Background: Autoimmune blistering diseases (AIBD) are characterised by the body’s self-production of antibodies against structural proteins in the epidermis and/ or the basement membrane on cutaneous and mucosal surfaces. Alopecia is a complication of AIBD that has generally been overlooked in patients with severe blistering diseases because it is regarded as a cosmetic issue. Recent research into quality of life tools has found that stigmatisation by appearance plays a significant role in blistering diseases, but there is no consensus about the types of alopecia present in these patients to possibly address the best management approach.
Aim: To review the current literature detailing the pathogenesis and clinical presentations of alopecia in AIBD patients.
Method: Relevant studies were searched in Medline, PubMed and EMBASE electronic databases up to July 2018, and included according to clinical presentations of disease in humans and animals.
Results: Only 35 human studies including 245 patients (220 pemphigus, 17 pemphigoid, 5 epidermolysis bullosa acquisita, 1 linear IgA disease) detailed the demographic and clinical manifestations of alopecia in AIBD patients. A range of hair evaluation methods was demonstrated to reach alopecia diagnosis. Furthermore, there is no universal validated scoring system for alopecia severity, so alopecia patterns are summarised.
Conclusion: With alopecia being an outcome that had not been highlighted as significant when previous randomised trials were conducted, epidemiological evaluation of the available literature can be helpful in summarising the trends between small case series and cohorts. Additionally, alopecia is a relatively long-term, and in some AIBD types, a rare complication, so preliminary evidence still demonstrates gaps and inconsistencies in the literature.