The Vascular and Metabolic Face of Alopecia Areata: Insights from an Indian Cohort

Abstract Background: Alopecia areata (AA) is a chronic, immune-mediated disorder characterized by nonscarring hair loss. Emerging evidence suggests that AA is associated with systemic inflammation, metabolic dysregulation, and coagulation abnormalities. However, data on these associations in the Indian population remain limited. Aim and Objectives: To evaluate coagulation parameters, metabolic profiles, and inflammatory markers in Indian patients with AA and assess their correlation with disease severity. Patients and Methods: A case-control study was conducted at a tertiary care center in North India, including 110 AA patients and 110 age- and sex-matched healthy controls. Coagulation parameters (D-dimer, fibrinogen, prothrombin time, and activated partial thromboplastin time), metabolic markers [fasting blood glucose, lipid profile, body mass index (BMI)], and inflammatory markers [C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)] were analyzed. Disease severity was assessed using the Severity of Alopecia Tool (SALT) score. Correlation and multivariate regression analyses were performed to identify predictors of severe AA. Results: AA patients exhibited significantly elevated D-dimer ( P < 0.001) and fibrinogen levels ( P < 0.001) compared to controls, indicating a hypercoagulable state. The prothrombin time was also prolonged ( P = 0.03). Metabolic abnormalities, including higher fasting blood glucose ( P < 0.001) and total cholesterol ( P = 0.008), were observed. Inflammatory markers (CRP and ESR) were significantly elevated in AA patients. A strong positive correlation was found between SALT scores and D-dimer levels (r = 0.64, P < 0.001). Multivariate regression analysis identified D-dimer (95% CI: 1.58–4.20), fibrinogen (95% CI: 1.41–3.11), CRP (95% CI: 1.23–2.97), and BMI (95% CI: 1.18–2.46) as independent predictors of severe AA. Limitations: Cross-sectional study design and lack of longitudinal follow-up. Conclusion: Indian AA patients exhibit significant coagulation abnormalities, metabolic dysregulation, and systemic inflammation, with these factors correlating with disease severity. These findings suggest that AA extends beyond a localized dermatological disorder and may have systemic implications. These associations imply a link rather than causality due to the cross-sectional nature of the study. Further research is warranted to explore the role of targeted therapies in mitigating these risks.