IMPACT OF LIFESTYLE FACTORS, NUTRITIONAL CHOICES AND SUPPLEMENTS ON ALOPECIA AREATA: A LITERATURE REVIEW

Keywords: Alopecia Areata, Lifestyle, Diet, Supplements

Abstract

Alopecia areata (AA) is a chronic, immune-mediated condition characterized by non-scarring hair loss which can significantly impact patients' quality of life. While its precise etiology remains elusive, emerging evidence suggests that various lifestyle factors may contribute to disease onset, progression, and severity. This review aims to synthesize current findings on the potential impact of modifiable lifestyle elements including smoking, alcohol consumption, psychological stress, sleep disturbances, physical activity, obesity, and diet on the pathogenesis and clinical course of AA. The role of specific micronutrients such as iron, vitamin D, zinc, B vitamins, and biotin is also examined. Although several studies suggest associations between these factors and AA, the evidence remains inconsistent and largely observational. At present, no definitive lifestyle modification guidelines can be proposed for AA patients. However, this review underscores the need for increased clinical awareness and further high-quality research to elucidate the mechanisms by which lifestyle and dietary habits may influence autoimmune processes involved in AA, with the ultimate goal of integrating holistic approaches into patient care.

References

Strazzulla, L. C., Wang, E. H. C., Avila, L., et al. (2018). Alopecia areata: Disease characteristics, clinical evaluation, and new perspectives on pathogenesis. Journal of the American Academy of Dermatology, 78(1), 1–12. https://doi.org/10.1016/j.jaad.2017.04.1141

Ho, C. Y., Wu, C. Y., Chen, J. Y., & Wu, C. Y. (2023). Clinical and genetic aspects of alopecia areata: A cutting edge review. Genes, 14(7), 1362. https://doi.org/10.3390/genes14071362

Mirzoyev, S. A., Schrum, A. G., Davis, M. D. P., & Torgerson, R. R. (2014). Lifetime incidence risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. Journal of Investigative Dermatology, 134(4), 1141–1142. https://doi.org/10.1038/jid.2013.464

Pratt, C. H., King, L. E., Jr., Messenger, A. G., Christiano, A. M., & Sundberg, J. P. (2017). Alopecia areata. Nature Reviews Disease Primers, 3, 17011. https://doi.org/10.1038/nrdp.2017.11

Delamere, F. M., Sladden, M. M., Dobbins, H. M., & Leonardi-Bee, J. (2008). Interventions for alopecia areata. Cochrane Database of Systematic Reviews, (2), CD004413. https://doi.org/10.1002/14651858.CD004413.pub2

Zhou, C., Li, X., Wang, C., & Zhang, J. (2021). Alopecia areata: An update on etiopathogenesis, diagnosis, and management. Clinical Reviews in Allergy & Immunology, 61(3), 403–423. https://doi.org/10.1007/s12016-021-08883-0

Rencz, F., Gulácsi, L., Péntek, M., Wikonkál, N., Baji, P., & Brodszky, V. (2016). Alopecia areata and health-related quality of life: A systematic review and meta-analysis. British Journal of Dermatology, 175(3), 561–571. https://doi.org/10.1111/bjd.14497

Sterkens, A., Lambert, J., & Bervoets, A. (2021). Alopecia areata: A review on diagnosis, immunological etiopathogenesis and treatment options. Clinical and Experimental Medicine, 21, 215–230. https://doi.org/10.1007/s10238-020-00673-w

Khanimov, I. (2022). Association between smoking and alopecia areata: A systematic review and meta-analysis. International Journal of Dermatology, 61(1), e22–e24. https://doi.org/10.1111/ijd.15898

Dai, Y. X., Yeh, F. Y., Shen, Y. J., et al. (2020). Cigarette smoking, alcohol consumption, and risk of alopecia areata: A population-based cohort study in Taiwan. American Journal of Clinical Dermatology, 21(6), 901–911. https://doi.org/10.1007/s40257-020-00547-7

Minokawa, Y., Sawada, Y., & Nakamura, M. (2022). Lifestyle factors involved in the pathogenesis of alopecia areata. International Journal of Molecular Sciences, 23(3), 1038. https://doi.org/10.3390/ijms23031038

Tanaka, K., Miyake, Y., Furukawa, S., & Arakawa, M. (2017). Pre- and postnatal smoking exposure and risk of atopic eczema in young Japanese children: A prospective prebirth cohort study. Nicotine & Tobacco Research, 19(7), 804–809. https://doi.org/10.1093/ntr/ntw299

Curtis, K. L., Stubblefield, O., & Lipner, S. R. (2024). Alopecia areata is associated with posttraumatic stress disorder and alcohol use in a case-control study of 4,785 patients. Skin Appendage Disorders, 10(6), 520–523. https://doi.org/10.1159/000539424

Šutić Udović, I., Hlača, N., Massari, L. P., Brajac, I., Kaštelan, M., & Vičić, M. (2024). Deciphering the complex immunopathogenesis of alopecia areata. International Journal of Molecular Sciences, 25(11), 5652. https://doi.org/10.3390/ijms25115652

Ahn, D., Kim, H., Lee, B., & Hahm, D. H. (2023). Psychological stress-induced pathogenesis of alopecia areata: Autoimmune and apoptotic pathways. International Journal of Molecular Sciences, 24(14), 11711. https://doi.org/10.3390/ijms241411711

Talaei, A., Nahidi, Y., Kardan, G., et al. (2017). Temperament-character profile and psychopathologies in patients with alopecia areata. Journal of General Psychology, 144(3), 206–217. https://doi.org/10.1080/00221309.2017.1304889

Díaz-Atienza, F., & Gurpegui, M. (2011). Environmental stress but not subjective distress in children or adolescents with alopecia areata. Journal of Psychosomatic Research, 71(2), 102–107. https://doi.org/10.1016/j.jpsychores.2011.01.007

Rehan, S. T., Khan, Z., Mansoor, H., Shuja, S. H., & Hasan, M. M. (2022). Two-way association between alopecia areata and sleep disorders: A systematic review of observational studies. Annals of Medicine and Surgery, 84, 104820. https://doi.org/10.1016/j.amsu.2022.104820

Seo, H. M., Kim, T. L., & Kim, J. S. (2018). The risk of alopecia areata and other related autoimmune diseases in patients with sleep disorders: A Korean population-based retrospective cohort study. Sleep, 41(9), zsy111. https://doi.org/10.1093/sleep/zsy111

Inui, S., Hamasaki, T., & Itami, S. (2014). Sleep quality in patients with alopecia areata: Questionnaire-based study. International Journal of Dermatology, 53(1), e39–e41. https://doi.org/10.1111/j.1365-4632.2012.05570.x

Rajoo, Y., Wong, J., Cooper, G., et al. (2019). The relationship between physical activity levels and symptoms of depression, anxiety and stress in individuals with alopecia areata. BMC Psychology, 7, 48. https://doi.org/10.1186/s40359-019-0324-x

Jiang, Y., Shi, Q., Huang, Y., Li, J., Xie, H., & Liu, F. (2021). Relationship between exercise and severity of androgenic alopecia. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 46(7), 725–730. https://doi.org/10.11817/j.issn.1672-7347.2021.200801

Wohl, Y., Mashiah, J., Noy, O., Drutin, Y., Vered, S., & Ben-Tov, A. (2025). Alopecia areata is associated with an increased risk for prediabetes and obesity: A nationwide case-control study. Journal of Personalized Medicine, 15(1), 16. https://doi.org/10.3390/jpm15010016

Versini, M., Jeandel, P. Y., Rosenthal, E., & Shoenfeld, Y. (2014). Obesity in autoimmune diseases: Not a passive bystander. Autoimmunity Reviews, 13(9), 981–1000. https://doi.org/10.1016/j.autrev.2014.07.001

Stochmal, A., Waśkiel-Burnat, A., Chrostowska, S., et al. (2021). Adiponectin as a novel biomarker of disease severity in alopecia areata. Scientific Reports, 11(1), 13809. https://doi.org/10.1038/s41598-021-92853-1

Nakamizo, S., Honda, T., Adachi, A., et al. (2017). High fat diet exacerbates murine psoriatic dermatitis by increasing the number of IL-17-producing γδ T cells. Scientific Reports, 7(1), 14076. https://doi.org/10.1038/s41598-017-14292-1

Silva, F. M. C. E., Oliveira, E. E., Ambrósio, M. G. E., et al. (2020). High-fat diet-induced obesity worsens TH2 immune response and immunopathologic characteristics in murine model of eosinophilic oesophagitis. Clinical & Experimental Allergy, 50(2), 244–255. https://doi.org/10.1111/cea.13533

Yan, A., Drake, L., Hadsall, S., Gaurav, A., Xia, E., & Mostaghimi, A. (2024). Evaluating the sources and types of dietary and nutritional advice for patients with alopecia areata. Archives of Dermatological Research, 316(6), 283. https://doi.org/10.1007/s00403-024-02940-2

Pham, C. T., Romero, K., Almohanna, H. M., Griggs, J., Ahmed, A., & Tosti, A. (2020). The role of diet as an adjuvant treatment in scarring and nonscarring alopecia. Skin Appendage Disorders, 6(2), 88–96. https://doi.org/10.1159/000504786

Tomobe, Y. I., Morizawa, K., Tsuchida, M., Hibino, H., Nakano, Y., & Tanaka, Y. (2000). Dietary docosahexaenoic acid suppresses inflammation and immunoresponses in contact hypersensitivity reaction in mice. Lipids, 35(1), 61–69. https://doi.org/10.1007/s11745-000-0495-0

Sawada, Y., Honda, T., Hanakawa, S., et al. (2015). Resolvin E1 inhibits dendritic cell migration in the skin and attenuates contact hypersensitivity responses. Journal of Experimental Medicine, 212(11), 1921–1930. https://doi.org/10.1084/jem.20150381

Bonaccio, M., Pounis, G., Cerletti, C., et al. (2017). Mediterranean diet, dietary polyphenols and low grade inflammation: Results from the MOLI-SANI study. British Journal of Clinical Pharmacology, 83(1), 107–113. https://doi.org/10.1111/bcp.12924

Rebello, D., Wang, E., Yen, E., Lio, P. A., & Kelly, C. R. (2017). Hair growth in two alopecia patients after fecal microbiota transplant. ACG Case Reports Journal, 4, e107. https://doi.org/10.14309/crj.2017.107

Trost, L. B., Bergfeld, W. F., & Calogeras, E. (2006). The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. Journal of the American Academy of Dermatology, 54(5), 824–844. https://doi.org/10.1016/j.jaad.2005.11.1104

Zhang, D., LaSenna, C., & Shields, B. E. (2023). Serum ferritin levels: A clinical guide in patients with hair loss. Cutis, 112(2), 62–67. https://doi.org/10.12788/cutis.0837

Aksu Cerman, A., Sarikaya Solak, S., & Kivanc Altunay, I. (2014). Vitamin D deficiency in alopecia areata. British Journal of Dermatology, 170(6), 1299–1304. https://doi.org/10.1111/bjd.12980

Harvey, C. J. (2020). Combined diet and supplementation therapy resolves alopecia areata in a paediatric patient: A case study. Cureus, 12(11), e11371. https://doi.org/10.7759/cureus.11371

Lin, X., Meng, X., & Song, Z. (2019). Vitamin D and alopecia areata: Possible roles in pathogenesis and potential implications for therapy. American Journal of Translational Research, 11(9), 5285–5300.

Abdel Fattah, N. S., Atef, M. M., & Al-Qaradaghi, S. M. (2016). Evaluation of serum zinc level in patients with newly diagnosed and resistant alopecia areata. International Journal of Dermatology, 55(1), 24–29. https://doi.org/10.1111/ijd.12769

Tzellos, T. G., Tahmatzidis, D. K., Lallas, A., Apostolidou, K., & Goulis, D. G. (2009). Pernicious anemia in a patient with type 1 diabetes mellitus and alopecia areata universalis. Journal of Diabetes and Its Complications, 23(6), 434–437. https://doi.org/10.1016/j.jdiacomp.2008.05.003

Zafad, S., Madani, A., Harif, M., Quessar, A., & Benchekroun, S. (2007). Pernicious anemia associated with autoimmune hemolytic anemia and alopecia areata. Pediatric Blood & Cancer, 49(7), 1017–1018. https://doi.org/10.1002/pbc.20896

Ertugrul, D. T., Karadag, A. S., Takci, Z., et al. (2013). Serum holotranscobalamine, vitamin B12, folic acid and homocysteine levels in alopecia areata patients. Cutaneous and Ocular Toxicology, 32(1), 1–3. https://doi.org/10.3109/15569527.2012.683499

Thompson, J. M., Mirza, M. A., Park, M. K., Qureshi, A. A., & Cho, E. (2017). The role of micronutrients in alopecia areata: A review. American Journal of Clinical Dermatology, 18(5), 663–679. https://doi.org/10.1007/s40257-017-0285-x

Trüeb, R. M. (2016). Serum biotin levels in women complaining of hair loss. International Journal of Trichology, 8(2), 73–77. https://doi.org/10.4103/0974-7753.188040

Camacho, F. M., & García-Hernández, M. J. (1999). Zinc aspartate, biotin, and clobetasol propionate in the treatment of alopecia areata in childhood. Pediatric Dermatology, 16(4), 336–338. https://doi.org/10.1111/j.1525-1470.1999.pdele65.x

Published
2025-12-26
Citations
How to Cite
Martyna Różańska, Karolina Niewola, Kacper Rozenberg, & Justyna Stryjecka. (2025). IMPACT OF LIFESTYLE FACTORS, NUTRITIONAL CHOICES AND SUPPLEMENTS ON ALOPECIA AREATA: A LITERATURE REVIEW. International Journal of Innovative Technologies in Social Science, 2(4(48). https://doi.org/10.31435/ijitss.4(48).2025.4255