Surprising Link Between Alopecia & the Gut

Emerging research suggests that probiotics may play a role in supporting individuals with alopecia areata by promoting a healthy gut microbiome. A well-balanced gut is linked to immune regulation, which is crucial in autoimmune conditions like alopecia. By addressing gut dysbiosis and inflammation, probiotics could offer a supportive approach to managing this condition.

Within this article:

• What is alopecia?
• Allopathic treatment
• A complimentary health perspective
• Probiotics for alopecia

What is alopecia?

Alopecia areata is an autoimmune condition in which the immune system mistakenly targets hair follicles, leading to hair loss that can be patchy or complete. This hair loss may be sudden or gradual, with potential relapses over time. While the exact cause remains unclear, research suggests a combination of genetic predisposition and environmental triggers, such as stress or coexisting autoimmune conditions like Systemic Lupus Erythematosus (SLE) or Hashimoto’s thyroiditis¹. Due to its unpredictable nature and emotional impact, alopecia continues to be a focus of ongoing research into potential treatments and management strategies.

Allopathic treatment

Conventional medical treatment for alopecia areata primarily involves corticosteroids, administered either through topical applications, intralesional injections, or systemic therapy². While these treatments may help suppress the autoimmune response and promote temporary hair regrowth, their effectiveness varies, and relapse is common. Other options, such as immunotherapy, minoxidil, and JAK inhibitors, have shown promise in some cases³, but there is currently no definitive cure. In some individuals, spontaneous regrowth occurs within a year, but this is not guaranteed. The psychological impact of alopecia can be significant, often leading to distress and anxiety, which may further influence disease progression⁴. As a result, a holistic approach - including psychological support and lifestyle interventions - is often beneficial in managing the condition.

A complimentary health perspective

It is generally accepted within the field of complementary health, that auto-immune conditions stem from the gut. Alopecia is thought to be a consequence of faulty digestion, rather than the primary condition. It appears that many sufferers of alopecia do have some form of digestive condition, or have been through a prolonged period of stress or anxiety which hinders digestion and alters gut flora.

Stress is well known to have a negative impact on digestion by reducing blood and nutrient flow to the digestive tract. Extreme stress can also reduce the levels of ‘friendly’ bacteria in the gut, which in turn can lead to an over-growth of pathogenic strains of bacteria. These pathogenic microbes release a myriad of different toxins and inflammatory factors which can damage the intestinal wall, and lead to a leaky gut situation. Once the epithelial lining of the GI tract has become ‘leaky’ (or permeable) in this way then toxins and partially digested food particles can leak through in to the blood stream causing many different health complications.

One of the biggest impacts of having a leaky gut is the burden this places on the immune system. Undigested food particles, that should not be present in the blood stream, cause the immune system to mount an immune response against them. If this is happening on a constant basis then the immune system can become hyper-sensitive and start attacking its own tissues, which in the case of alopecia would mean the destruction of hair follicles, resulting in hair loss.

Probiotics for alopecia

Recent research has begun to explore the potential role of probiotics in managing alopecia areata (AA), an autoimmune condition characterized by hair loss. The gut-skin axis suggests a connection between intestinal health and skin conditions, including AA. Probiotics, known for their immunomodulatory effects, may influence this axis and offer therapeutic benefits.

A 2024 randomized, double-blind, placebo-controlled clinical trial investigated the effects of an oral probiotic mixture on patients with AA⁵. The study administered a combination of Lactobacillus rhamnosus and Bifidobacterium longum strains over a 24-week period. Results indicated that 56% of participants in the probiotic group experienced a reduction in the number of alopecia plaques, compared to 30% in the placebo group. Additionally, improvements in affected scalp surface area were observed in 45% of the probiotic group versus 20% of the placebo group. Notably, changes in the skin microbiota were detected among those receiving probiotics, suggesting a potential mechanism of action.

While emerging studies suggest that specific probiotic strains may offer benefits in managing alopecia areata and promoting overall hair health, further research is needed to establish standardized treatment protocols. Health practitioners should consider the potential of probiotics as a complementary approach, tailored to individual patient needs and based on the latest clinical evidence.

To read more about the impact of our gut flora on auto-immune conditions, you may like to read the following blog:

Gut bacteria linked to rheumatoid arthritis and other auto-immune conditions.

References

1. Strazzulla, L. C., Wang, E. H., 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.
2. Gilhar, A., Etzioni, A., & Paus, R. (2012). Alopecia areata. New England Journal of Medicine, 366(16), 1515-1525.
3. King, B., Ohyama, M., Kwon, O., et al. (2021). Two Phase 3 Trials of Baricitinib for Alopecia Areata. New England Journal of Medicine, 386(18), 1687-1699.
4. Liu, L. Y., King, B. A., & Craiglow, B. G. (2016). Health-Related Quality of Life in Alopecia Areata: A Systematic Review and Meta-analysis. JAMA Dermatology, 152(1), 90-96.
5. Navarro-Belmonte, M. R., et al., (2024). The Effect of an Oral Probiotic Mixture on Clinical Evolution and the Gut and Skin Microbiome in Patients with Alopecia Areat