Associated factors for Extensive Alopecia Areata

Tarinee Korviriyakamol MD, Supaporn Siripun MD, Pinyo Rattanaumpawan MD. MSCE, Suthep Jerasutat MD, Tawatchai Suttikoon MD, Chinmanat Tangjaturonrusamee MD.

Background
Alopecia areata (AA) a major cause of hair loss. Associated factors for extensive AA in Thai are not well documented.

Objective
To determine risk factors in AA among Thai patients

Material & Methods

Cross sectional study Inclusion criteria
Diagnosed as alopecia area by clinical and histopathology Age 18 years Informed consent

Material & Methods (cont.)

Exclusion Criteria
Diagnosed as other diseases : Tinea capitis, seborrheic dermatitis, lupus erythematosus, syphilis Histopathology showed other diagnosis Pregnancy

Method
Patient who was diagnosis AA by histopathology History and illness Interview Stress Related illness BMI Area involvement

Physical examination

Complete blood count

Blood sampling Thyroid function test Antinuclear antibody

Statistical Analysis
Demographic data : Wilcoxon signed rank test Related illness and Stress factor : Fishers exact test p value of 0.05 = statistic significance

Result

97 Alpecia areata patients registered

4 was excluded
93 Alopecia areata patients were enrolled

81 Patchy alopecia, Ophiasis Area < 50 %

12 Extensive alopecia Area 50 %

Demographic Data
Characteristic
Age
Current onset (month) First episode (month) Body weight
AA Area < 50%
Median ( Min.-Max)

AA Area 50%
Median ( Min.-Max)

Univariate analysis P * 0.8815 0.1582 0.0548 0.261

35 (17-67) 6 (1-252) 2 (1-144) 60 (45-89)

35 (19-62) 3 (1-24) 1.5 (1-4) 57.5 (43-73)

Height
BMI

164 (135-185)
21.87 (16.96-31.95)

163 (150-178)
20.7 (17.72-27.77)

0.4625
0.3964

Interview Question
Previous treatment Emotional stress

Personal problem

Job/Financial problem

Underlying disease

Related to illness

Family problem

30

Past History
28.4 25

25

P = 0.043
20 16.67 15 16.67

Area<50%
10 6.17 5 1.23 0 3.7 2.47

Area>50%

factors

Ever had previous treatment

Related to illnesses

Related to fever Related to new Problems with within 6 months medication sweating

Related to illnesses
Factor Related to illnesses AA Area<50% 1.23% AA Area50% 16.67% Univariate analysis P* 0.043

Common cold

Respiratory tract infection

Tension headache

Emotional stress & Family problem

30

Not significant
24.69

25

AA Area <50%
20
16.67 15

AA Area > 50 %

10

8.33

5 1.23 0 0 1.23 1.23 0

factors

Emotional stress

Death of a family member

Illness of a family member

New person in the family

Personal problem
8.33 8.33 6.17

Not significant
AA Area < 50% AA Area > 50%

2.47

2.47

2 1.23 1.23

factors
0 0 0 0

Change of sleep Change food habit

accident

Exam

Change of residence

Job & financial problem

18 16 14 12 10 8.33 8 6 4 2 0 3.7 7.41 6.17 4.94 8.33 8.33

16.67

AA Area < 50% AA Area >50%

Not significant

factors
Dismissal Economic status Responsibility overworking

Emotional stress & Family problem

30 25 24.69

Personal problem
9 8 7 6 5 4 3 2 1 0 8.33 8.33

6.17

20
15 10 5 0

16.67

8.33

2.47 1.23 0
Change of sleep

2.47 1.23 0
Exam

1.23

1.23

1.23

0
Change of residence

Job & financial problem

18 16 14 12 10 8 6 4 2 0
Dismissal Economic status Responsibility

Emotional stress Death of a family Illness of a family New person in member member the family

9 8 7 6

Underlying Disease
8.33 6.17

Change food habit

Accident

16.67

8.33

7.41

8.33 6.17

8.33 4.94

5 4 3 2 1 0 1.23 0
Atopy Thyroid disease

3.7

1.23 0 0
Vitiligo

1.23 0 0
DM type I

overworking

Psychiatric disorder

Underlying Disease
9 8 7 6.17 6 5 4 3 2 1.23 1.23 1.23

8.33

Not significant
AA Area <50% AA Area >50%

1
0 0 0 0 0 0

factors

Atopy

Thyroid disease Overall 6%

Vitiligo

Psychiatric disorder

DM type I

Laboratory
%
30 25 24.69 20

Not significant
AA Area < 50% AA Area >50%

15

10

8.33

7.41

8.33

3.7

3.7

factors
0

Anemia

Abnormal thyroid function

Thyroglobulin antibody

ANA

Positive low ANA titer

Overall Blood Test

Alpha-Thalassemia trait= 4 Beta-Thalassemia trait= 1 Hb Constant spring = 1 Hb E trait = 2

Autoimmune thyroiditis

ANA 13% Thyroglobulin Antibody 10% TFT 9%

Anemia 68%

Subclinical hypothyroid

Single patchy VS Multiple patchy

Factor Single patchy alopecia N = 34 21.085 16.96 31.95 Multiple patchy Univariate analysis alopecia P* N = 59 23.14 17.00 31.23 P value = 0.0614 Body mass index - Mean - Min. Max.

Discussion
Information Study design N Onset of AA Related illness Study1 Retrospective 1040 Early onset Study2 Cross sectional 513 Our study Prospective 93 Not associated Associated

Atopy Thyroid disease

Autoimmune Stress factor Obesity

Associated Not associated

Not associated -

Associated Associated
Associated -

Not associated Not associated

Not associated Not associated Associated

Discussion
We have not found iron deficiency anemia in our study Interesting topic about BMI in multiple patch group > single patch Limitation : Cross sectional study Work in Process : Prognosis factor in the treatment of Alopecia areata

Conclusion
Extensive alopecia areata was significantly associated with illnesses. We found a borderline association between a higher BMI and the extensive type of alopecia areata.

Thank You