Alopecia Areata (patchy baldness)
FOOD INTOLERANCE NETWORK FACTSHEET
Keywords: alopecia areata, totalis, universalis, gluten, coeliac disease
Alopecia is loss of hair. There are three types:
- alopecia areata (patchy baldness)
- alopecia totalis (complete loss of hair on the scalp)
- alopecia universalis (complete loss of hair on the entire body)
The connection between alopecia and coeliac disease (CD) or gluten intolerance was first reported in 1995(1) and has been followed by similar reports (2,3,4). Alopecia is regarded as a form of coeliac disease that affects the skin like dermatitis herpetiformis so intestinal symptoms are not necessarily present (5).
In one study 6), five patients with both CD and alopecia showed no improvement in hair regrowth on a gluten free diet. Could this be due to mistakes in the diet as mentioned in another Italian study (4)? See reader reports and scientific references below.
FROM  Allergy clinic didn't know about connection (April 2007)
I recently had my appointment with the Allergy Clinic and they didn't know anything about the connection that your website mentions between gluten intolerance and alopecia. I first had alopecia back in 1995 very badly and I do remember my diet being very poor and high in wheat and gluten products, I have only been told that it was probably caused by stress but am interested to learn more. I have had small patches ever since, and my general intake of wheat has been much lower than in 1995. I am now doing the elimination diet for the second time and it has been going better. I failed the wheat challenge on the 3rd night and am interested in the connection with alopecia to gluten as I still have some joint, lethargy and lack of focus issues. – by email
FROM  Discovered the cause of alopecia areata by accident (April 2007)
I suffered from alopecia areata on and off for many years without having any clue about what caused it. It was very embarrassing and difficult for my self confidence. I only stumbled across the answer by accident after I found out about bread preservative 282 - that was where my journey started. I was staying with people who ate preserved bread so it was easier for me to eat rice cakes instead, and I noticed my alopecia improving. I have been gluten free now for three years and have had no more problems with alopecia.
FROM  Alopecia led to diagnosis of coeliac disease (April 2007)
Led to diagnosis of coeliac disease: Your mention of alopecia areata and gluten in "Fed Up" led to my being diagnosed with coeliac disease. No one else seemed to know anything about it, so I really wanted to say thank you. It has led to a huge improvement in my quality of life.
FROM  First bit of useful advice (April 2007)
The information on your website about alopecia areata and gluten is the first bit of useful advice I have received suggesting that alopecia could have another association besides stress.
 Alopecia universalis in a family full of coeliacs (October 2010)
My family is full of coeliacs - I'm about the only one who can eat gluten. I've had the blood test and I don't have CD. My problem is alopecia universalis - for the last 18 years I haven't had a single hair on my entire body (I wear a wig). What is the most likely cause for that? Gluten!?! But I love bread - it’s my favourite food! It’s the only gluten I eat.
- from the Fed Up Roadshow 2010 (In my experience, relatives of coeliacs may pass the blood test but often do much better when avoiding gluten. It could be that they are not eating enough gluten when they do the test because the family diet is likely to be low in gluten to avoid contamination for the coeliacs – S)
 Coeliac, alopecia and Down syndrome (October 2010)
I was interested to read about gluten in your newsletter. I have a niece who is a coeliac, and one of my daughters has alopecia. She also has Down Syndrome. - by email (People with Down Syndrome have a higher prevalence of CD (7%) than the general population which some doctors think as high as 1%.)
 Completely bald from Alopecia Areata (October 2010)
Around the age of about 10 months, my daughter went completely bald from Alopecia Areata (she lost all hair on her head, eyebrows and eye lashes), but fortunately the hair started to grow back around 19 or 20 months. However, we are very disappointed to discover the alopecia appears to be returning as a bald patch has recently appeared on the top of her head. Are you aware of any foods or additives which may have triggered this condition? – by email, we are waiting for a progress report …
People who have a first degree relative with coeliac disease have a very high (10%) chance of being a coeliac. Not all coeliacs experience intestinal symptoms.
Some possible signs of coeliac disease in self or relatives:
bulky, greasy, foul-smelling stools; exceptionally skinny or short stature; type 1 diabetes; Down syndrome; unexplained anaemia, calcium deficiency or other nutritional deficiencies; bone pain; unexplained infertility; alopecia; bowel cancer; skin rashes (dermatitis herpetiformis and others).
More symptoms and photos of rash available here (AAFP.org) (7)
Undiagnosed coeliacs who continue to eat gluten have an increased risk of bowel cancer.
Until recently it was thought that coeliacs should avoid oats but it is now recognised that the majority of people with coeliac disease can tolerate moderate amounts of pure oats, that is, free from contamination by wheat, rye or barley(8). If you are a coeliac, ask your coeliac society for advice. e.g. coeliac support in Australia via the coeliac society.
You don’t have to be a diagnosed coeliac to have problems with gluten. People with severe symptoms of food intolerance are normally advised to do a gluten free version of their elimination diet. In my experience, relatives of coeliacs often do better - with a variety of symptoms - on gluten free diets, whether coeliac or not.
1. Corazza GR and others, Gastroenterology, Celiac disease and alopecia areata: report of a new association,1995;109(4):1333-7.
This was the first report of the association between CD and alopecia areata in a routine clinical practice in Italy. The first patient, a 14 year old boy, was diagnosed with CD due to malabsorption symptoms. A gluten-free diet resulted in complete regrowth of scalp and body hair. Another 3 patients with alopecia areata but no intestinal symptoms, however, biopsy showed they had CD.
2. Storm W, Celiac disease and alopecia areata in a child with Down's syndrome, J Intellect Disabil Res, 2000;44 ( Pt 5):621-3.
A 9-year-old girl with Down's syndrome, alopecia areata and documented celiac disease displayed a normal growth of hair after a gluten-free diet.
3. Fessatou S and others, Coeliac disease and alopecia areata in childhood, J Paediatr Child Health, 2003;39(2):152-4.
A 13-year-old girl and a 29-month-old girl with CD both experienced complete hair growth and improved gastrointestinal symptoms on a gluten free diet.
4. Viola F and others, Reappearance of alopecia areata in a coeliac patient during an unintentional challenge with gluten [Article in Italian], Minerva Gastroenterol Dietol, 1999 ;45(4):283-5.
In a patient with diagnosed coeliac disease whose only presenting symptom was alopecia, the alopecia disappeared completely after a few months of strict gluten free diet and reappeared after an unintentional prolonged introduction of gluten. After a severe gluten free diet, a new and persistent hair growth in the alopecia areas was observed.
5. Collins P and others, Recognition and management of the cutaneous manifestations of celiac disease: a guide for dermatologists, Am J Clin Dermatol, 2003;4(1):13-20.
6. Bardella MT, Alopecia areata and coeliac disease: no effect of a gluten-free diet on hair growth, Dermatology. 2000;200(2):108-10.
In 5 CD patients diagnosed with alopecia (universalis in 3 cases and patchy in 2 cases) a gluten free diet had no effect on hair growth. Did they get the diet right? – it is very difficult to follow a strict gluten free diet anywhere but especially in Italy(4).
7. Pruessner HT. Detecting celiac disease in your patients. Am Fam Physician. 1998 ;57(5):1023-34, 1039-41.
8. Pulido OM and others Introduction of oats in the diet of individuals with celiac disease: a systematic review. Adv Food Nutr Res. 2009;57:235-85.
© Sue Dengate update October 2010