American Academy of Pediatrics – Section on Dermatology

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Released January 27, 2021

Do not routinely order laboratory tests for patients with alopecia areata in the absence of signs and/or symptoms of the diseases in question.

Alopecia areata is a hair loss disorder believed to have an autoimmune origin. It is well-established that patients with alopecia areata have an
increased risk of other autoimmune conditions, with thyroid disease being the most common. As in the case of vitiligo, it is more common to find
thyroid autoantibodies or subclinical hypothyroidism than overt thyroid disease, unless there are clinically suspicious findings. Patients identified
as having subclinical hypothyroidism are not currently treated and may even have resolution of the abnormal TSH.

Recognizing the risk of associated autoimmune disease has led physicians over time to screen patients with alopecia areata for other diseases. There
is no convincing evidence that extensive workups in the absence of specific clinical suspicion improves outcomes for patients and may in fact beget
additional costs, including follow-up for patients screening positive, as well as harms. Although many studies suggest ordering these tests, this is
based largely on the increased cosegregation of alopecia areata and thyroid disease and not on improved management strategies or outcomes from
having identified an abnormal laboratory test result. Therefore, thyroid function testing, including screening for thyroid autoimmune disease or
hypothyroidism, is only indicated for clinical findings such as goiter, slow growth and hypothyroid symptoms, or a strong family history of thyroid disease.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

Members of the American Academy of Pediatrics Section on Dermatology submitted the top 5 topics for Choosing Wisely items based on a review of the literature and expert opinion of the most common dermatologic problems seen in primary care pediatrics. The list was then peer reviewed and approved by more than a dozen relevant AAP Committees, Councils and Sections. The AAP Executive Committee and Board of Directors granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Patel D, Ping L, Bauer A, Castelo-Soccio L. Screening guidelines for thyroid function in children with alopecia areata. JAMA Dermatol. 2017;153(12):1307-1310

Kinoshita-Ise, M; Martinez-Cabriales S & Alhusayen, R. Chronological association between alopecia areata and autoimmune thyroid disease: a systematic review and meta-analysis. J Dermatol
2019; Aug 46(8): 702-709.