|Year : 2020 | Volume
| Issue : 2 | Page : 122-124
The clinico-epidemiological profile of alopecia areata: A hospital-based study in Jeddah, Saudi Arabia
Taghreed T Mahjoub
Department of Dermatology, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
|Date of Submission||13-Dec-2019|
|Date of Acceptance||25-Jun-2020|
|Date of Web Publication||10-Nov-2020|
Dr. Taghreed T Mahjoub
Dr. Soliman Fakeeh Hospital, Jeddah
Source of Support: None, Conflict of Interest: None
Background: There is a paucity of the epidemiologic studies of alopecia areata (AA) in Arab countries, especially from Saudi Arabia. Purpose: The aim was to describe the epidemiological and the clinical features of AA and its associated disease in Jeddah, Saudi Arabia. Methods: A retrospective review of medical records of 83 patients with AA seen at King Abdulaziz Medical City, Jeddah, was performed between July 2017 and July 2018. AA was classified into mild (with <10% scalp involvement and AA limited to beard area), moderate (patchy AA with <50% scalp involvement), and severe (alopecia universalis, ophiasis, alopecia totalis, and patchy AA with ≥ 50% scalp involvement). Results: The most common types of AA were mild patchy AA with <10% scalp in 35 (42.2%) patients, followed by AA limited to beard area in 24 (28.9%). The most common associated disease was atopic dermatitis which was seen in 10 (12%) patients, followed by thyroid disorder in 9 (10.8%). The most common treatment was intralesional corticosteroid (79.7% of mild and 83% of moderate) for mild and moderate and diphencyprone for severe AA (44.4%). Conclusion: Early age of onset is associated with more severe AA. The most commonly associated diseases are atopic dermatitis and thyroid disorder.
Keywords: Alopecia areata, association, epidemiology
|How to cite this article:|
Mahjoub TT. The clinico-epidemiological profile of alopecia areata: A hospital-based study in Jeddah, Saudi Arabia. J Dermatol Dermatol Surg 2020;24:122-4
|How to cite this URL:|
Mahjoub TT. The clinico-epidemiological profile of alopecia areata: A hospital-based study in Jeddah, Saudi Arabia. J Dermatol Dermatol Surg [serial online] 2020 [cited 2020 Dec 4];24:122-4. Available from: https://www.jddsjournal.org/text.asp?2020/24/2/122/300399
| Introduction|| |
Alopecia areata (AA) is a nonscaring hair loss that can affect the scalp or any other body hairy area. This condition commonly presents with asymptomatic round or oval patch of hair loss on the scalp. Other presentations include a band-like pattern of hair loss in the occipital and temporal area (ophiasis), complete scalp hair loss (alopecia totalis), and complete scalp and body hair loss (alopecia universalis). Although the exact pathogenesis of AA is unknown, autoimmunity as well as genetic factors play an important role., The estimated prevalence of AA is 0.2% of the world population., The prevalence of AA is 0.7% among blind and deaf students in southwestern Saudi Arabia. Although there are several studies of epidemiological and clinical features of AA, little is known about the clinico-epidemiological profile of AA in Saudi Arabia.,,,, The aim of this study was to describe the epidemiological and clinical features of AA and its associated disease in Jeddah, Saudi Arabia. The three main objectives of this study were to describe the age of onset and the gender of patients with AA, to describe the clinical pattern (type) and the most frequent treatment used in each type, and to determine comorbidities associated with AA.
| Methods|| |
We reviewed medical records of 83 patients diagnosed with AA at the Dermatology Outpatient Clinic, King Abdulaziz Medical City in Jeddah, Saudi Arabia, during the period from July 2017 to July 2018. Patients' demographic and clinical information including age, gender, family history, clinical type of AA, treatment used, and associated disorders was recorded. AA was classified into three main types: mild, moderate, and severe. Mild form includes two subtypes, AA with <10% scalp involvement and AA limited to beard area. Moderate form includes cases of patchy AA with <50% scalp involvement. Severe AA includes four subtypes: alopecia universalis, ophiasis, alopecia totalis, and patchy AA with ≥50% scalp involvement.
Data were analyzed using IBM SPSS statistics for Windows, version 24. Armonk, N.Y, USA. Descriptive statistics for categorical (frequency and percentage) and quantitative (mean, standard deviation, median, and range) variables were performed.
The research proposal was approved by the Ethical Committee, Institutional Review Board, at King Abdullah International Medical Research Center-King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| Results|| |
Characteristics of the study group
The mean age of onset of AA was 21 ± 12.1 years, with the great majority of cases (95.2%) occurring before reaching 40 years of age [Table 1].
Clinical characteristics of the cases
Patchy AA with < 10% scalp involvement was the most common type of AA, occurring in 42.2% of the cases, followed by AA limited to beard area in 28.9% of the cases [Table 2]. The mean age of onset of severe AA was 10 ± 6.2 years, compared to 23.9 ± 11.6 years for the mild form (P < 0.05) [Table 3].
Family history was assessed in 51 patients; of those, 15.7% had a positive family history. The most common medications used to treat AA were intralesional corticosteroid for mild and moderate AA and contact immunotherapy with diphencyprone for severe AA [Table 4].
|Table 4: Medications used for treatment of alopecia areata by severity (n=83)|
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Disease associated with alopecia areata
The most common associated disease was atopic dermatitis, observed in 10 (12%) of the cases, and thyroid diseases, observed in 9 (10.8%), followed by bronchial asthma and diabetes mellitus in 4 (4.8%) each. Moreover, allergic rhinitis and food allergies were observed in 3 (3.6%) and 2 (2.4%) patients, respectively. The other diseases included single case of autoimmune polyendocrinopathy and a single case of Down's syndrome.
| Discussion|| |
A few AA clinico-epidemiological studies have been done in Arab countries. AA affects all age groups with almost equal sex ratio.,, Our study showed a slight male predominance (54.2%). In previous studies done in Riyadh, Singapore, and India, the majority of cases occurred before the age of 40 years.,, In a study done in Riyadh, the mean age of onset of AA was 18; the mean age of onset was 21 years in our patients, with 95% of the cases occurring before the age of 40. In accordance with other studies, younger age of onset was associated with more severe disease,,, with a mean age of onset of 10 years in patients with severe AA.
Although the pathogenesis of AA is not completely understood, autoimmunity and genetic factors play important roles. AA is a polygenic autoimmune disease; genes involved in the pathogenesis of AA have been identified also in the pathogenesis of other autoimmune diseases such as Hashimoto's thyroiditis, Type 1 diabetes, and allergies., Positive family history of AA is present in 9%–51.6% of AA patients.,,,
Various diseases have been associated with AA. In our study, atopic dermatitis is the most associated disease and was reported in 12% of the cases. The percentages of associated atopy in published reports were as follows: 27.8% in Singapore, 20% in Kuwait, 17.5% in India, and 13% in Riyadh.,,, Our figure of associated atopy is similar to that observed in the Riyadh study. AA is associated with the risk of thyroid disease. The frequency of associated thyroid disorder in previous study was as follows: 5.4% in Riyadh, 2.3% in Singapore, 1% in India, 9% in Kuwait, and 0.88% in China.,,,, Thyroid disorder was more common (10.8%) in our population. Vitiligo has been reported in previous studies in relatively low frequency ranging from 3.5% in India to 4.1% in Singapore., In our study, we did not identify vitiligo in any of our AA patients; this finding is consistent with the Riyadh study. Down's syndrome has been reported in association with AA., In our study, a single case of Down syndrome has been identified in association with AA.
| Conclusion|| |
In summary, early age of AA onset is associated with more severe disease. AA is most commonly associated with atopic dermatitis and thyroid disorder.
I would like to thank Dr. Fayssal Farahat, Consultant Public Health and Medicine, Infection Prevention and Control Program at King Abdulaziz Medical City, Jeddah, for his review for the research proposal.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]