10.5826/dpc.1301a17
Objective: To investigate the role of ischemia-modified albumin (IMA) and IMA/albumin levels in patients with AA.
Methods: The present prospective crossectional study includes patients ≥ 18 who admitted to the Dermatology and Venerology Department of XXXX University Hospital between April 1 2021, and September 30 2021. 70 patients participated in the study (n=34 for the study group and n=36 for the control group). Demographic features, clinical characteristics, IMA, and IMA/albumin levels were compared between the groups. Study group was divided into subgroups based on the number of patches, disease duration, and number of disease attacks. IMA and IMA/albumin levels were compared between each subgroup.
Results: Study and control groups were similar with regard to demographic features and clinical characteristics. Significant differences were observed between the mean IMA and IMA /albumin ratio (p=0.004 and 0.012, respectively). The study subgroups were comparable for the number of patches, disease duration and number of disease attack.
Conclusion: Although oxydative stress is an important component in the etiology of AA, IMA and IMA/albumin may not be useful in the prediction of disease severity in patients with AA.
text/xml
2160-9381
2420
en
Erel Ozcan
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
disease severity
The Role of Ischemia-modified Albumin and Ischemia-modified Albumin to Albumin Ratios in Patients with Alopecia Areata
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-01-31
2022-02-25
2023-01-31
2023-02-27
e2023017
Dermatol Pract Concept
Objective: To investigate the role of ischemia-modified albumin (IMA) and IMA/albumin levels in patients with AA.
Methods: The present prospective crossectional study includes patients ≥ 18 who admitted to the Dermatology and Venerology Department of XXXX University Hospital between April 1 2021, and September 30 2021. 70 patients participated in the study (n=34 for the study group and n=36 for the control group). Demographic features, clinical characteristics, IMA, and IMA/albumin levels were compared between the groups. Study group was divided into subgroups based on the number of patches, disease duration, and number of disease attacks. IMA and IMA/albumin levels were compared between each subgroup.
Results: Study and control groups were similar with regard to demographic features and clinical characteristics. Significant differences were observed between the mean IMA and IMA /albumin ratio (p=0.004 and 0.012, respectively). The study subgroups were comparable for the number of patches, disease duration and number of disease attack.
Conclusion: Although oxydative stress is an important component in the etiology of AA, IMA and IMA/albumin may not be useful in the prediction of disease severity in patients with AA.
Erel Ozcan
2023/01/31
10.5826/dpc.1301a17
e2023017
Department of Clinical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
2160-9381
disease severity
en
e2023017
Amin SS, Sachdeva S. Alopecia areata: A review. Journal of the Saudi Society of Dermatology & Dermatologic Surgery. 2013;17(2):37-45.
The Role of Ischemia-modified Albumin and Ischemia-modified Albumin to Albumin Ratios in Patients with Alopecia Areata
https://dpcj.org/index.php/dpc/article/download/2420/1953
       The Role of Ischemia-modified Albumin
  and Ischemia-Modified Albumin to Albumin Ratios
           in Patients with Alopecia Areata
          Efsun Tanacan1, Aynure Oztekin2, Unsal Savcı3, Engin Senel2, Coskun Oztekin4,
                                 Salim Neselioglu5, Ozcan Erel5


1 Department of Dermatology and Venerology, Ufuk University Hospital, Ankara, Turkey
2 Department of Dermatology and Venerology, Hitit University Faculty of Medicine Çorum, Turkey
3 Department of Microbiology, Hitit University Faculty of Medicine, Çorum, Turkey
4 Department of Family Medicine, Hitit University Faculty of Medicine, Çorum, Turkey
5 Department of Clinical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey



Key words: alopecia areata, ischemia-modified albumin, IMA/albumin, disease severity
Citation: Tanacan E, Oztekin A, Savci U, et al. The Role of Ischemia-modified Albumin and Ischemia-modified Albumin to Albumin Ratios
in Patients with Alopecia Areata. Dermatol Pract Concept. 2023;13(1):e2023017. DOI: https://doi.org/10.5826/dpc.1301a17
Accepted: September 7, 2022; Published: January 2023
Copyright: ©2023 Tanacan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Efsun Tanacan, Department of Dermatology and Venerology, Ufuk University Hospital, Ankara, Turkey.
Tel: +903122044151 E-mail: efsunkln@yahoo.com




  ABSTRACT             Introduction:
                       Objective: To investigate the role of ischemia-modified albumin (IMA) and IMA/albumin levels in
                       patients with AA.
                       Methods: The present prospective crossectional study includes patients ≥18 who were admitted to
                       the Dermatology and Venerology Department of Hitit University Hospital between April 1, 2021, and
                       September 30, 2021. 70 patients participated in the study (n=34 for the study group and n=36 for the
                       control group). Demographic features, clinical characteristics, IMA, and IMA/albumin levels were
                       compared between the groups. The study group was divided into subgroups based on the number
                       of patches, disease duration, and the number of disease attacks. IMA and IMA/albumin levels were
                       compared between each subgroup.
                       Results: The study and control groups were similar with regard to demographic features and clinical
                       characteristics. Significant differences were observed between the mean IMA and IMA/albumin ratio
                       (p=0.004 and 0.012, respectively). The study subgroups were comparable in the number of patches,
                       disease duration, and number of disease attacks.
                       Conclusion: Although oxidative stress is an important component in the etiology of AA, IMA and
                       IMA/albumin may not be useful in the prediction of disease severity in patients with AA.


Original Article | Dermatol Pract Concept. 2023;13(1):e2023017                                                                      1
Introduction                                                      of patches, disease duration, and number of disease attacks.
                                                                  IMA and IMA/albumin levels were compared between each
Alopecia areata (AA) is a chronic, immune-mediated dis-           subgroup. All the blood samples (peripheral venous blood)
ease resulting in non-scarring hair loss with an approximate      from all participants were collected after overnight fast. Sta-
prevalence of 1/1000 [1]. Hair follicles in the anagen phase      tistical analyses were performed by Statistical Package for
prematurely transform into catagen and telogen phases by          the Social Sciences (SPSS.22, IBM SPSS Statistics for Win-
autoimmune and inflammatory mechanisms resulting in a             dows, Version 22.0 Armonk, NY: IBM Corp.).
sudden hair loss in patients with AA [2]. Although the patho-         Student t-test was used for comparing the mean values
physiological mechanisms behind AA have not been clearly          between the groups as the data was normally distributed.
revealed yet, immune dysregulation, genetic predisposition,       Chi-square test was conducted to compare the categorical
and excessive oxidative stress seem to be the main predispos-     variables. Pearson correlation test was performed for cor-
ing factors behind the development of AA [3].                     relation analyses. A two-tailed P value < 0.05 was regarded
    Oxidative stress and free radical damage alter the            as statistically significant.
chemical structure of albumin, leading to the production
of ischemia-modified albumin (IMA) [4]. Hence, the util-
                                                                  Results
ity of IMA and IMA/albumin were investigated in various
studies for revealing the oxidative stress-related events be-     The clinical characteristics of the patients with Alopecia
hind the etiology of autoimmune and inflammatory dis-             Areata were shown in Table 1. In the alopecia areata group,
eases [5, 6].                                                     most of the participants were male. Approximately 60% of
    The role of IMA was also investigated in several derma-       the patients had a single patch. Disease duration was less
tologic diseases like psoriasis, Behçet’s disease, and alopecia   than one year in 19 patients. Only three patients had a fam-
areata [7-9]. However, no consensus has been reached on the       ily history of alopecia areata.
utility of IMA in daily dermatology practice. For this reason,
more data is necessary to reach more precise results.
    The aim of the present study is to investigate the role of       Table 1. Demographic features and Disease
IMA and IMA/albumin levels in patients with AA.                      Characteristics of the patients with Alopecia
                                                                                        Areata.
Material and Methods                                                                                     N                %
                                                                   Gender
The present prospective crossectional study consisted of pa-
                                                                     Female                             12             35.3%
tients ≥18 who were admitted to the Dermatology and Ven-
                                                                     Male                               22             64.7%
erology Department of Hitit University Hospital between
                                                                   Patern of AA
April 1, 2021, and September 30, 2021. Seventy patients
                                                                     Single patch                       20             58.8%
participated in the study (n=34 for the study group and n=36
for the control group). Patients with alopecia areata served         Multiple patch                     14             41.2%

as the study group. Thirty-six gender and age-matched pa-          Duration of illnes
tients with dermatologic complaints other than inflamma-             < 1 year                           19             55.9%
tory skin diseases were used as the control group. Cases             1-4 years                           9             26.5%
with pregnancy, lactation, history of malignancy, and active         ≥5 years                            6             17.6%
or chronic infection were excluded from the study. Written         Family history of AA
informed consent was signed by all participants. The insti-          Yes                                 3               8.8%
tutional ethics committee approved the study protocol with           No                                 31             91.2%
reference number 449. Firstly, the clinical characteristics        Involvement area
of AA patients were evaluated. Gender, pattern of alopecia           Scalp                              22             64.7%
area, duration of disease, family history with AA, involved          Beard                               8             23.5%
area (scalp, beard, eyebrow) and the number of disease at-
                                                                     Eyebrow                             2               5.9%
tacks were evaluated for each AA patient. Both study and
                                                                     ≥2                                  2               5.9%
control groups were evaluated for gender, age, height (m),
                                                                   Number of attacks
weight (kg), Body mass index (BMI), smoking and alcohol
                                                                     1                                  20             58.8%
consumption, IMA, and albumin levels. The IMA/albumin
                                                                     2                                  10             29.4%
ratio of all participants was calculated. Afterwards, the
study group was divided into subgroups based on number               3                                   4             11.8%



2                                                                      Original Article | Dermatol Pract Concept. 2023;13(1):e2023017
    The patients’ most common areas of disease involvement            Excessive oxidative stress is considered to be another trigger-
were scalp, beard, and eyebrows, respectively. In addition,           ing event in the development of AA. There are many studies
58.8% of the patients had an alopecia attack for the first            showing the effect of oxidative stress on AA and many other
time, while the other 4 in 10 patients had an alopecia attack         dermatological diseases [10-17]. Degradation products re-
for the third time.                                                   sulting from oxidative stress may damage hair follicles and
    Comparison of the gender distribution, mean age, height,          they may alter the balance between the anagen, telogen and
weight, BMI, smoking, alcohol consumption, IMA, and                   catagen phases. Furthermore, some of these products may be
albümin levels between the study and control groups are               used as biological markers of oxidative stress [18-20].
shown in Table 2.                                                        IMA (ischemic modified albumin) is produced by the
    Significant differences were observed between the mean            modification of albumin due to the reactive oxygen spe-
IMA and IMA/albumin ratio (p=0.004 and 0.012, respec-                 cies (ROS). A higher level of IMA was observed in various
tively). The study subgroups were comparable for the num-             diseases like ischemic heart disease, pulmonary embolism,
ber of patches, disease duration, and number of disease               cancer, and stroke [21-24]. The role of IMA was also evalu-
attacks, as shown in Table 3.                                         ated in dermatological diseases. Elevated levels of IMA were
                                                                      shown in psoriasis, hair diseases, and vitiligo. In recent years,
                                                                      some studies have addressed the risk of thrombosis, acute
Discussion
                                                                      myocardial infarction, and stroke in AA with various results
The pathogenetic mechanisms of AA have still not been clar-           [25-28]. Shakoei et al. found elevated D- Dimer levels and in-
ified. Impaired immune system activation and genetic predis-          creased risk of thromboembolism in AA. Kang et al. defined
position seem to be the main events behind AA. Destruction            that patients with AA were associated with a higher risk of
of hair follicles by immune-mediated cells and inflammatory           stroke in the 3-year follow-up period. However, some data
products results in reversible hair loss in a specific pattern [1].   do not support the risk of heart attack and stroke in alopecia



  Table 2. Comparison of the gender distribution, mean age, height, weight, BMI, smoking, alcohol
            consumption, IMA, and albümin levels between the study and control groups.
                                                    Patients (n=34)              Controls (n=36)                   P value
 Gender
   Female                                                  12                           13                           0.57
   Male                                                    22                           23
 Mean age                                              31.56±8.5                      31±8.5                         0.78
 Height                                                170.8±9.5                    169.7±9.9                        0.72
 Weight                                                72.6±12.8                   72.2±10.04                        0.86
 BMI                                                   24.79±3.3                    25.05±2.8                        0.72
 Smoking                                                    0                            0                           N/A
 Alcohol consumption                                        0                            0                           N/A
 Family history of AA                                       3                            0                           N/A
 IMA                                                   0.71±0.17                    0.50±0.14                        0.04
 Albumin                                               4.09±0.10                    4.08±0.11                        0.62
 IMA/Albumin                                           0.17±0.04                    0.12±0.03                       0.012




 Table 3. Comparison of IMA, Albumin, and IMA/Albumin according to number of patches, disease
                           duration, and number of disease attacks.
                       Single      Multiple                    <6           >6                   Number         Number
                        patch        patch                   months       months                 of attack     of attack
                       (n=20)       (n=14)      P value      (n=19)       (n=15)      P value    1 (n=20)      ≥2 (n=14)     P value
 IMA                  0.70±0.20   0.72±0.10       0.76      0.75±0.21 0.66±0.09         0.13     0.73±0.21     0.68±0.08      0.39
 Albumin              4.09±0.11   4.10±0.09       0.65      4.05±0.10 4.13±0.09         0.04     4.08±0.13     4.11±0.05      0.38
 IMA/Albumin          0.17±0.05   0.17±0.02       0.81      0.18±0.05 0.16±0.02         0.11     0.18±0.05     0.16±0.02      0.35



Original Article | Dermatol Pract Concept. 2023;13(1):e2023017                                                                       3
areata [27, 28]. On the other hand, recently, in alopecia                 6. Türedi, S., et al., Ischemia-modified albumin and the IMA/­
areata, literature data show a tendency to thrombosis and an                 albumin ratio in the diagnosis and staging of hemorrhagic shock:
                                                                             A randomized controlled experimental study. Turkish Journal of
increased risk of heart attack and stroke. In addition, studies
                                                                             Trauma and Emergency Surgery, 2020. 26(2): p. 153-162.
have found elevated levels of cardiac biomarker troponin I
                                                                          7. Işik, S., et al., The correlation between the psoriasis area severity in-
and congestive heart disease biomarker BNP in patients with                  dex and ischemia-modified albumin, mean platelet volume levels in
alopecia areata [29, 30].                                                    patients with psoriasis. Advances in Dermatology and ­Allergology
    There are publications in the literature indicating the                  /Postȩpy Dermatologii i Alergologii, 2016. 33(4): p. 290.
association of IMA with the severity and deterioration of                 8. Kılıç, S., et al., The ischemia modified albumin and mean platelet
                                                                             volume levels in patients with Behçet’s disease. Advances in Der-
AA [9, 31]. These reports focused on the pathophysiological
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                                                                             2016. 33(5): p. 345.
AA. As excessive oxidative stress was reported to be an im-               9. Incel-Uysal, P., et al., Assessment of metabolic profile and
portant triggering event in the development of AA, markers                   ­ischemia-modified albumin level in patients with alopecia areata:
associated with oxidative stress might increase with disease                  A case–control study. Indian journal of dermatology, 2019.
severity [32]. Moreover, although the utility of IMA/albumin                  64(1): p. 12.
                                                                         10. Sachdeva, S., et al., Does oxidative stress correlate with disease
was investigated in various conditions like chronic liver dis-
                                                                              activity and severity in alopecia areata? An analytical study.
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                                                                              J Cosmet Dermatol, 2021.
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                                                                              ­
etiology of AA is complex, and using a single oxidative bio-                  20(7): p. 2305-2310.
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                                                                              capacity and peroxidation biomarkers in psoriasis. J Biomed Sci,
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                                                                              2016. 23(1): p. 52.
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                                                                         13. Qiu, L., Z. Song, and V. Setaluri, Oxidative stress and vitiligo:
with regard to patch characteristics, duration of the disease                 the Nrf2-ARE signaling connection. J Invest Dermatol, 2014.
and number of attacks per year. In our opinion, more studies,                 134(8): p. 2074-2076.
including a larger number of cases and many more study                   14. Shah, A.A., et al., Increased oxidative stress in pemphigus
parameters, are necessary to reach more reliable results for                  ­vulgaris is related to disease activity and HLA-association. Auto-
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                                                                         15. Emre, S., et al., The association of oxidative stress and disease
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                                                                             ­activity in seborrheic dermatitis. Arch Dermatol Res, 2012.
tive design and investigation of IMA/albumin levels in patients               304(9): p. 683-7.
with AA. On the other hand, the relatively low number of                 16. Narendhirakannan, R.T. and M.A. Hannah, Oxidative stress and
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                                                                         17. Okayama, Y., Oxidative stress in allergic and inflammatory skin
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                                                                              logical science, 2002. 29(2): p. 85-90.
                                                                         19. Naziroglu, M. and I. Kokcam, Antioxidants and lipid peroxida-
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Original Article | Dermatol Pract Concept. 2023;13(1):e2023017                                                                                 5
