Ann Dermatol.  2014 Dec;26(6):722-726. 10.5021/ad.2014.26.6.722.

Differences in Comorbidity Profiles between Early-Onset and Late-Onset Alopecia Areata Patients: A Retrospective Study of 871 Korean Patients

• Lee NR
• Kim BK
• Yoon NY
• Lee SY
• Ahn SY
• Lee WS

• KMID: 2264867
• DOI: http://doi.org/10.5021/ad.2014.26.6.722

Abstract

BACKGROUND
Alopecia areata (AA) is a common dermatologic condition with a broad spectrum of clinical features and age of onset, classically characterized by nonscarring patches of hair loss. In the past, early-onset (before adolescence) AA has been associated with various autoimmune diseases, especially atopic diseases and lupus erythematosus and demonstrates a worse prognosis compared with late onset AA.
OBJECTIVE
To evaluate the differences in the comorbidity profile of AA with regard to age at onset.
METHODS
We completed a retrospective study of 871 Korean AA patients seen at our department within the last 10 years. After these patients were subdivided according to onset before or after age 13 years, the two groups were compared on the basis of their comorbid disorders, family history of AA, and hematologic test results.
RESULTS
Our results demonstrate that significantly more patients in the early-onset group had a personal history of atopic dermatitis or family history of AA. These findings are consistent with previous reports associating early-onset AA with autoimmune diseases and a family history of AA in different ethnic populations. Most of the serologic test values showed no significant differences between the groups and the results were considerably affected by age.
CONCLUSION
This study is significant because it is a large group study in Korean AA patients, and Korean AA patients with an onset age before adolescence show similar clinical manifestations to other ethnic populations.

Keyword

Alopecia areata; Autoimmune diseases; Comorbidity; Onset age

MeSH Terms

Adolescent
Age of Onset
Alopecia Areata*
Autoimmune Diseases
Comorbidity*
Dermatitis, Atopic
Hair
Hematologic Tests
Humans
Prognosis
Retrospective Studies*
Serologic Tests

Reference

1. Safavi K. Prevalence of alopecia areata in the First National Health and Nutrition Examination Survey. Arch Dermatol. 1992; 128:702.

2. Xiao FL, Yang S, Yan KL, Cui Y, Liang YH, Zhou FS, et al. Association of HLA class I alleles with aloplecia areata in Chinese Hans. J Dermatol Sci. 2006; 41:109–119.

3. Rebora A. Acute diffuse and total alopecia of the female scalp: a new subtype of diffuse alopecia areata that has a favorable prognosis--a reply. Dermatology. 2003; 207:339. author reply 340.

4. Cho HH, Jo SJ, Paik SH, Jeon HC, Kim KH, Eun HC, et al. Clinical characteristics and prognostic factors in early-onset alopecia totalis and alopecia universalis. J Korean Med Sci. 2012; 27:799–802.

5. 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; 23:13–18.

6. Hordinsky M, Ericson M. Autoimmunity: alopecia areata. J Investig Dermatol Symp Proc. 2004; 9:73–78.

7. Barahmani N, Schabath MB, Duvic M. National Alopecia Areata Registry. History of atopy or autoimmunity increases risk of alopecia areata. J Am Acad Dermatol. 2009; 61:581–591.

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; 41:748–753.

9. Kakourou T, Karachristou K, Chrousos G. A case series of alopecia areata in children: impact of personal and family history of stress and autoimmunity. J Eur Acad Dermatol Venereol. 2007; 21:356–359.

10. Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY, et al. Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. J Am Acad Dermatol. 2011; 65:949–956.

11. Barber HW. Case of vitiligo, with (formerly) alopecia areata and lupus erythematosus. Proc R Soc Med. 1925; 18:51.

12. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part I. Clinical picture, histopathology, and pathogenesis. J Am Acad Dermatol. 2010; 62:177–188. quiz 189-190.

13. Sharma VK, Kumar B, Dawn G. A clinical study of childhood alopecia areata in Chandigarh, India. Pediatr Dermatol. 1996; 13:372–377.

14. Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. Int J Dermatol. 1996; 35:22–27.

15. Muller SA, Winkelmann RK. Alopecia areata. An evaluation of 736 patients. Arch Dermatol. 1963; 88:290–297.

16. Goh C, Finkel M, Christos PJ, Sinha AA. Profile of 513 patients with alopecia areata: associations of disease subtypes with atopy, autoimmune disease and positive family history. J Eur Acad Dermatol Venereol. 2006; 20:1055–1060.

17. Shellow WV, Edwards JE, Koo JY. Profile of alopecia areata: a questionnaire analysis of patient and family. Int J Dermatol. 1992; 31:186–189.

18. Tan E, Tay YK, Giam YC. A clinical study of childhood alopecia areata in Singapore. Pediatr Dermatol. 2002; 19:298–301.

19. Cunliffe WJ, Hall R, Stevenson CJ, Weightman D. Alopecia areata, thyroid disease and autoimmunity. Br J Dermatol. 1969; 81:877–881.

20. Ahmed I, Nasreen S, Bhatti R. Alopecia areata in children. J Coll Physicians Surg Pak. 2007; 17:587–590.

21. Serarslan G, Savaş N, Yenin JZ. Is atopy and autoimmunity more prevalent in patients with alopecia areata? A comparative study. J Eur Acad Dermatol Venereol. 2012; 26:720–723.

22. Al Shobaili HA. The impact of childhood atopic dermatitis on the patients' family. Pediatr Dermatol. 2010; 27:618–623.

23. Tosti A, Bellavista S, Iorizzo M. Alopecia areata: a long term follow-up study of 191 patients. J Am Acad Dermatol. 2006; 55:438–441.

24. Bertolini M, Gilhar A, Paus R. Alopecia areata as a model for T cell-dependent autoimmune diseases. Exp Dermatol. 2012; 21:477–479.

25. Alexis AF, Dudda-Subramanya R, Sinha AA. Alopecia areata: autoimmune basis of hair loss. Eur J Dermatol. 2004; 14:364–370.

26. Ker J, Hartert TV. The atopic march: what's the evidence? Ann Allergy Asthma Immunol. 2009; 103:282–289.

27. De Waard-van der Spek FB, Oranje AP, De Raeymaecker DM, Peereboom-Wynia JD. Juvenile versus maturity-onset alopecia areata--a comparative retrospective clinical study. Clin Exp Dermatol. 1989; 14:429–433.