Alopecia areata - pattern in industrial city of Baroda

Introduction

Alopecia areata (AA) not only causes cosmetic concern but also evokes feeling of vulnerability, loss of self esteem, alteration in self image and perhaps self identity. Hospital based studies of AA in different regions and geographical surroundings may have different profile and hence different treatment strategies to slow down the progression or in some cases to achieve cure. This holds true because of multifactorial etiology. In the present hospital based study, profile of AA is true because of multifactorial etiology. In the present hospital based study, profile of AA in industrial city of Baroda was studied so as to establish the pattern of AA in the region.

Materials and Methods

Patients of AA attending SSG hospital Baroda were included in the study. Detailed interrogation with special reference to atopic state, family history, associated co-morbid conditions was done followed by clinical examination of hair, skin and nail.

Observations

The study included 150 subjects of AA. Demographic profile:- The patients ranged from 3 to 69 year in age, majority (80%) being in 12-69 age group. Nearly half (52.1 %) were in 20-39 year group. The decade of 20-29 itself only had 31.5% AA [Table - 1].

AA

• Time of presentation - 78% (117/1 50) AA presented within 6 months of onset.
• Type - Practically all (148/150) had alopecia of AA type. Only 5 had both AA and ophiasis
• Site -Scalp was the commonest (72.67%) site of AA and in only 12.67% the patches were on areas other than scalp. In 14.66% the site was combined i.e. scalp and other areas.

On scalp common site was parietal area followed by occipital area. The sites other thar scalp were beard (11.5%) and moustache (6.75%)

• Number - Multiple patches were present it 64.66% and single patch in 35.34%.

Co morbidity

Atopic manifestations were associated it 11.37% patients, the others being tuberculosis vitiligo, hypothyroidism, hypertension and eczema [Table - 3]. Among atopic manifestation/seasona rhinitis was the commonest (13/17).

Nail involvement

Nails were involved in 20 patients a (13.34%) AA. The commonest being pitting (12 followed by leuconychia (2), longitudinal ridgin(, (2), longitudinal melanonychia (2), onychophagi (1) and nail pigmentation (1).

Family history:- Only 7.34% had family history of AA, being sister (6), parents (3), brother (1) and offspring (1). A family history of auto immune disease was present in 18 first degree, second and third degree relatives each.

It is usually within 6 months that 70% and within 1 year that 86.01 % patients of AA see treatment as also observed earlier.[5] However others[6] observed that only 50% seek treatmer within 1 year. The problem of AA is thus of cosmeti significance as more than 3/4 report within 6 months.

Practically all (98.6%) were the cases of AA and only 3.3 had both AA and ophiasis. The pattern may help prognostication. AA and ophiasis have variable prognosis depending on associated atopic state. Though Shellow,[3] encountered 30% AT and 20% AU, these two types were conspicuous by their absence in the present study. Schmitt I observed complete recovery in only 10/50 AU, Muller recorded 1 % children and 10% adults with AT to have complete regrowth.

The common site is scalp where it is parietal area followed by occipital and frontal as recorded earlier also.[5] Among areas other than scalp beard is the commonest followed by moustache. Co-morbidity especially atopic state in AA affects prognosis. Atopic state was associated in only 11.37%. As majority (88.63%) has no atopic state, the group predicted an overall good prognosis. AA in atopic state has poor prognosis while in non-atopic state has reasonably good prognosis. Ophiasis is bad especially in atopic state.[8]

Nail involvement was not common as also observed by Muller et al. King Muller,[2] land Read noted pitting in 66%. We also observed pitting to be the commonest nail change. Family history of AA is not common, so also autoimmune diseases.