Patients with alopecia areata show signs of insulin resistance

  • Mohammad Shahidi-Dadras
  • Negin BahrainiEmail author
  • Fateme Rajabi
  • Shima Younespour
Original Paper


Alopecia areata (AA) is an autoimmune disease associated with high levels of proinflammatory cytokines. Since chronic inflammation plays a major role in the pathogenesis of insulin resistance, AA can theoretically increase the risk of diabetes. We sought to investigate this theory by conducting a case–control study. Sixty patients with alopecia areata and 60 healthy volunteers (matched for age, sex, and body mass index) were evaluated. Fasting blood glucose (FBS), C-peptide, plasma insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) were measured for each individual. Plasma levels of insulin [median (interquartile range IQR): 11.22 (7.28–18.15) µIU/ml vs. 4.80 (3.20–9.00), p < 0.0001)], C-peptide [median (IQR): 2.10 (1.61–3.00) ng/ml vs. 1.40 (1.20–1.88), p < 0.0001)] and HOMA-IR [median (IQR): 2.70 (1.58–3.96) µIU/ml vs. 1.01 (0.64–1.98, p < 0.0001)] were significantly higher in patients with AA compared to controls. The differences remained significant even after controlling for age, gender, and BMI. Patients with a more severe disease (alopecia totalis/universalis) had higher levels of insulin [median (IQR): 15.80 (9.68–21.55) vs. 9.30 (5.33–14.40), p = 0.02)] and HOMA-IR [median (IQR): 3.30 (2.20–4.84) vs. 2.15 (1.29–3.52), p = 0.01] compared to those with patchy hair loss. Our data suggest that individuals with AA are at a higher risk of developing insulin resistance. This may be due to common inflammatory pathogenesis or a shared genetic background.


Insulin resistance Diabetes Alopecia areata C-Peptide Homeostasis model assessment for insulin resistance 



Alopecia areata


Alopecia totalis


Alopecia universalis


Homeostasis model assessment for insulin resistance


Interquartile range



This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical standards

The Ethics Committee of Shahid Beheshti University of Medical Sciences approved this study and the study was conducted according to the latest revision of the Helsinki Declaration.

Informed consent

Written informed consent was obtained from all participants before enrolment.


  1. 1.
    Boehncke S, Thaci D, Beschmann H, Ludwig RJ, Ackermann H, Badenhoop K, Boehncke WH (2007) Psoriasis patients show signs of insulin resistance. Br J Dermatol 157:1249–1251CrossRefGoogle Scholar
  2. 2.
    Chung CP, Oeser A, Solus JF, Gebretsadik T, Shintani A, Avalos I, Sokka T, Raggi P, Pincus T, Stein CM (2008) Inflammation-associated insulin resistance: differential effects in rheumatoid arthritis and systemic lupus erythematosus define potential mechanisms. Arthritis Rheum 58:2105–2112CrossRefGoogle Scholar
  3. 3.
    Devaraj S, Dasu MR, Jialal I (2010) Diabetes is a proinflammatory state: a translational perspective. Expert Rev Endocrinol Metab 5:19–28CrossRefGoogle Scholar
  4. 4.
    Donath MY (2014) Targeting inflammation in the treatment of type 2 diabetes: time to start. Nat Rev Drug Discov 13:465–476CrossRefGoogle Scholar
  5. 5.
    Esteghamati A, Ashraf H, Khalilzadeh O, Zandieh A, Nakhjavani M, Rashidi A, Haghazali M, Asgari F (2010) Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007). Nutr Metab 7:26CrossRefGoogle Scholar
  6. 6.
    Gayoso-Diz P, Otero-González A, Rodriguez-Alvarez MX, Gude F, García F, De Francisco A, Quintela AG (2013) Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord 13:47CrossRefGoogle Scholar
  7. 7.
    Goh C, Finkel M, Christos P, Sinha A (2006) Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol 20:1055–1060CrossRefGoogle Scholar
  8. 8.
    Gonzalez-Gay MA, Gonzalez-Juanatey C, Vazquez-Rodriguez TR, Miranda-Filloy JA, Llorca J (2010) Insulin resistance in rheumatoid arthritis: the impact of the anti-TNF-α therapy. Ann N Y Acad Sci 1193:153–159CrossRefGoogle Scholar
  9. 9.
    Huang KP, Mullangi S, Guo Y, Qureshi AA (2013) Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States. JAMA Dermatol 149:789–794CrossRefGoogle Scholar
  10. 10.
    Hunt N, McHale S (2005) The psychological impact of alopecia. Bmj 331:951–953CrossRefGoogle Scholar
  11. 11.
    Huvers FC, Popa C, Netea MG, van den Hoogen FH, Tack CJ (2007) Improved insulin sensitivity by anti-TNFα antibody treatment in patients with rheumatic diseases. Ann Rheum Dis 66:558–559CrossRefGoogle Scholar
  12. 12.
    Karadag AS, Ertugrul DT, Gunes Bilgili S, Takci Z, Tutal E, Yilmaz H (2013) Insulin resistance is increased in alopecia areata patients. Cutan Ocul Toxicol 32:102–106CrossRefGoogle Scholar
  13. 13.
    Karadag AS, Tutal E, Ertugrul DT (2011) Insulin resistance is increased in patients with vitiligo. Acta Dermato Venereol 91:541–544CrossRefGoogle Scholar
  14. 14.
    Knol MJ, Heerdink ER, Egberts AC, Geerlings MI, Gorter KJ, Numans ME, Grobbee DE, Klungel OH, Burger H (2007) Depressive symptoms in subjects with diagnosed and undiagnosed type 2 diabetes. Psychosom Med 69:300–305CrossRefGoogle Scholar
  15. 15.
    Marra M, Campanati A, Testa R, Sirolla C, Bonfigli A, Franceschi C, Marchegiani F, Offidani A (2007) Effect of etanercept on insulin sensitivity in nine patients with psoriasis. Int J Immunopathol Pharmacol 20:731–736CrossRefGoogle Scholar
  16. 16.
    Olefsky JM, Glass CK (2010) Macrophages, inflammation, and insulin resistance. Annu Rev Physiol 72:219–246CrossRefGoogle Scholar
  17. 17.
    Rajabi F, Drake L, Senna M, Rezaei N (2018) Alopecia areata: a review of disease pathogenesis. Br J Dermatol 179:1033–1048CrossRefGoogle Scholar
  18. 18.
    Reddy MPL, Wang H, Liu S, Bode B, Reed JC, Steed RD, Anderson SW, Steed L, Hopkins D, She J-X (2011) Association between type 1 diabetes and GWAS SNPs in the southeast US Caucasian population. Genes Immun 12:208CrossRefGoogle Scholar
  19. 19.
    Safavi K (1992) Prevalence of alopecia areata in the first national health and nutrition examination survey. Arch Dermatol 128:702CrossRefGoogle Scholar
  20. 20.
    Stunkard AJ, Faith MS, Allison KC (2003) Depression and obesity. Biol Psychiatry 54:330–337CrossRefGoogle Scholar
  21. 21.
    Tangvarasittichai S (2015) Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World J Diabetes 6:456CrossRefGoogle Scholar
  22. 22.
    van Asseldonk EJ, van Poppel PC, Ballak DB, Stienstra R, Netea MG, Tack CJ (2015) One week treatment with the IL-1 receptor antagonist anakinra leads to a sustained improvement in insulin sensitivity in insulin resistant patients with type 1 diabetes mellitus. Clin Immunol 160:155–162CrossRefGoogle Scholar
  23. 23.
    Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 27:1487–1495CrossRefGoogle Scholar
  24. 24.
    Wang SJ, Shohat T, Vadheim C, Shellow W, Edwards J, Rotter JI (1994) Increased risk for type I (insulin-dependent) diabetes in relatives of patients with alopecia areata (AA). Am J Med Genet 51:234–239CrossRefGoogle Scholar
  25. 25.
    Rajabi F, Amoli MM, Robati RM, Almasi-Nasrabadi M, Jabalameli N, Moravvej H (2019) The Association between Genetic Variation in Wnt Transcription Factor TCF7L2 (TCF4) and Alopecia Areata. Immunological Investigations. Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Network of Dermatology Research (NDR)Universal Scientific Education and Research Network (USERN)TehranIran
  3. 3.National Institute of Health ResearchTehran University of Medical SciencesTehranIran

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