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Fatty Liver More Frequent in Alopecia Universalis and Patchy Alopecia Areata


Investigators examined the association between fatty liver and AA subtypes.

Nadya Kolobova/AdobeStock
Nadya Kolobova/AdobeStock

A recent study published in the Journal of Cosmetic Dermatology examined the frequency of fatty liver in patients with alopecia areata subtypes, including alopecia universalis (AU) and patchy alopecia areata (PAA).1 After reviewing data from patients with AU and PAA referred to a dermatology clinic from September 23, 2019, to September 23, 2020, study investigators determined that fatty liver was more frequent in patients with AU and PAA compared to a control group, but without statistically significant differences.

Patients without hair loss disorders who attended the same clinic were selected as the control group. Additionally, patients with known liver diseases were excluded from the case-control study. The study investigators began collecting data from the AU and PAA patient groups, including age, sex, weight, and waist circumference. Disease duration and the Severity of Alopecia Tool (SALT) score were also documented among the AU and PAA patient groups.

Overall, 32 patients were included in each study group: AU, PAA, and control. Age, sex, weight, height, BMI, and waist circumference were comparable across all 3 groups. The study investigators found that the frequency of hyperlipidemia was the highest in AU patients (31.3%), followed by PAA patients (15.6%), but the difference was not statistically significant among the groups (p = 0.131). Abnormal liver enzymes were recorded in 9.4% of AU patients, 12.5% of PAA patients, and 3.1% of controls (p = 0.524). Statin use was also the highest in AU patients (28.1%), with no statistically significant difference among the 3 groups. Finally, disease duration and SALT score were significantly higher in the AU patient group than in the PAA patient group (p = 0.009 and p < 0.001, respectively).

The study investigators noted that “The higher frequency of fatty liver in AU patients compared with the PAA group can be attributed to the longer disease duration and the higher SALT score in this group. To the best of our knowledge, in previous studies, fatty liver has not been evaluated in patients with AA. Still, recently the replacement of nonalcoholic fatty liver disease (NAFLD) with metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed, highlighting the association between fatty liver and metabolic syndrome.”

The investigators also noted that the higher frequency of fatty liver in AA patients may be related to an oxidant/antioxidant imbalance, which was reported in the study’s patients. Overall, the study suggests that there may be an association between fatty liver and the AU subtype, but larger studies are needed to confirm the correlation.


  1. Tehranchinia, Z, Abdollahimajd, F, Haghighatkhah, H, Talebi, A, Yarahmadi, A, Zoghi, G. The frequency of fatty liver in patients with alopecia areata: A case–control study. J Cosmet Dermatol. 2023; 00: 1- 5. doi:10.1111/jocd.15754
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