33936 The characterization and prevalence of alopecia diagnoses: A retrospective, cross-sectional study

Abstract

Specific alopecia diagnoses are important clinical items for systemic lupus erythematosus (SLE) diagnosis in the latest Systemic Lupus International Collaborating Clinics (SLICC) and American College of Rheumatology (ACR) classification systems. Despite the importance of alopecia diagnosis in patients diagnosed with lupus and subsequent patient management, there is limited research as to how often alopecia is actually being diagnosed in lupus patients with hair loss symptoms. Moreover, the potential for misdiagnosis among similar-appearing alopecia raises the question of whether biopsies are being ordered to increase accuracy in diagnosis. In our study, we sought to retrospectively characterize and quantify alopecia diagnoses and biopsy rates in a national cohort of lupus patients. We conducted a retrospective, cross-sectional analysis using patient visits from the U.S. National Ambulatory Medical Care Survey (NAMCS) database from 2002-2016 and 2018. Three major findings were found after generalizing our results: 1) only 12.42% (26,312 of 211,911) of lupus patients with hair loss symptoms received a specific alopecia diagnosis, 2) only 3.68% (7793 of 211,911) of lupus patients with hair loss symptoms received a biopsy, and 3) the proportion of lupus patients having alopecia diagnosed in dermatology was significantly higher than that of family medicine and other specialty groups. These results suggest that alopecia is underdiagnosed and infrequently biopsied in lupus patients who present with hair loss symptoms. We hope that these findings encourage clinicians to consider diagnosing alopecia or order referrals when an alopecia diagnosis is uncertain.