D1.241 - Clinical and Immunological Phenotypes of Alopecia Areata in Children with Atopic Dermatitis

Alopecia areata (AA) and atopic dermatitis (AD) are chronic immune-mediated diseases that frequently coexist in children with an  association between AA and AD.  The goal of the study was to  characterize clinical and immune phenotypes of AA in children with concomitant AD using cluster analysis.

A single-center, cross-sectional study included 68 children aged 5-16 years with AA and AD. Clinical and laboratory assessments included the study of disease severity by SALT -severity of alopecia tool and  SCORAD -SCORing atopic dermatitis,  age of AA onset, quality of life (CDLQI),  and atopic comorbidity. The total IgE level was determined by  ELISA. Spearman’s correlation and k-means clustering (variables: SALT, SCORAD, IgE, age of AA onset) were used.

Spearman’s correlation analysis revealed several significant relationships. A moderate positive correlation was observed between AA severity (SALT) and AD severity (SCORAD) (ρ = +0.512, p < 0.001). Both SALT and SCORAD showed moderate positive correlations with impaired quality of life (CDLQI: ρ = +0.532 and ρ = +0.469, respectively; p <0.001 for both). A  significant moderate negative correlation between SALT and the age of AA onset (ρ = -0.418, p = 0.001), indicated that an earlier disease onset was associated with more severe hair loss. Serum IgE levels demonstrated significant positive correlations in  both disease severity measurements. Cluster analysis   identified 3 distinct clinical phenotypes.  The findings suggest at least two pathways to severe alopecia: driven by very early disease onset and another by a severe, systemic Th2 atopic burden.

Heterogeneity in pediatric AA with AD, delineating distinct phenotypic profiles occurs. Stratification by age of onset, disease severity, and atopic load facilitates personalized management and identifies children at the highest risk for severe disease and quality of life impairment.