The pattern and profile of alopecia areata in Singapore

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Int J Dermatol 2002 Nov;41(11):748-53

The pattern and profile of alopecia areata in Singapore - a study of 219 Asians.

BACKGROUND: Alopecia areata is believed to be an autoimmune condition with a worldwide occurrence. It usually presents as patchy, nonscarring hair loss. There is a paucity of clinical data in Asians. OBJECTIVE: To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in an Asian population over a 1-year period. METHODS: Records of all newly diagnosed alopecia areata cases seen from May 1998 to April 1999 at the National Skin Center were collated with regard to the epidemiology, pattern of alopecia, and associations according to the investigational guidelines published by Oslen et al. The treatment and psychologic impact of alopecia areata were also assessed. RESULTS: Two hundred and nineteen new case referrals of alopecia areata were seen from May 1998 to April 1999. The incidence of alopecia areata was 3.8%. There were 173 Chinese (79%), 35 Indians (16%), and 11 Malays (5.0%). The male to female ratio was 1 : 1.3. The median age at presentation was 25.2 years. The majority of patients (85.5%) had their first episode of alopecia areata before the age of 40 years. Of the patients with onset of alopecia areata before the age of 40 years, 36.5% presented with extensive alopecia, compared with 5.5% above the age of 40 years (P < 0.05). Nail changes, consisting of pitting, trachyonychia, and longitudinal ridging, were reported in 23 patients (10.5%). A significant percentage of patients had an associated personal and family history of atopy (60.7%). There was no significant association between a personal history of atopy and the extent of alopecia areata. The frequencies reported for the following associated diseases were: thyroid disease, 2.3%; vitiligo, 4.1%; diabetes mellitus, 3.2%; Down's syndrome, 1.4%; and rheumatic arthritis, 0.9%. A family history of alopecia areata was reported in 4.6%. Intralesional triamcinolone acetonide was the first-line treatment for limited alopecia areata, while squaric acid dibutyl ester was used for extensive involvement. The majority of patients with limited alopecia areata (82.1%) had more than 50% improvement with intralesional triamcinolone acetonide after 3 months. The majority of patients who received squaric acid dibutyl ester (87.5%) achieved more than 50% regrowth at the end of 6 months. Poor prognostic factors for alopecia areata were extensive involvement, early age of onset, and Down's syndrome. Thirteen out of 132 respondents (9.8%) recalled stressful events preceding hair loss. Patients with extensive alopecia areata experienced more psychologic adverse effects than those with limited alopecia areata (P < 0.05). Males with extensive alopecia areata experienced more severe psychologic ill-effects, such as depression and feelings of inability to improve hair loss. CONCLUSIONS: Our findings are similar to those reported in the Western literature where alopecia areata is predominantly a disease of the young. A holistic approach is important in the management of alopecia areata as the disease can have a severe psychologic impact on an individual's well-being.

Clin Exp Dermatol 2002 Jul;27(5):418-21

Cosmetics and hair loss.

Cosmetic hair care products are often implicated by the user or the clinician in cases of hair loss. Yet, these products are used ad lib, in a wide variety of home conditions and on a wide variety of hair types, by millions of consumers every day with no adverse effects. Based on this extensive data set, the absence of literature reports, and a detailed understanding of the mode of action of cosmetic hair care products, we can conclude that they do not cause hair loss. Clinicians investigating cases of hair loss must fully appreciate the hair cycle, the length of time a single fibre may be present on the head, and its biological and cosmetic history in order to understand the causes of hair loss and make the correct diagnosis. With a better understanding of the cosmetic practices used by everyday consumers, the clinician will be in a strong position to help patients re-grow their hair and guide them through a high quality hair care regime.

J Dermatol 2002 Jul;29(7):419-22

Frictional hair loss in Iraqi patients.

A total of 50 Iraqi male patients with frictional hair loss were studied. Their ages ranged from 27-55 years with a mean +/- SD of 40.60 +/- 7.82 years. The age of onset ranged from 26-50 years with a mean +/- SD of 38 +/- 7.3 years. The duration of disease was 1-5 years, mean +/- SD 2.2 +/- 1.3. Middle age was the most common age group affected. Patterns of hair loss were as follows; bilateral thighs & legs 13 (26%), bilateral thighs alone in 9 patients (18%), bilateral shins & calves (legs) in 4 patients (8%), abdomen alone in 8 patients (16%), thigh and abdomen 4 (8%) patients, legs & abdomen 4 (8%) patients, and all sites in 12 patients (24%). The pattern of patchy hair loss showed some etiological preference. It was found to be due to continuous pressure from socks, trousers and bed. Skin biopsies from five patients showed apparently normal histology. Twenty-six (52%) of the cases were healthy. There were no important medical or dermatological associations, such as alopecia areata or peripheral neuropathy in any patient although unrelated medical conditions were seen in 24 (48%). To the best of our knowledge, this type of patchy hair loss has attracted very little attention in the past, and the literature appeared to be deficient in references to this problem.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 1999 Jan;13(1):28-30

The clinical application of scalp expansion in the repair of cicatricial baldness in children

OBJECTIVE: To introduce the clinical application of the expanded graft from scalp in the repair of cicatricial baldness in children. METHODS: 45 cases with baldness following burn from 1988 to 1998 were reported. All of these patients (age ranged from 5-11 years) were treated by soft tissue expander. RESULTS: 5 cases were followed up for 1-2 years, the clinical results showed that the result from the graft of scalp expansion was satisfactory, and the long-term follow-up revealed that the hair in expended area and that in normal area was almost the same except the orientation of hair distribution had some difference. CONCLUSION: The head scalp expansion might be the first choice in the repair of cicatricial baldness following burn.

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