Aeopecia areata in Kashmir: A study of 200 patients

Sheikh Manzoor, Cazi Masood

 Department of Dermatology, Government Medical College, Srinagar, Kashmir, India

Correspondence Address:
Sheikh Manzoor
C/O Empire Medicate, Opp. Fire Services Head Quarters Batmaloo Srinagar Kashmir
India

Introduction

Alopecia areata is one of the common dermatological problems encountered during day to day practice, and is characterized by the initial lesion of circumscribed totally bald smooth patches. It is not at present possible to attribute all or indeed any case of alopecia areata to a single cause. Among the many factors which appear to be implicated in at least a proportion of cases are the patients genetic constitution, the atopic state, non-specific immune and organ specific autoimmune reactions and possibly emotional stress.

Materials and Methods

Randomly selected 200 patients with clinically diagnosed alopecia areata who attended the outpatient department of S.M.H.S Hospital were taken for study. In all patients a detailed history regarding the disease was taken, including a family history and any such history in past or history of any associated disease especially atopy was taken.

In all patients site of lesions either scalp, face or any other body site was noted. Number of lesions was also noted. Presence of marginal lesions if present was also considered. Nail changes were also studied. Feature of atopy, if any was also recorded.

Observation

Out of 200 patients 145 were males and 55 females. Age of onset was between 3 to 50 years. In 144 patients only scalp lesions were seen. In 46 patients face was involved. In 20 patients scalp and face were affected. Other body sites were involved in 8. Marginal lesions were seen in 4. Nail changes were seen in 3 and atopic changes in 3.

In one patient lichen planus was noted on the body and in another patient vitiligo patches were seen. Age group distribution is shown in [Table - 1].

Discussion

Alopecia areata accounts about 2% of new dermatological outpatient attendences in Britain and the United States. Among the many factors which appear to be implicated in its aetiopathogenesis are; the patients genetic constitutions, the atopic state, non specific immune and organ specific auto immune reactions and possibly emotional stress.[1] The incidences of family history of alopecia areata have been reported as from 4 to 27% in various studies.[2],[3] In our study it was 1.5%. The mode of inheritance is autosomal dominant with variable penetrance. Recial factors may also be important.

Regarding age and sex incidence the statistics are all based on hospital attendance figures and therefore do not reflect the true incidence of alopecia areata. The reported sex incidence has varied widely, from males out numbering females by 3 to 1. through equality, to twice as common in females.[5] In our study out of 200 patients 145 were males and 55 were females.

The peak incidence of manifestations in all clinical variants of alopecia areata if grouped together, is between the age of 20 and 50 years, and the onset to occur is at any age. In our study mean age of manifestations was between 3 to 50 and the youngest age to manifest was 3 years. As far as age of presentation is concerned we noticed maximum number of patients in the age group of third and fourth decade followed by first and second decade with only 1 patient above 61 years. In fourth and fifth decade as far as other associated diseases are concerned thyroid disease is most commonly associated and in previous studies an incidence of 8% has been seen.[6] Other associated diseases of a possible immunological nature have also been reported in association with alopecia areata. They include pernicious anaemia, SLE, rheumatoid arthritis, lichen planus and vitiligo. We noticed vitiligo in 1 patient, lichen planus in 1 and atopy in 3 patients.

In our study scalp was involved in 144 patients 100 having single lesions and 44 having multiple patches. Face was involved in 46 patients 20 having single lesion and 26 having multiple lesions.

In 8 patients other body sites were involved. Marginal alopecia was noted in 8 patients. Nail involvement in alopecia areata has been reported from 7-66%[8] and we noticed such changes in 3 patients.

Recurrence is known to occur in alopecia areata, and we noticed past history of same disease in 50 patients. Alopecia areata is common hair disorder in day to day practice in Kashmir. Our aim was to analyse patients suffering from this disorder. The number of patients studied was only 200. We intend to carry out the same study at a large scale in future.

1.	Rook A, Wilkinson DS, Ebling FJG. Textbook of Dermatology, 5th edition, Oxford Blackwell Scientific Publications 1992; vol 4 2586-2594. [Google Scholar]
2.	De- Waard- Van der spek FB, Oranje AP, De Racymaecke DM, et al. Juvenile versus maturity- onset alopecia areata- a comparative retrospective clinical study. Clin Exp Dermatol 1989;14: 429-436. [Google Scholar]
3.	Friedmann PS. Alopecia areata and autoimmunity. J Dermatol 1981; 105:157. [Google Scholar]
4.	Arnold HL. Alopecia areata; prevalence in Japanese and prognosis after reassurance. AMA Arch Dermatol Syphilol 1952; 66: 191-197. [Google Scholar]
5.	Friedmann PS. Clinical and immunologic associations of alopecia areata. Semin Dermatol 1985; 4: 4-24. [Google Scholar]
6.	Muller SA, Weinkelmann RK. Alopecia areata. Arch Dermatol 1963; 88 :290. [Google Scholar]
7.	Brenner W, Diem E, Gschnait F. Coincidence of vitiligo, alopecia, onychodystroply, localised scleroderma and lichen planus. Dermatologia 1979; 159: 356-360. [Google Scholar]
8.	Baran R, Dawber RPR, eds. Diseases of the Nails and Their Management. Oxford; Blackwell Scientific Publications, 1984; 192-195. [Google Scholar]