Hindawi

Dermatology Research and Practice

Volume 2020, Article ID 7194270, 4 pages
https://doi.org/10.1155/2020/7194270

Research Article
Prevalence and Clinical Characteristics of Alopecia Areata at a
Tertiary Care Center in Saudi Arabia

Aysha A. Alshahrani,1,2 Rawan Al-Tuwaijri,1,3 Zainah A. Abuoliat,1,3 Mesnad Alyabsi,4

Mohammed I. AlJasser ,1,3,4 and Rayan Alkhodair1,3,4
1
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2
Division of Family Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
3
Division of Dermatology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
4
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

Correspondence should be addressed to Mohammed I. AlJasser; [email protected]

Received 20 December 2019; Accepted 22 February 2020; Published 13 March 2020

Academic Editor: Craig G. Burkhart

Copyright © 2020 Aysha A. Alshahrani et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Introduction. Alopecia areata (AA) is a common autoimmune disorder of hair follicles characterized by patches on nonscarring
hair loss. Reports of prevalence and clinical characteristic of AA in Saudi Arabia are limited. The aim of our study is to describe the
prevalence and clinical characteristics of Saudi patients with AA. Materials and Methods. A retrospective cross-sectional study was
conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia. All patients diagnosed with AA between January 2016 and
December 2017 were included. Data included patient demographics, type of AA, disease duration, family history of AA, and
comorbid autoimmune diseases. Results. A total of 216 patients with AA were included. The overall prevalence of AA was
approximately 2.3%. The mean disease duration at the time of presentation was 2 months while the mean age of onset was 25.61
years. The most common type of AA in both adult and pediatric groups was the patchy type involving the scalp. Comorbid diseases
were found in 32.41% of patients. Common associated conditions included hypothyroidism, diabetes mellitus, and atopic diseases.
Conclusion. The overall prevalence of AA among a population of Saudi patients is 2.3%. AA prevalence is higher in pediatrics than
adults. Common comorbid conditions include hypothyroidism, diabetes mellitus, and atopic diseases.

1. Introduction endocrine, autoimmune, psychological, and genetic factors

may play a role in AA pathogenesis [1]. One of the most
Alopecia areata (AA) is a nonscarring alopecia caused by a important risk factors of developing AA is family history
T-cell-mediated autoimmune destruction of hair follicles which is portrayed in one of the studies that showed the
[1]. The general population has an approximately 2% risk to lifetime risk of AA was 7.1%, 7.8%, and 5.7% in siblings,
develop AA at any time of their life [2, 3]. The worldwide parents, and children of patients with AA, respectively [5, 6].
incidence of AA varies from 2.1%, 0.7%, to 3.8% in USA, Another risk factor is atopy as shown in 60% of adults and
India, and Singapore, respectively [4]. Reports showed that 25% of pediatric patients with AA who either had personal
there is no gender predominance in AA (5). AA is con- or family history of atopy [5, 7, 8].
sidered as a disease of all age group; however, most patients AA has three main variants which are patchy AA (lo-
present at age of 21–40 years [5]. Globally, AA onset was at calized hairless areas), alopecia totalis (entire scalp affected),
25 and 36 years of age in Singapore and USA, respectively and alopecia universalis affecting all body surface area [9].
[4]. Other AA subtypes include ophiasis (band-like alopecia in
There are several hypotheses regarding AA pathogenesis. the occipital and temporal scalp), sisaipho (central hair loss
It has been suggested that viral and bacterial infection, sparing the marginal hair line), and diffuse form [5]. AA
2 Dermatology Research and Practice

severity can be divided into mild (≤3 patches), moderate (≥3 Table 1: Patient characteristics (N � 216).
patches without alopecia totalis or universalis), and severe Characteristic N %
(alopecia totalis, universalis, and ophiasis) [10].
Mean age at onset (SD) 25.61 (12.92)
There are different treatment modalities for AA patients Gender
starting from minimal approach with topical or injectable Male 125 57.87
corticosteroids to more extensive one with systemic im- Female 91 42.13
munomodulators. Treatment response varies depending on Adult (≥14 years old) 167 77.3
the severity of AA, age of onset, and other factors [11, 12]. Pediatrics (<14 years old) 49 22.69
Despite AA being commonly seen in daily practice among Family history of alopecia areata 13 6
Saudi patients, studies are limited and outdated in our Family history of autoimmune diseases 12 5.5
population [13]. This study aims to describe the prevalence Disease status
and clinical characteristics of patients diagnosed with AA at (i) Respond to treatment 100 46.30
King Abdulaziz Medical City in Riyadh, Saudi Arabia. (ii) Active 18 8.33
(iii) Stable 18 8.33
(iv) Unknown 61 28.24
2. Methods (v) Hair regrowth without treatment 19 8.8

This study was a retrospective cross-sectional study con-

ducted at King Abdulaziz Medical city. It included all pa- moderate AA 187 (86.6%) while the rest had a severe AA 29
tients diagnosed with AA between January 2016 and (13.4%). Children were more likely to have severe AA as
December 2017. Data were retrospectively collected by compared to adults (P < 0.01). There was no statistically
reviewing the electronic medical records. Data included significant association between the severity of AA and
patient demographics, type of AA, disease duration, family gender or comorbidities (Table 3).
history of AA, and comorbid autoimmune diseases. Severity Associated diseases were found in 70 (32.41%) patients
of AA was divided into patchy hairless area as mild/mod- (Table 4). Hypothyroidism and diabetes mellitus were
erate and alopecia totalis, universalis, or ophiasis as severe. among the most common comorbidities. Atopy was found
Sample size calculation was performed using Raosoft.com in 13.89% of patients with asthma being the most common
with a 5% margin of error and 95% confidence level. The followed by atopic dermatitis and allergic rhinitis. A positive
minimum recommended sample size was 197. A conve- family history of autoimmune disease was found in 5.5% of
nience sampling technique was used. Descriptive statistics cases. Response to therapy was noted in 46.3% of patients,
were presented as frequencies and percentages for cate- and spontaneous hair regrowth was found in 8.8%.
gorical variables (age categories, gender, types of AA, family
history, presence of comorbidities, and autoimmune dis- 4. Discussion
eases). Mean ± standard deviation was used for numerical
variables (age at onset and disease duration). The signifi- Although AA is stressful disorder with social stigma, studies
cance of associated comorbidities and autoimmune diseases on its prevalence and clinical characteristics are limited in
in alopecia areata patients was presented as a 95% confidence Saudi Arabia. The prevalence of AA in our study was 2.3%
interval. A P value <0.05 was considered as statistically which is comparable with the worldwide figures [14]. In the
significant. Data were analyzed using SAS statistical software United States, the prevalence of AA was approximately 2%
version 9.4 (SAS Institute Inc. Cary, NC). This study was [15] while it is slightly more in Japan reaching 2.45% [16].
approved by the Institutional Review Board in King Although AA is a disease of all ages, it is more prevalent in
Abdullah International Medical Research Center (study the younger age group. In this study, the prevalence in
number RC18/050/R). children was 4.24% with lower prevalence in adults (2%). In
one meta-analysis, similar findings were demonstrated as
3. Results higher prevalence of AA in children 1.83% (1.21–2.58%)
compared to adults 1.64% (1.30–2.03%) [17].
A total of 216 patients with AA were included (Table 1). Previous studies showed that patients with disease onset
During the study period, 9,317 new patients were referred to in the first 2 decades of life had more severe AA [7, 8]. In our
the dermatology clinic. Therefore, the overall prevalence of study, there was a statistically significant difference in terms
AA was estimated to be approximately 2.3%. Pediatric and of severity between adults and children. Pediatric patients
adult cases accounted for approximately 4.24% and 2% of all were more likely to have severe AA as compared with adults
new referrals to the pediatric and adult dermatology clinics, (P < 0.01).
respectively. The mean age at onset was 25.61 ± 12.92 years. The mean age of onset of AA in the present study was
A disease onset before the age of 15 years was observed in 25.61. This is similar to some previous studies of Asians with
22.6% of cases. The mean disease duration at the time of AA. The reported age of onset was 25.2, 28.98, 36.3, and 32.2
presentation was 2 months. Males with AA were more than in Singapore, China, USA, and Taiwan, respectively [4].
females with a ratio of 1.37 : 1. A family history of AA was Studies in the literature with regard to gender predominance
positive in 6% of patients. The most common type of AA in in AA are conflicting. A systematic review concluded that
both adult and pediatric groups was the patchy type in- there is no difference in the incidence of AA between males
volving the scalp (Table 2). Most of the patients had mild-to- and females [4]. Our study showed a male predominance of
Dermatology Research and Practice 3

Table 2: The frequency of alopecia areata types.

Types of alopecia areata Adults n (%) Pediatrics n (%) Overall n (%)
Patchy scalp 83 (49.7) 22 (44.89) 105 (48.6)
Patchy scalp + patchy beard 14 (8.38) 0 14 (6.48)
Patchy scalp + patchy limbs 1 (0.6) 0 1 (0.46)
Patchy scalp + patchy eyebrows 1 (0.6) 4 (8.16) 5 (2.3)
Patchy scalp + patchy eyelashes + patchy eyebrows 1 (0.6) 4 (8.16) 5 (2.3)
Patchy scalp + patchy beard + patchy eyebrows 1 (0.6) 0 1 (0.46)
Patchy eyebrows 3 (1.8) 5 (10.2) 8 (3.7)
Patchy limbs 2 (1.2) 0 2 (0.92)
Patchy beard 46 (27.5) 0 46 (21.3)
Totalis\subtotalis 7 (4.19) 3 (6.12) 10 (4.63)
Universalis 1 (0.6) 3 (6.12) 4 (1.85)
Diffuse 2 (1.2) 1 (2.04) 3 (1.39)
Ophiasis 5 (2.99) 7 (14.29) 12 (5.56)
Total 167 (77.31) 49 (22.69) 216 (100)

Table 3: Factors associated with severity in alopecia areata patients.

Mild-to-moderate (n � 187) Severe (n � 29) P value
Gender
Male (n � 125) 112 (89.6%) 13 (10.4%) 0.12
Female (n � 91) 75 (82.4%) 16 (17.6%)
Age
Adult (n � 167) 152 (89.4%) 15 (10.6%) <0.01
Pediatric (n � 49) 35 (71.4%) 14 (28.6%)
Comorbidity
Yes (n � 70) 58 (82.9%) 12 (17.1%) 0.26
No (n � 146) 129 (88.4%) 17 (11.6%)

Table 4: The association of comorbidities with severity in alopecia areata patients.

Comorbidity Mild-to-moderate (n � 187) Severe (n � 29) Total n (%)
Hypothyroidism 15 3 18 (8.33)
Asthma 14 2 16 (7.41)
Diabetes mellitus 9 2 11 (5.09)
Atopic dermatitis 5 3 8 (3.70)
Allergic rhinitis 6 0 6 (2.78)
Psoriasis 3 1 4 (1.85)
Vitiligo 3 0 3 (1.39)
Rheumatoid arthritis 1 1 2 (0.93)
Systemic lupus erythematous 1 0 1 (0.46)
Seborrheic dermatitis 1 0 1 (0.46)
Total 58 12 70 (32.41)

AA while other studies showed female predominance [18]. which is in agreement with the findings of Al-Khawajah’s
AA has different types with patchy scalp being the most study [13].
predominant type in our study as shown in agreement with Our study has several limitations. We have conducted a
previous studies [4]. retrospective chart review as the main source for data col-
The association of AA with other autoimmune disease lection. Another limitation is the relatively small sample size.
had variable results in the literature. Some studies showed
that AA is not related to other autoimmune diseases [19, 20].
However, many other studies demonstrated that AA is as-
5. Conclusion
sociated with several autoimmune diseases [21–23]. In our The overall prevalence of AA in our study population is
study, the 3 most commonly reported comorbidities were 2.3%. AA prevalence is higher among children than adults.
hypothyroidism, asthma, and diabetes mellitus. A previous Furthermore, children were more likely to have severe AA.
local study showed an association between AA and thyroid The severity of AA was not associated with gender or the
disease [21]. Atopic diseases were common in our patients, presence of comorbidities. Several comorbid conditions
4 Dermatology Research and Practice

were found to be common in our patients including hy- [14] E. Darwin, P. Hirt, R. Fertig, B. Doliner, G. Delcanto, and
pothyroidism, diabetes mellitus, and atopic diseases. Future J. Jimenez, “Alopecia areata: review of epidemiology, clinical
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R. R. Torgerson, “Lifetime incidence risk of alopecia areata
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The data used to support the findings of this study are in- [16] M. Furue, S. Yamazaki, K. Jimbow et al., “Prevalence of
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