Prevalence of pediatric alopecia areata among 572,617 dermatology patients

Abstract

To the Editor: The authors initiated this retrospective analysis to evaluate the prevalence, age, and sex of pediatric patients with alopecia areata (AA) and the impact that pediatric AA has on a typical dermatology practice. Billing data from Leavitt Medical Associates of Florida, doing business under the name Advanced Dermatology and Cosmetic Surgery, was collected from offices throughout Florida and Ohio, and 572,617 dermatology patients were identified. The study population included 71,951 pediatric patients (1-17 years of age): 33,800 boys and 37,791 girls. Of all 572,617 dermatology patients, 3633 had AA (0.63%). Of 71,951 pediatric patients, 656 had AA. Girls (n = 365) outnumbered boys (n = 291) (P = .004) with a ratio of 1.25:1. Overall, pediatric patients with AA were 18.1% (656/3633) of all patients with AA and 11.9% (656/5520) of all patients with any hair abnormality. Pediatric AA patients represented 0.1% (656/572,617) of all patients and 0.9% (656/71,591) of pediatric patients. The prevalence distribution of both sexes resembled a bell-shaped curve, with boys peaking at 12 years of age and girls peaking at 9 years of age (Fig 1). To compare the prevalence of AA among different age groups, the patients were divided into 3 broad groups: toddlers (1-5 years of age), children (6-11 years of age), and adolescents (12-17 years of age). Table I shows the prevalence of AA in these age groups.Table INumbers and rates of alopecia areata patients and patients with hair disorders by demographicAge, yearsSexPatients, NPatients with AA, NPatients with hair disorder, NAA patients, N/1000 patientsAA patients, N/1000 patients with hair disorder1-5Male4253142553.354.9Female4318283416.582.1Total8571425964.970.56-11Male12,3901239199.9133.8Female13,32516693612.5177.4Total25,715289188511.2155.812-17Male17,15715415369100.3Female20,14817115338.5111.5Total37,30532530698.7105.91-17Male33,80029127108.6107.4Female37,79136528109.7129.9Total71,59165655209.2118.81-80Total572,617363351,1936.371.0AA, Alopecia areata. Open table in a new tab AA, Alopecia areata. In 2004, Stern estimated that 9598 total US office-based dermatologists see 47,990,000 dermatology patients per year, with the average dermatologist seeing ∼5000 patients per year.1Stern R.S. Dermatologists and office-based care of dermatologic disease in the 21st century.J Investig Dermatol Symp Proc. 2004; 9: 126-130Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Given our prevalence of a diagnosis of AA in 0.63% (3633/572,617) of dermatology patients of all ages, we estimate that 302,337 patients with AA visit US dermatology practices each year. A 1992 study reported a similar nationwide prevalence of 306,000 AA patients.2Safavi K. Prevalence of alopecia areata in the First National Health and Nutrition Examination Survey.Arch Dermatol. 1992; 128: 702Crossref PubMed Scopus (176) Google Scholar Our study found that pediatric AA patients represented 18.1% of AA patients of all ages. Thus, we estimate that ∼54,000 pediatric AA patients visit dermatology offices per year. McMichael et al reported that 16% of total visits for AA involved patients 0-19 years of age,3McMichael A.J. Pearce D.J. Wasserman D. et al.Alopecia in the United States: outpatient utilization and common prescribing patterns.J Am Acad Dermatol. 2007; 57: S49-S51Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar and Safavi et al found that 27.7% of 292 AA patients were 0-19 years of age.4Safavi K.H. Muller S.A. Suman V.J. Moshell A.N. Melton 3rd, L.J. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989.Mayo Clin Proc. 1995; 70: 628-633Abstract Full Text Full Text PDF PubMed Scopus (449) Google Scholar The rate of 5000 dermatology patients per year per dermatologist noted above can be viewed as 21 patients per day (assuming a 5-day work week 52 weeks/year) or 1000 patients in ∼2.4 months.3McMichael A.J. Pearce D.J. Wasserman D. et al.Alopecia in the United States: outpatient utilization and common prescribing patterns.J Am Acad Dermatol. 2007; 57: S49-S51Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar On the basis of our data, pediatric patients represent 126 of these 1000 patients; 10 of 126 will have a hair condition, and 1 of 126 will have AA. Thus, on average, 1 pediatric patient with AA will appear for treatment at a private dermatology office in the United States every 2.4 months; this single AA patient is 1.25 times more likely to be a girl than a boy.