Vitiligo, an autoimmune disease causing depigmentation in certain areas of the body, can also affect hair by causing it to discolour. But is this condition also linked to hair loss in affected patients? Find out here.
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Can vitiligo lead to hair loss?
Summary
Published February 6, 2025,
updated on February 7, 2025,
by
Lilia, Scientific Editor
—
7 min read
Could there be a connection between vitiligo and alopecia areata?
Vitiligo is an autoimmune disease, that is, it is related to a dysfunction of the immune system which results from a loss of melanocytes, the cells responsible for the production of melanin. It manifests as a depigmentation of certain areas of the body in the form of white patches. The causes are numerous: genetic predispositions, the Koebner phenomenon, stress, or even exposure to mites .
Alopecia areata is also an autoimmune disease that manifests itself through hair loss in areas such as the scalp, beard or moustache, in the form of round or oval patches. It is caused by a disruption of the immune system that attacks hair follicles. Hair loss during the active phase of the disease is associated with an infiltrate of activated cytotoxic CD4+ lymphocytes around the hair follicles, as well as the presence of cytotoxic CD8+ lymphocytes within the follicles. This phenomenon prevents the hair from renewing normally and results in localised hair loss. Various factors are responsible for this dysfunction, such as hereditary predispositions, stress, viral infections, but it can also be associated with other autoimmune diseases, such as type 1 diabetes or Hashimoto's thyroiditis.
Alopecia areata and vitiligo share a common autoimmune mechanism.
Indeed, both are caused by an attack on the immune system. Vitiligo involves the destruction of melanocytes and alopecia areata attacks the hair follicles, leading to hair loss. In some cases, these two diseases can coexist. Studies reveal that vitiligo and alopecia areata share a similar pathogenesis. Indeed, the populations of immune cells and the cytokines involved in these diseases are similar and are often associated. Moreover, these two conditions present with common genetic risk factors, reinforcing their pathophysiological link. Therefore, it is common to observe both diseases in the same individual or within the same family. The HLA, IL2RA and CTLA4 genes, which play a role in the regulation of the immune system, are notably involved. Furthermore, the cytokine responses for vitiligo and alopecia areata are both dependent on the TH1/IFN-γ pathway, an inflammatory type immune response.
| Similarities between vitiligo and alopecia areata | Characteristics |
|---|---|
| Primarily asymptomatic | Mild itching in the minority |
| Histopathology | Characteristic infiltration of CD8+ and CD4+ T cells |
| Immune Mechanisms | Innate and adaptive cellular populations involved |
| Cytokine Response | TH1/IFN-γ dependent TNF-α is present at low levels, but TNF-α inhibitors are ineffective as treatments |
| Shared genetic risk, alleles | HLA, IL2RA, CTLA4 |
| Non-overlapping coincidence of lesions | Increased risk of alopecia areata in patients with vitiligo and vice versa |
| Correlation with the overlap of lesions | Case Reports, Targeting Pigmented Hair in Alopecia Areata |
Summary of similarities between vitiligo and alopecia areata.
HARRIS J.E. Vitiligo and Alopecia Areata: Apples and Oranges? Experimental Dermatology (2013).
According to some studies, patients with vitiligo have an increased risk of developing alopecia areata, and vice versa, even if the lesions do not necessarily overlap on the body. A review published in Dermatology examined the prevalence of comorbidities associated with vitiligo and revealed a possible association with alopecia areata. Among the 565 patients with vitiligo, 59 cases of alopecia areata were recorded, which is 2.4%. Although this percentage remains relatively low, it nevertheless suggests a correlation between these two autoimmune diseases. However, the evidence remains limited and studies on this link are still ongoing to confirm a direct relationship.
There exists a theory regarding the role of oxidative stress that could explain the link between vitiligo and hair loss. In the case of vitiligo, oxidative stress disrupts redox homeostasis, leading to an overproduction of reactive oxygen species (ROS) and insufficient elimination. These ROS, generated by both endogenous and exogenous factors, ultimately induce the death of melanocytes. During melanogenesis, excessive production of ROS creates a pro-oxidant environment, making melanocytes more vulnerable to oxidative stress-related damage. Oxidative stress, implicated in the development of vitiligo, could also lead to a weakening of the hair follicle and damage to follicular melanocytes. An excess of ROS can also promote inflammation and disrupt the hair mechanism. Furthermore, it affects the stem cells of the hair bulb, reducing their renewal capacity and potentially leading to thinning or premature hair loss.
Although oxidative stress is a recognised factor in vitiligo, direct evidence of its involvement in triggering alopecia areata in patients with vitiligo is still limited and requires further research.
Sources
KALISH R.S & al. Alopecia Areata: A tissue specific autoimmune disease of the hair follicle. Autoimmunity reviews (2006).
KUCHABAL D. & al. Alopecia Areata Associated with Localized Vitiligo. Case Reports in Dermatology (2010).
HARRIS J.E. Vitiligo and alopecia areata: apples and oranges? Experimental Dermatology (2013).
QURESHI A.A & al. Comorbidities Associated with Vitiligo: A Ten-Year Retrospective Study. Dermatology (2013).
EZZEDINE K. & al. Follicular vitiligo: A report of 8 cases. Journal of the American Academy of Dermatology (2016).
HARRIS J. & al. Understanding autoimmunity of vitiligo and alopecia areata. Current opinion in pediatrics (2016).
ZHANG C. & al. The Role of Oxidative Stress in the Pathogenesis of Vitiligo: A Culprit for Melanocyte Death. Oxidative medicine and cellular Longevity (2022).
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