Alopecia Areata Research: ANA, Thyroid Tests and Prevalence Study

This report presents a comprehensive study on Alopecia Areata (AA), an autoimmune disease characterized by sudden hair loss, focusing on its prevalence and associations within the Omani population. The research investigates the correlation between AA and both ANA blood testing and thyroid dysfunction, aiming to identify diagnostic procedures and improve treatment strategies. The study outlines the rationale, aims, and objectives, including the prevalence of AA and its association with autoimmune disorders and thyroid dysfunctions. The methodology includes a detailed research design, study location, target population characteristics, and data analysis plans. The report also addresses limitations, ethical considerations, and expected results, emphasizing the importance of early diagnosis and its potential impact on reducing the lifetime risk of AA. The literature review provides background on AA, its types, pathogenesis, and the role of autoimmune disorders. The research aims to measure the prevalence and association between ANA blood testing and thyroid dysfunction testing among the patients with alopecia areata. The study employs both a null and an alternative hypothesis to test the relationships between these factors. The report concludes with a discussion of the findings and recommendations for further research in this area.

Running head: HEALTHCARE
TESTS FOR ALOPECIA AREATA
Name of the Student
Name of the University
Author Note

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Table of Contents
Introduction................................................................................................................................3
Background............................................................................................................................3
Rationale................................................................................................................................4
Justification of the Research..................................................................................................6
Aims and Objectives..............................................................................................................7
Research Hypothesis..............................................................................................................8
Literature Review.......................................................................................................................8
Methodology and Research Design.........................................................................................14
Study Design........................................................................................................................14
Study Location.....................................................................................................................15
Target population Characteristics........................................................................................15
Study Period.........................................................................................................................16
Expected Sample Size..........................................................................................................17
Research strategy and plan for Data analysis.......................................................................17
Study area and Target population........................................................................................18
Sample Design.....................................................................................................................19
Data collection and tools for measurement..........................................................................20
Pilot study.............................................................................................................................21
Data Management................................................................................................................21
Quality Control of Data........................................................................................................22

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Importance of the Topic.......................................................................................................22
Work Plan.............................................................................................................................23
Monitoring of research activities...........................................................................................0
Limitations.............................................................................................................................0
Ethical Considerations...........................................................................................................0
Expected results.........................................................................................................................1
Beneficiaries of the results...................................................................................................17
Conclusion................................................................................................................................17
Recommendations....................................................................................................................18
References................................................................................................................................19

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Introduction
Background
Alopecia areata has been observed to be an autoimmune disease which arise due to
various environmental and genetic factors. The name of this disease can be abbreviated as
AA (Alopecia areata). This is a dermatological and multifactorial disorder which is
characterized by hair loss which is sudden. This condition has been observed to get improved
by itself without scarring (1). Autoimmune diseases are conditions which arise when the
body’s own immune system attacks the normal constituents of it. This means that, the body
recognizes its own components as foreign antigens and generates antibodies against it to kill
them. The primary function of the human immune system is to recognize its own body
components as self and to recognize any external components as foreign (2). This procedure
has been phrased as self non self-recognition and is mainly done by antigen presenting cells.
The antigen presenting cells function by exposing the segments of external antigens to the
antibodies for their neutralization. There are various signs and symptoms of the disease
characterized by an acute phase (). In the acute phase, lymphocytic infiltration is observed
around the hair bulb region of the anagen follicles. Inspite of the effects of inflammatory
components, the follicles still has its potential to produce hair which implies the fact that
follicular stems remains viable. Next comes the relapsing phase which has its effect on the
physical appearance. This phase makes the development of a distressing and life changing
effect in many of the affected individuals. According to various statistical reports, it has been
observed that the prevalence perentage of AA is 0.15% and is observed to affect 2.5% of all
dermatological patients presented in hospitals per year (3). AA has various types which
includes patchy alopecia, alopecia totalis and alopecia reticularis. Scientific studies have still
not identified the actual pathway of pathogenesis associated with alopecia. According to

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some research studies, it can be said that patients with thyroid dysfunction have higher
chances of AA along with a higher frequency. This condition is accompanied by an
autoimmune disorder to enhance the effect of AA (4). Thus, it can be stated that the
combination of an autoimmune disorder and thyroid dysfunction enhances the effect of AA.
All these interpretations have been made from existing research studies in the field of
pathology and medical science. Concomitant cutaneous and systemic diseases have been
found to be related to alopecia areata, according to several pieces of literatures. This study
will focus on understanding the prevalence and association of ANA blood testing and
abnormal thyroid function tests in patients with alopecia areata (5). In Oman, there is a
significant amount of cases considering AA which do not have any statistical knowledge in
the human population (6). This means that this research has not been conducted by different
researchers at an initial stage of the disease. Majority of AA has been observed to be
prevalent among all the age groups. However, the prevalence of this disease is higher
between 2nd and 4th decades of the human life. AA has been observed as a chronic disease
which is primarily due to characteristic and episodic recurrent patterns. The diagnosis of this
disease is based on inspection ,and the pathophysiology and etiology of the disease is still
unclear. The autoimmune disease condition has been observed to be characterized by the
infiltration of T cells (7). AITD can also be expected to be associated to the autoimmune
diseased condition. However, according to the number of researches done on the frequency of
AA in patients and their associations with blood testing and thyroid testing are still lower.
This study has been performed on the autoimmune diseases because the prevalence of AA
has increased in patients suffering from type 1 diabetes mellitus, thyroiditis, vitiligo and
pemphigus vulgaris (autoimmune diseases).

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Rationale
The context of this research study is the prevalence of AA among the Oman
population. The main discussion of this study is the prevalence, association of ANA blood
testing, and abnormal thyroid tests in patients with alopecia areata. Rationale section provides
the reason of choosing this topic for this research study. ANA blood testing can be used to
check whether the autoimmune condition is present in the blood associated with thyroid
dysfunction. Thus, two types of testing will be considered for this study, which will identify
the correlation between thyroid related factors and blood with the occurrence of AA (8).
According to various research studies, it has been found that much research has not
been done on the prevalence of AA among the Omani population. AA is characterized by T
cell infiltration and the production of cytokines. This disease is characterized by an acute
progressive phase which is characterized by the lymphocytic infiltration which occurs around
the follicles (9). Thus, a prompt identification of the disease is required in the Omani
population since much studies has not been performed. AA is a disease which has not been
researched well in today’s world sue to its unclear pathology and etiology.
The chosen topic of this research study is the association and prevalence of alopecia
areata in ANA blood testing and thyroid function testing. This research topic has no
identified pathology and thus there is an increased interest if the researchers in this topic. AA
is one of the common causes of alopecia (nonscarring) which occurs in a confluent, patchy
and diffuse pattern. The reported incidence of AA in the world is 0.1 to 0.2% with a risk of
1.7% for lifetime prevalence in some women and men. Men and women has been found to be
affected equally (10).
This research study is helpful for the treatment of people suffering from AA in Oman
since it helps in an early diagnosis of the disease. AN early diagnosis helps in the decrease in

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the prevalence of the disease and reduces the lifetime risk of the disease. Since there is no
clear pathological procedure available for this disease and is also associated with an
autoimmune condition, therefore an early diagnosis can lead to a complete treatment of this
disease and decreases the prevalence of lifetime risk among the patients (11). Thus, it can be
stated that in this way this research will help in the identification of the diagnostic procedures
responsible for the curing of AA in the associated patients.
Justification of the Research
Any research study, either qualitative or quantitative requires a justification before it
is performed on a particular topic. The above stated topic is of significant importance since it
is has not been researched still in depth for the Omani population. This research study will be
of a significant importance in the field of medical science and pathology. This is because of
the fact that much research studies have not been performed on this topic, which is associated
with a disease. This disease is farther associated with an autoimmune condition along with an
effect of thyroid dysfunction. Omani population has been found to be associated with the
prevalence of this disease throughout the world from a long period of time (12). This is
because of the fact that the scientists did not perform research studies to understand the
complicated pathology of this disease. This research study is helpful for the treatment of
people suffering from AA in Oman since it helps in an early diagnosis of the disease. AN
early diagnosis helps in the decrease in the prevalence of the disease and reduces the lifetime
risk of the disease. The above stated rationale discusses the facts, which is the primary reason
for research on this topic (13). Since there is no clear pathological procedure available for this
disease and is also associated with an autoimmune condition, therefore an early diagnosis can
lead to a complete treatment of this disease and decreases the prevalence of lifetime risk
among the patients. Thus, it can be stated that in this way this research will help in the
identification of the diagnostic procedures responsible for the curing of AA in the associated

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patients. Thus, the reason of associations between blood testing processes and thyroid
dysfunction tests cannot be identified in the previous research studies. Alopecia areata has
been studied in only in terms of signs and symptoms of the disease along with its lifetime
prevalence rates and risks. However, no study about the pathophysiology of this disease and
importance of the identification and diagnosis tests required for the treatment of AA was not
performed (14). Therefore, it can be stated that a research based on this topic is justified and
is also supported by the presence of rationale as discussed in the previous section of this
paper.
Aims and Objectives
The primary aim of this research study is to measure the prevalence and association
between ANA blood testing and thyroid dysfunction testing among the patients with alopecia
areata. The secondary aim of this research study is to measurer the incidence and prevalence
of alopecia areata in patients with autoimmune disorders and thyroid dysfunctions.
The objectives of this research study are-
 To identify the prevalence of ANA blood testing in patients with alopecia areata.
 To measure the association between ANA blood testing in patients with alopecia
areata.
 To measure the prevalence of thyroid dysfunction testing among the patients with
alopecia areata.
 To measure the association between thyroid dysfunction testing among the patients
with alopecia areata.
 To measure the prevalence and association between ANA blood testing and thyroid
dysfunction among the patients with alopecia areata.
The research questions are as follows-

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RQ1: What is the prevalence of ANA blood testing in patients with alopecia areata.
RQ2: What is the association between AN blood testing in patients with alopecia areata.
RQ3: What is the prevalence of thyroid dysfunction test among the patients with alopecia
areata.
RQ4: What us the association between thyroid dysfunction test and alopecia in patients.
RQ5: What is the measure of prevalence and association between ANA blood testing and
thyroid dysfunction testing among the patients with alopecia areata.
Research Hypothesis
There are two hypothesis of this research study, one null hypothesis and an alternate
hypothesis. These two hypothesis are stated below-
H0 = The null hypothesis states that there is no prevalence or association between ANA blood
testing and thyroid dysfunction testing in patients with alopecia areata.
H1 = The alternate hypothesis states that there is an increased prevalence and association
between ANA blood testing and thyroid dysfuncton testing in patients with alopecia arerata.
These two hypothesis will be tested after the results section for the existence of
prevalence and association between those two tests among the patients with alopecia areata.
The following sections will discuss the existing pieces of literature available on this
topic followed by a sectioned discussion of the methodology used for this research study,
observing the results and analyzing them followed by a proper discussion of the research.
This paper ends by stating the conclusion and further recommendations for this study. A
work plan for this research will be stated at the end of this research.

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Literature Review
Alopecia areata is one of the most common causes of localized and non scarring
alopecia (15). However, there is very few data about this topic since the clinical features of
pathology and epidemiological data of alopecia areata are not available on a large scale. The
clinical course of the patient suffering from alopecial areata is also unpredictable. The main
objective if this study was to investigate the risk factors of alopecia areata and the clinical
profiles of the associated patients. The procedure of this study followed a retrospective cross
sectional study which involved a total of 1137 patients from 2006 to 2015. The patients were
divided into two groups (mild to moderate and sever alopecia areata). After the study was
conducted, it was found that patients with nail changes and thyroid diseases were the most
common in the severe group. Various other symptoms are also associated with the disease
which have been identified by this study. Hypertension, diabetes mellitus, atopic dermatitis,
dyslipidemia and family history did not differ between the groups proving that these were the
associated risk factors of the disease. Thus, it can be stated that there are various risk factors,
out of which thyroid dysfunction is the major factor for the occurrence of alopecia areata.
Therefore, thyroid dysfunction tests are important for the early diagnosis of AA in human
beings.
According to the authors of a study discussing the pathophysiology and risk factors of
AA, this is one of the most common autoimmune disorders characterized by the loss of hair
in single or multiple circumscribed round patches which occur typically on the human scalp
(16). The authors stated that the disorders associated with AA includes the present of auto
reactive T cells which attacks the hair follicles in the growth phase which disrupts the normal
cycle of hair. AA has been observed to be an autoimmune disorder which is most frequently
associated with Hashimoto’s thyroiditis which has a limited evidence guiding the disorder
treatment. There are various successes in the filed on intralesional steroid injections, topical

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immunimudulators, topical corticosteroids and phototherapy. According to the scientists,
there is no observable and effective cure for AA especially with those, which experiences a
spontaneous regrowth of hair. Thus, it can be stated ANA blood testing to check the presence
of auto reactive T cells is important in the early diagnosis of the disease. This paper also talks
about certain secondary associations of AA, which make the disorder more prevalent and
become harder to be cured.
Another research study stated that characterization of blood profiles is important in
AA not only for the treatment procedure but also for the identification of biomarkers
responsible for the elimination of the need for biopsies of scalp (17). This study aimed at the
comparative study of CLA+ skin homing vs CLA- polar CD4+ and CD8+, which activates the T
cell subsets in AD (atopic dermatitis) vs AA and control blood. This study also performed
flow cytometry study in order to measure the levels interferon gamma “IFN‐γ” and “L‐13,
IL‐9, IL‐17, and IL‐22 cytokines in CD4+ and CD8+ T cells”. After the comparison of
peripheral blood from moderate to severe AA exposed adults was performed it was found that
T regulatory cells were decreased in patients with AA. On a concluding note, it was found
that the activation of helper T cells in skin homing was associated with the severity of
disease. Since these cells are primarily found to be associated with blood, it can be said that
ANA blood testing is important to understand the prevalence of AA in a particular individual.
This study can also be stated to enhance the process of pathogenesis understanding of the
disease AA in human beings.
Alopecia areata has been observed as an autoimmune disorder, which is characterized
by non scarring and transient hair loss. This disease is also associated with the preservation of
hair follicle (18). The process of hair loss ranges from a loss in well defined patches to a total
loss of hair. Alopecia areata has been found to be affect nearly 2% of the general population
of Oman during some point of the life. According to the skin biopsies performed for the

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detection of AA, lymphocytic infiltration has been found to occur around the skin and around
the lower part of the hair follicle (anagen). Thus, it can be stated that, blood testing is
important the identification of this disorder. Genetic studies has showed that patient and
mouse models shows a complex and polygenic pathology of the disease. Alopecia areata has
been observed to be based on dermoscopy and histopathology, which can be very helpful.
This study also stated that AA is very difficult to manage medically however recent advances
in the understanding the pattern of molecular mechanisms associated with the treatment and
possibility of remission. Thus, it can be stated that AA can easily be diagnosed by ANA
blood testing since the symptoms are associated with the presence of associated lymphocytes
in blood.
Another research paper studies that cytotoxic T lymphocyte associated protein 4
associated with programmed cell death protein and cell deaths associated with protein ligand
1 monoclonal antibodies, which are immune checkpoint inhibitors) have been used to treat
several malignancies (19). The authors stated that the disorders associated with AA includes
the present of auto reactive T cells which attacks the hair follicles in the growth phase which
disrupts the normal cycle of hair. According to this study, the inhibition of negative
regulators associated with immune activation, which results in adverse events, which includes
pneumonitis, hepatitis, colitis, and dermatological events. Secondary immune checkpoint
inhibitors have been reported 1 to 2% patients with AA. Four cases have been reported in
patients who developed complete alopecia while the treatment was going on with immune
checkpoint inhibitors. Thus, it can be stated that ANA blood testing is require for the
diagnosis and onset of AA among the human population.
According to the epidemiologic reports, retrospective analysis of the thyroid function
records have always been found to be associated with AA (20). Thus, it can be stated that a
high prevalence of AA has been associated with the increase of thyroidal dysfunction among