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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 24  |  Issue : 2  |  Page : 122-124

The clinico-epidemiological profile of alopecia areata: A hospital-based study in Jeddah, Saudi Arabia


Department of Dermatology, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

Date of Submission13-Dec-2019
Date of Acceptance25-Jun-2020
Date of Web Publication10-Nov-2020

Correspondence Address:
Dr. Taghreed T Mahjoub
Dr. Soliman Fakeeh Hospital, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_77_19

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  Abstract 


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 Nov 27];24:122-4. Available from: https://www.jddsjournal.org/text.asp?2020/24/2/122/300399




  Introduction Top


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).[1] Although the exact pathogenesis of AA is unknown, autoimmunity as well as genetic factors play an important role.[2],[3] The estimated prevalence of AA is 0.2% of the world population.[4],[5] The prevalence of AA is 0.7% among blind and deaf students in southwestern Saudi Arabia.[6] 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.[6],[7],[8],[9],[10] 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 Top


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 Top


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].
Table 1: Demographic characteristics of the study group (n=83)

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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].
Table 2: Clinical characteristics of the cases (n=83)

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Table 3: Alopecia areata age of onset severity

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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 Top


A few AA clinico-epidemiological studies have been done in Arab countries. AA affects all age groups with almost equal sex ratio.[7],[8],[11] 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.[7],[8],[12] 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.[7] In accordance with other studies, younger age of onset was associated with more severe disease,[8],[9],[11] 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.[13],[14] Positive family history of AA is present in 9%–51.6% of AA patients.[8],[10],[11],[12]

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.[7],[9],[10],[11] Our figure of associated atopy is similar to that observed in the Riyadh study.[7] 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.[7],[8],[9],[10],[12] 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.[8],[11] In our study, we did not identify vitiligo in any of our AA patients; this finding is consistent with the Riyadh study.[7] Down's syndrome has been reported in association with AA.[8],[15] In our study, a single case of Down syndrome has been identified in association with AA.


  Conclusion Top


In summary, early age of AA onset is associated with more severe disease. AA is most commonly associated with atopic dermatitis and thyroid disorder.

Acknowledgment

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bolognia J, Jorizzo J, Schaffer J. Dermatology 3rd ed. Philadelphia Elsevier Health Sciences Publisher; 2012;11:1100-2.  Back to cited text no. 1
    
2.
Martinez-Mir A, Zlotogorski A, Ott J, Gordon D, Christiano AM. Genetic linkage studies in alopecia areata. J Investig Dermatol Symp Proc 2003;8:199-203.  Back to cited text no. 2
    
3.
Norris D. Alopecia areata: Current state of knowledge. J Am Acad Dermatol 2004;51:S16-7.  Back to cited text no. 3
    
4.
Price VH. Alopecia areata: Clinical aspects. J Invest Dermatol 1991;96:68S.  Back to cited text no. 4
    
5.
Safavi K. Prevalence of alopecia areata in theFirst National Health and Nutrition Examination Survey. Arch Dermatol 1992;128:702.  Back to cited text no. 5
    
6.
Abolfotouh MA, Bahamdan K. Skin disorders among blind and deaf male students in Southwestern Saudi Arabia. Ann Saudi Med 2000;20:161-4.  Back to cited text no. 6
    
7.
Al-Khawajah M. Alopecia areata and associated diseases in Saudi patients. Ann Saudi Med 1991;11:651-4.  Back to cited text no. 7
    
8.
Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore – A study of 219 Asians. Int J Dermatol 2002;41:748-53.  Back to cited text no. 8
    
9.
Xiao FL, Yang S, Liu JB, He PP, Yang J, Cui Y, et al. The epidemiology of childhood alopecia areata in China: A study of 226 patients. Pediatr Dermatol 2006;23:13-8.  Back to cited text no. 9
    
10.
Nanda A, Al-Fouzan AS, Al-Hasawi F. Alopecia areata in children: A clinical profile. Pediatr Dermatol 2002;19:482-5.  Back to cited text no. 10
    
11.
Sharma VK, Kumar B, Dawn G. A clinical study of childhood alopecia areata in Chandigarh, India. Pediatr Dermatol 1996;13:372-7.  Back to cited text no. 11
    
12.
Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. Int J Dermatol 1996;35:22-7.  Back to cited text no. 12
    
13.
Petukhova L, Duvic M, Hordinsky M, Norris D, Price V, Shimomura Y, et al. Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature 2010;466:113-7.  Back to cited text no. 13
    
14.
Betz RC, Petukhova L, Ripke S, Huang H, Menelaou A, Redler S, et al. Genome-wide meta-analysis in alopecia areata resolves HLA associations and reveals two new susceptibility loci. Nat Commun 2015;6:5966.  Back to cited text no. 14
    
15.
Carter DM, Jegasothy BV. Alopecia areata and Down syndrome. Arch Dermatol 1976;112:1397-9.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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