Evaluation of nuclear factor E2-related factor 2 in patients with alopecia areata: a relation with systemic oxidative stress

Background Alopecia areata (AA) is a common dermatologic disease with autoimmune etiology. Systemic and tissue oxidative stresses are present in AA. Nuclear factor-E2-related factor 2 (Nrf2) is a transcription factor that stimulates transcription of antioxidant genes. Objective To investigate the role of Nrf2 in systemic oxidative stress in AA. Patients and methods A case-control study was designed. A total of 30 cases with AA and 30 age-matched and sex-matched healthy participants were included. Cases were diagnosed clinically and by dermoscopy and evaluated according to the severity of the alopecia tool score. Nrf2, total oxidant capacity (TOC), and total antioxidant capacity (TAC) were measured by enzyme-linked immunosorbent assay, and the oxidative stress index (OSI) was calculated. Results Serum Nrf2 and TAC were significantly lower in AA than the control group (P < 0.001 for both), whereas TOC and OSI were significantly higher in AA than the control group (P < 0.001 for both). There was a significant negative correlation between TAC and age (r=-0.5, P=0.004). High Nrf2 serum level was significantly associated with positive hair pull test (86.7%), whereas low Nrf2 was significantly associated with alopecia totalis (P=0.02 for both). There was a significant positive correlation between Nrf2 and TAC (r=0.4, P=0.01) and a significant negative correlation between Nrf2 and TOC (r=-0.3, P=0.01) and between Nrf2 and OSI (r=-0.4, P=0.01). Conclusion Nrf2 is lower in AA than control, indicating that systemic oxidative stress may be, at least in part, owing to low Nrf2. The use of Nrf2 activators may be beneficial in the treatment of AA, which needs further studies.