Introduction
Alopecia areata (AA) is T cell mediated autoimmune disease resulting in nonscarring alopecia. The incidence of AA is around 2% in both hospital and community based studies.1 Overall incidence in India varies from 0.7 to 2.1% and usual age of presentation is 20 to 40 years.2
Health related quality of life is poor in majority of patients. 3 Multiple etiological factors like genetic, autoimmune, psychological and viral infections have been suggested in the pathogenesis of this condition. A positive family history of AA is also an important predisposing factor and studies have shown that the lifetime risk of AA is 7.1%, 7.8%, and 5.7% in siblings, parents, and children of patients with AA, respectively.4
Atopy as a risk factor presents in around 60% of adults and 25% children with AA who either had personal or family history of atopy. 4, 5
According to severity, it can be classified as mild (≤3 patches), moderate (≥3patches without alopecia totalis or universalis), and severe (alopecia totalis, universalis, and ophiasis). 6
Management of AA includes topical or Intralesional corticosteroids, and systemic immunotherapy is usually considered for diffuse and more severe variants.
Even though AA is commonly seen in daily practice; there is a paucity of data in our population. This study aims to describe the prevalence and clinical characteristics of patients diagnosed with AA at a tertiary care hospital in western Odisha.
Materials and Methods
This study was a descriptive cross-sectional study conducted at VIMSAR Burla. It included all patients diagnosed with AA between March 2017 and March 2020. Data were retrospectively collected by reviewing the Outpatient registries. Data included patient demographics, type of AA, family history of AA, and associated comorbidities. Severity of AA was divided into mild/moderate variant with patchy area of hair loss and severe variant including alopecia totalis, universalis, or ophiasis.
Sample size calculation was performed using Raosoft.com with a 5% margin of error and 95% confidence level. Minimum recommended sample size was 197 And we had a total sample size of 531. A convenience sampling technique was used. Descriptive statistics were presented as frequencies and percentages for categorical variables (age categories, gender, types of AA, family history, presence of comorbidities, and autoimmune diseases). Mean ± standard deviation was used for numerical variables (age at onset and disease duration). Data were analyzed using SPSS statistical software. Study was approved by the Institutional Ethical Committee VIMSAR, Burla.
Table 1
Patient characteristics
Table 2
Frequency of alopecia areata types
Out of 531 cases, 16 patients presented as alopecia totalis and 4 as alopecia universalis.
Table 3
Family history of alopecia areata patients
Table 4
Nail changes
|
Type of Nail changes |
No of Patients |
Percentage |
|
Pitting |
37 |
6.96 |
|
Twenty Nail dystrophy |
23 |
4.33 |
|
Longitudinal Ridging |
11 |
2.07 |
|
Dystrophy |
7 |
1.31 |
|
Total |
78 |
14.68 |
Table 5
Clinical types and severity as per area of alopecia areata of scalp table 7
|
Clinical Types |
No of patients |
Percentage |
|
Ophiasis |
7 |
1.31 |
|
Sisapho |
18 |
3.38 |
|
<50% |
511 |
96.23 |
|
50-99% |
4 |
0.7 |
|
100 |
16 |
3.01 |
(Percentage means Percentage area of scalp involved)
Table 6
The association of comorbidities with severity in alopecia areata patients
Results
A total of 531 patients with clinically diagnosed AA were included in the present study. During the study period, 12644 new patients were referred to the dermatology OPD. The overall prevalence of AA was calculated to be approximately 4.1%. The mean age at onset was 27.4 ± 12.92 years. A disease onset before the age of 15 years was observed in 28.81% of cases. Males with AA were more than females with a ratio of 1.31: 1. A family history of AA was positive in 25 cases (4.7%) of patients. Upper class people (31.6%), salaried people (34.08%) and Graduates (40.48%) were more commonly affected.
Associated diseases were found in 105(19.7%) patients. Hypothyroidism 29(5.46%) and Bronchial Asthma 14(2.6%) were among the most common comorbidities. Atopy was found in 1.69% of patients. Psychiatric comorbidities also found in 1.6 % cases. A positive family history of atopic dermatitis was most common and found in 18.4% of cases which was followed by hypothyroidism (13.3%) cases, and chronic idiopathic urticaria (12.6%) cases. Nail changes was found in (14.68%) cases with pitting was the most common nail finding among nail changes.
Discussion
AA is a common disorder associated with significant social stigma. However, studies on its epidemiological and clinical characteristics are limited in western Odisha. Prevalence of AA in our study was 4.1% which is comparable to other studies conducted woridwide. 8, 9, 10, 11 Countries like the United States and Japan have reported prevalence of 3.2% and 3.45% respectively. 8, 11 Children and young adults are more commonly affected by this condition though it can affect people of any age group (1.21–2.58% vs 1.30–2.03%). 9
The mean age of onset of AA was 27.4 years in our study. This finding has also been shared by various studies conducted across the world where the range has varied between 25.2 to 36.3 years. 1 There was a definite male preponderance among the cases of alopecia areata observed in our study with a male to female ratio of 1.31:1. However, both male and female preponderance and even an equal gender distribution has been found by workers in different countries. 12 In our study AA was more common in patients with higher socioeconomic status, graduates and among salaried persons.
As far as clinical presentation was concerned, patchy hair loss over the scalp was the most common one in our study and most of the clinical studies on alopecia areata have reported a similar pattern. 1
Nail changes in form of pitting, twenty nail dystrophy, ridging, also found in 14.68 % of patients similar to studies reported earlier. 2
AA is usually associated with various atopic and autoimmune diseases. 12, 13, 14 In our study bronchial asthma, hypothyroidism, rheumatoid arthritis are most commonly reported comorbidities. We could find a similar association in few studies where hypothyroidism and rheumatoid arthritis, SLE were the predominat comorbidities seen in patients of alopecia areata. 15, 16, 14
Our study has several limitations. We have conducted a retrospective data review as the main source for data collection and also our study had a relatively small sample size.17
Conclusion
AA is a commonly encountered entity in the Dermatology OPD. However, the paucity of data regarding the epidemiological and clinical patterns should necessitate more number of such studies with a larger sample size. Educated, employed persons in the urban area are more susceptible to develop this condition which could be related to the stress involved in their personal and professional life. Proper counselling must be a part of the treatment protocol along with specific pharmacological therapy. Patients with this seemingly mild condition often suffer from various comorbid conditions like hypothyroidism, bronchial asthma and diabetes mellitus. Therefore, all patients of AA should be thoroughly examined to look for other comorbidities so as to reduce preventable complications in the future.
