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.