Epidemiology of alopecia areata in Black patients: A retrospective chart review

Abstract

To the Editor: Recent studies show an increased incidence of alopecia areata (AA) in Blacks compared to Whites.1Lee H. Jung S.J. Patel A.B. Thompson J.M. Qureshi A. Cho E. Racial characteristics of alopecia areata in the United States.J Am Acad Dermatol. 2020; 83: 1064-1070https://doi.org/10.1016/j.jaad.2019.06.1300Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,2Thompson J.M. Park M.K. Qureshi A.A. Cho E. Race and alopecia Areata amongst US Women.J Investig Dermatol Symp Proc. 2018; 19: S47-S50https://doi.org/10.1016/j.jisp.2017.10.007Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Despite this information, few studies have examined the epidemiology of AA in Black patients exclusively. We retrospectively identified Black patients who were diagnosed with AA at the Wake Forest Baptist Health Dermatology Clinic from January 1, 2015 to December 31, 2020. The patients who satisfied the inclusion criteria were identified through patient self-identification of race and the International Classification of Diseases, Tenth Revision, Clinical Modification code confirmed through electronic patient medical records. The study included 198 Black patients with AA, of whom 144 were female (72.7%) and 54 were male (27.3%), with a female-male–ratio of 2.7:1. Patient ages ranged from 3 to 72 years, with a mean age of 32.2 ± 17.78 years. The age of patients at diagnosis ranged from 2 to 70 years. The mean age at diagnosis was 27 ± 17.63 years, with a mean age at diagnosis of 22.1 ± 14.73 years for males and 28.8 ± 18.32 years for females. Overall, 151 patients (76.3%) were diagnosed with AA before the age of 40 years. The largest age group at diagnosis was the 10- to 19-year age group, comprising 56 (28.3%) patients (Table I).Table IDistribution of age and sex at the time of diagnosisAge (y)Male, n (%)Female, n (%)Total, n (%)0-99 (4.5)23 (11.6)32 (16.2)10-1918 (9.1)38 (19.2)56 (28.3)20-2915 (7.6)15 (7.6)30 (15.2)30-395 (2.5)28 (14.1)33 (16.7)40-493 (1.5)14 (7.1)17 (8.6)50-593 (1.5)17 (8.6)20 (10.1)60-69—9 (4.5)9 (4.5)70-791 (0.5)—1 (0.5)Total54 (27.3)144 (72.7)198 (100) Open table in a new tab Forty-four patients (22.2%) had 1 or more coexisting autoimmune comorbidities. The most common was thyroid disease, seen in 13 (6.6%) patients. The majority of patients (117; 59.1%) had 1 or more medical comorbidities. Approximately half of the patients (98; 49.5%) had dermatologic disease. Atopy was most common, with 88 (44.4%) patients having 1 or more atopic conditions, including allergic rhinitis (57 patients; 28.8%), atopic dermatitis (41 patients; 20.7%), asthma (40 patients; 20.2%), and the complete atopic triad (6 patients; 3.0%). Other comorbidities in patients with AA included hypertension (38; 19.2%), seborrheic dermatitis (29; 14.6%), obesity (26; 13.1%), type 2 diabetes mellitus (16; 8.1%), anemia (10; 5.1%), and traction alopecia (13; 6.6%). Thirty-nine (19.7%) patients had psychiatric comorbidities, including depression or anxiety (Table II).Table IIMedical, dermatologic, and psychiatric comorbiditiesComorbiditiesMale, n (%)Female, n (%)Total, n (%)Medical/dermatologic Allergic rhinitis16 (29.6)41 (28.5)57 (28.8) Anemia—10 (6.9)10 (5.1) Atopic dermatitis7 (13.0)34 (23.6)41 (20.7) Asthma11 (20.4)29 (20.1)40 (20.2) Central centrifugal cicatricial alopecia—4 (2.8)4 (2.0) Female pattern hair loss—9 (6.3)9 (4.5) Gastroesophageal reflux disease—5 (3.5)5 (2.5) Hidradenitis suppurativa—3 (2.1)3 (1.5) Hypertension5 (9.3)33 (22.9)38 (19.2) Irritable bowel syndrome—5 (3.5)5 (2.5) Obesity7 (13.0)19 (13.2)26 (13.1) Psoriasis—2 (1.4)2 (1.0) Seborrheic dermatitis3 (5.6)26 (18.1)29 (14.6) Sickle cell trait—4 (2.8)4 (2.0) Telogen effluvium—3 (2.1)3 (1.5) Traction alopecia—13 (9.0)13 (6.6) Type 2 diabetes mellitus1 (1.9)15 (10.4)16 (8.1)Psychiatric Depression4 (7.4)25 (17.4)29 (14.6) Anxiety1 (1.9)7 (4.9)8 (4.0) Open table in a new tab The most common clinical presentation was patchy disease, present in 135 (68.2%) patients. This clinical pattern was followed by an ophiasis pattern, seen in 30 (15.1%) patients. Facial involvement affecting the eyebrows, eyelashes, and/or facial hair was present in 42 (21.2%) patients, and nail involvement was present in 30 (15.6%) patients. Other clinical types were less common. Our study indicates that AA in Black patients is characterized by marked female predominance, increased prevalence of disease in younger patients, and increased prevalence of atopic conditions. Our findings for gender and age distribution at diagnosis are similar to those in previous studies, indicating female predominance and increased prevalence of disease in younger patients.3Huang K.P. Mullangi S. Guo Y. Qureshi A.A. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States.JAMA Dermatol. 2013; 149: 789-794https://doi.org/10.1001/jamadermatol.2013.3049Crossref PubMed Scopus (124) Google Scholar, 4Conic R.Z. Miller R. Piliang M. Bergfeld W. Mesinkovska N.A. Comorbidities in patients with alopecia areata.J Am Acad Dermatol. 2017; 76: 755-757https://doi.org/10.1016/j.jaad.2016.12.007Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 5Villasante Fricke A.C. Miteva M. Epidemiology and burden of alopecia areata: a systematic review.Clin Cosmet Investig Dermatol. 2015; 8: 397-403https://doi.org/10.2147/CCID.S53985Crossref PubMed Scopus (160) Google Scholar Although prior research demonstrates an association between history of atopy and the risk of AA, atopic diseases (atopic dermatitis, allergic rhinitis, and asthma) in our study were the most common comorbidity with a higher prevalence than that reported in several previous studies.3Huang K.P. Mullangi S. Guo Y. Qureshi A.A. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States.JAMA Dermatol. 2013; 149: 789-794https://doi.org/10.1001/jamadermatol.2013.3049Crossref PubMed Scopus (124) Google Scholar, 4Conic R.Z. Miller R. Piliang M. Bergfeld W. Mesinkovska N.A. Comorbidities in patients with alopecia areata.J Am Acad Dermatol. 2017; 76: 755-757https://doi.org/10.1016/j.jaad.2016.12.007Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 5Villasante Fricke A.C. Miteva M. Epidemiology and burden of alopecia areata: a systematic review.Clin Cosmet Investig Dermatol. 2015; 8: 397-403https://doi.org/10.2147/CCID.S53985Crossref PubMed Scopus (160) Google Scholar Limitations of this study include retrospective study design, limited sample size, and the lack of a control group. Further evaluation of racial and ethnic differences in AA can shape physicians' understanding of the disease, diagnostic approach, disease risk, and associated comorbidities. Dr McMichael has received research grants, royalties, and/or consulting support from a variety of companies, including Allergan; Almirall; Arcuits; Bioniz; Cassiopea; Concert Pharmaceuticals; Covance; eResearch Technology, Inc; Galderma; Incyte; Informa Healthcare; Johnson & Johnson; Keranetics; Lilly; Merck & Co, Inc; Pfizer; Proctor & Gamble; Revian; Samumed; and UpToDate. Author Feaster has no conflicts of interest to declare.