not be identified in patients with alopecia areata.  There are a variety of triggers that have been studied through the years. Stress, medications, vaccines have all be proposed to play a role in a small minority of patients. It is extremely rare that cancer is a trigger, but such a phenomenon whereby a cancer triggers clinical manifestations at a site far away from the cancer itself is called a 'paraneoplastic syndrome.'

Paraneoplastic syndromes associated with Alopecia

Álvarez Otero J in 2017 reported the case of a man who developed alopecia areata two months before being diagnosed with gastric adenocarcinoma. Of course, it is challenging to know with certainly in these cases whether the alopecia is coincidental or not and this is the challenge with all paraneoplastic syndromes. However, often the timing of the alopecia, and the improvement in the hair loss with removal of the tutor lends some support to the possibility of a link.

Cancers of the gastrointestinal system have some of the most frequent reports of being associated with alopecia areata. Other cancers which may have a paraneoplastic relationship to hair loss are thymomas and Hodgkin disease. Overall though, the link is quite rare and work up an evaluation for cancer is not appropriate for most patients with alopecia areata. Nevertheless, these paraneooplastic syndromes are reminders that there can be many potential triggers of alopecia areata. 

REFERENCE

Álvarez Otero J, et al. Alopecia areata as a paraneoplastic syndrome of gastric cancer.  Rev Esp Enferm Dig. 2017

Alopecia areata as a paraneoplastic syndrome of Hodgkin's lymphoma: A case report.Gong J, et al. Mol Clin Oncol. 2014

Multiple paraneoplastic syndromes: myasthenia gravis, vitiligo, alopecia areata, and oral lichen planus associated with thymoma.Qiao J, et al. J Neurol Sci. 2011

[Alopecia areata as the initial paraneoplastic presentation of gastric adenocarcinoma].Molina Infante J, et al. Gastroenterol Hepatol. 2009. Article in Spanish.

[Gastrointestinal tumor (GIST) of the esophagus in a 34-year-old man: clubbed fingers and alopecia arealis as an early paraneoplastic phenomenon].Axel J, et al. Dtsch Med Wochenschr. 2005. Article in German.

Alopecia areata and multifocal bone involvement in a young adult with Hodgkin's disease.Mlczoch L, et al. Leuk Lymphoma. 2005