Translate this page into:
Atopy and alopecia areata in North Indians
2 Department of Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Vinod Kumar Sharma
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi-110 029
|How to cite this article:
Kaur S, Sharma V, Kumar L, Kumar B. Atopy and alopecia areata in North Indians. Indian J Dermatol Venereol Leprol 2002;68:267-269
AbstractThe study was undertaken with the aim of evaluating the effect of associated atopy on severity and age at onset of alopecia areata in north Indians. Presence of atopy was elicited by detailed history, examination and intracutaneous tests. Chisquare test was carried out to evaluate statistical significance. One hundred patients (76 males and 24 females) with alopecia areata were evaluated. Historical evidence of atopywas present in 50 including patients alone (23), patients and first degree relatives (11) and first degree relatives alone (16). Intracutaneous tests were positive in 23 out of 50 patients tested randomly. There was a trend towards increasing frequency of severe alopecia as evidence of atopy became stronger e.g. both patient and first degree relatives with atopy or positive intracutaneous test but the results did not attain statistical significance. Similarly the age at onset and duration of alopecia areata was not significantly related to the presence of atopy.
It is concluded that in north Indians with alopecia areata, the presence of atopy is not significantly associated with severe alopecia or onset at younger age.
Alopecia areata (AA) is a common disorder of hair loss the cause of which still remains unknown. Association of AA with atopy, autoimmune diseases, Down′s syndrome and emotional factors has been studied by various investigators.,,,,, Atopic disorders have been reported to occur with an incidence of 1 to 52% in patients with alopecia areata.,,, It has also been observed that alopecia areata pursues a severe course in the presence of atopy and has an early onset of alopecia and a longer duration of disease with a poor response to treatment,, however, the clinical experience has not been subjected to statistical evaluation. In a study from Chandigarh, no relationship was observed between presence of atopy and an early onset of an increased severity of alopecia areata. Many previous studies,,,, have relied only on the history of atopy in the patient and/or family as an evidence of atopy and not intracutaneous test. We evaluated the effect of associated atopy on severity and age at onset of Alopecia areata by applying statistical methods.
Materials and Methods
One hundred consecutive patients above the age of 12 years with alopecia areata were studied during year 1997. A comprehensive medical history was obtained from each patient with a special reference to personal and family history (parents and sibs only) of atopic disorders which included bronchial asthma, nasal allergy and atopic dermatitis as recommended by the expert groups.,, Alopecia areata was classified into circumscribed, extensive and totalis/universalis type. Less than 10 patches of hair loss was labeled as circumscribed alopecia areata whole extensive alopecia areata was defined as hair loss involving more than 40% scalp and/or more than 10 patches on the scalp, arms, legs or other sites. Alopecia areata totalis/universalis and extensive alopecia areata were considered as severe alopecia areata.
Fifty patients selected on the basis of the random table were subjected to intracutaneous skin sensitivity tests after informed consent. Intracutaneous test was carried out with eight common allergens (1:500 dilution) including female cockroach, Alternatia tenus, Aspergillus fumigatus, Ageratum conyzoides, Cassia siamea, Prosopis juliflora, Cynodon dactylon and wheat grain dust (supplied by Council of Scientific and Industrial Research, Delhi). These allergens were selected based on experience in Allergy Clinic at Advanced Paediatrics Centre, PGIMER, Chandigrah. In all the patients a positive control with 0.01 % histamine base solution and a negative control test with buffered normal saline was performed. The size of wheal and flare was recorded after 15-20 minutes as the mean of the largest diameter and its orthogonal diameter. A skin reaction which was 5mm more than the reaction observed with the saline control solution was taken as a positive test.
Thirty age and sex matched controls with no personal or family history of atopy were also subjected to intracutaneous tests.
Atopy was classified into 4 types as I) First degree relatives with atopy ii) patient with atopy, iii) patient and first degree relatives with atopy, iv) positive intracutaneous tests. A correlation of above types of atopy was examined with age at onset of alopecia areata and severe alopecia and duration of disease.
The statistical analysis was carried out using the Chi square test.
Patients with Alopecia areata included 76 males and 24 females. Majority of them (76%) were between 20 to 40 years. Mean duration of disease was 7.1 months (range 1 day to 19 years). Circumcribed alopecia areata was observed in 76% patients and severe alopecia areata in 24%, which include 21 patients with extensive alopecia and 3 with alopecia and 3 with alopecia universalis.
Historical evidence of atopy was present in 50 patients and/or first degree relatives (patients and sibs only). Evidence of atopy was presents in patients alone in 23, patients and first degree relatives 11 and first degree relatives alone 16 patients. Allergic rhinitis was the most common and observed in 42 patients or first degree relatives followed by bronchial asthma in 6 and atopic dermatitis in 2.
Intracutaneous tests were positive to one or more allergens in 23 (46%) out of 50 patients with alopecia areata compared to 7 (23.3%) out of 30 control (no personal or family history of atopy; p< 0.05). The correlation between presence of atopy by history or intracutaneous tests and severe alopecia, age at onset and duration of alopecia is depicted in [Table - 1] and [Table - 2].
There was trend towards increasing frequency of severe alopecia and presence of atopy in both patient and first degree relatives and positive intracutaneous tests, but the results did not attain statistical significance [Table - 1] and [Table - 2]; p>0.05). Similarly no correlation was found in age at onset and duration of alopecia and presence of atopy [Table - 1].
Atopy has been reported to occur with an increased frequency in patients with alopecia areata,,,,,,,,,,,, [Table - 3]. The atopic type in Ikeda′s classification comprised 10% of total of 1989 patients. Similarly 11 % of 736 patients studied by Muller and Winkelmann had concomitant asthma or atopic dermatitis. In the present study atopy was detected in increased frequency in patients with alopecia areata. Based on a detailed history 50% of our patients had evidence of atopy (patient alone in 23, patients and first degree relatives in 1 1 and first degree relatives alone in 16). These results are similar to those reported by Penders and Young et al. Atopy is reported in 10% to 52.4% [Table - 3] of patients with alopecia areata and our findings are within this range. Alopecia areata may become severe in upto 75% patients who have associated atopy.,. In present study despite increasing frequency of severe alopecia in atopics the results did not attain statistical significance [Table - 1] and [Table - 2]. It is in agreement with our previous report. Muller and Winkelmann and lkeda, had stated that patients with atopy have onset at relatively younger age and have longer duration of disease but same was not confirmed in the present study.
It is concluded that associated atopy apparently does not affect the severity of alopecia areata in north Indians. Previous studies, created converse impression without statistical analysis of their data. It is possible that severity of associated atopic disorders may be a critical factor in determining the severity of alopecia areata than the mere presence of atopic disorder. It has been reported that atopic dermatitis is less severe in Asian and in other underdeveloped and tropical countries., It may partly explain our findings and additional variation may be due to genetic factors.
Ikeda T. A new classification of alopecia areata. Dermatologica 1965;131:421-446.[Google Scholar]
Muller SA, Winkelmann RK. Alopecia areato. Arch Dermatol 1963;88:290-297.[Google Scholar]
Milgraum SS, Mitchell AJ, Bacon GE, et al. Alopecia areata, endocrine function and autoantibodies in patients 16 years of age or younger. J Am Acad Dermatol 1987;17:57-61.[Google Scholar]
Lewinski A, Broniarczyk Dyla G, Swerynek E, et al. Abnormalities in structure and function of thyroid gland in patients with alopecia areata. J Am Acad Dermatol 1990;23:768-769.[Google Scholar]
Cunliffe WJ, Hall R, Stevenson CJ, et al. Alopecia areata, thyroid disease and autoimmunity. Br J Dermatol 1969;81:877-881.[Google Scholar]
Duvivier A, Munro DP. Alopecia areata, autoimmunity and Down's syndrome. Br Med J 1975;1:191.[Google Scholar]
Dawber RPR, Ebling FJG, Wojnaro ska FT. In: Champion RM Burton JL, Ebling FJG (eds). Textbook of Dermatology. Oxford: Blackwell Scientific Publication 1994, 2533-3638.[Google Scholar]
Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. Int J Dermatol 1996;35:22-27.[Google Scholar]
De Weert J, Temmerman L, Kint A. alopecia areata : A clinical study. Dermatologica 1984;168:224-229.[Google Scholar]
Shellow WVR, Edwards JE, Koo JYM. Profile of Alopecia areata: A questionnaire analysis of patients and family. IntJ Dermatol 1992;31:186-189.[Google Scholar]
Nelson SH. Diagnostic procedures in allergy. Allergy skin testing. Annals of Allergy 1983; 51:411-417.[Google Scholar]
Hogan MB, Grammer LC, Patterson R. Rhinitis. Annals Allergy 1994; 72:293-300.[Google Scholar]
The U.K. Working Party's diagnostic criteria for atopic dermatitis derivation of minimum set of discriminators for allergic dermatitis. Br J Dermatol 1994; 135-388-396.[Google Scholar]
Executive Summery: Guidelines for the diagnosis and management of asthma. National Asthma Education Program. Expert Panel Reports, 1991.[Google Scholar]
Penders AJM. Alopecia areata and atopy. Dermatologica 1968; 136:395-399.[Google Scholar]
Young E, Bruns HM, Barrens L. Alopecia areata and atopy. Dermatologica 1978; 156-306-308.[Google Scholar]
Kanwar AJ, Dhar S. Severity of atopic dermatitis in India Br J Dermatol 1994; 131:733-734.[Google Scholar]
Davis RH, Sarkany I. Atopic eczema in Europeans and Negro West Indian Infant in London. Br J Dermatol 1961; 73:410-414.[Google Scholar]