Alopecia areata in Tunisia: epidemio‐clinical aspects and comorbid conditions. A prospective study of 204 cases

Abstract

Background Alopecia areata (AA) is an autoimmune condition that usually presents as patchy, nonscarring hair loss. Autoimmune disorders and atopy are reported as comorbid conditions. We aimed to investigate the demographics, clinical characteristics, and associations of AA in Tunisian patients. Methods Demographic data, pattern of alopecia, age of onset, and associations were evaluated in 204 patients from January 2012 to June 2016. Results Two hundred and four cases of AA were seen. The male to female ratio was 0.68. The mean age at presentation was 23 years old. Positive family history was noticed in 22.1% of patients. Personal history of atopy was associated with AA in 18.1%. Associated autoimmune diseases were thyroid disorders (12.7%), vitiligo (1.5%), psoriasis (three cases), type 1 diabetes (two cases), autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED) syndrome (two cases), lichen sclerosus atrophicus (one case), and pemphigus vulgaris (one case). Patchy AA was the most common manifestation (49.5%) followed by alopecia universalis (27.5%), alopecia ophiasis (12.7%), and alopecia totalis (10.3%). Nail changes consisting of pitting, trachyonychia, and longitudinal ridging were reported in 24.8%. AA patterns were more severe in females (P = 0.049). Severe forms showed more persistent disease duration (P = 0.005), earlier onset (P = 0.001), and more recurring episodes (P = 0.002) and were significantly associated with nail involvement (P < 0.001). Conclusions Our study aimed to review epidemio‐clinical characteristics and comorbid conditions of AA in Tunisian patients. More severe cases with a pejorative value of early‐onset AA, long disease duration, and nail involvement were seen in our study.

Association Between Vitamin D and Zinc Levels With Alopecia Areata Phenotypes at a Tertiary Care Center

“…Similarly, a study conducted in Egypt which included 60 patients stated that patchy alopecia was the commonest (53.3%), then both totalis and universalis with lesser frequencies (26.7%) [15]. Besides, a study in Tunisia performed on 204 patients showed similar findings to ours [16]. Therefore, patchy alopecia is the most commonly encountered pattern of hair loss in dermatology clinics as revealed by our study and other previous studies.…”

“…This is in contrast with other studies in the literature which demonstrated atopic disease as the most common comorbidity followed by hypothyroidism as the second most common. For example, Arousse et al found that atopic disease occurred in 18.1% of their sample whereas hypothyroidism was noted in 12.7% of cases [16]. However, a previous local study demonstrated findings similar to ours as hypothyroidism was the most common comorbidity in their sample [14].…”

Alopecia areata in Black African patients: epidemiological, clinical, and therapeutic aspects

“…Apart from this, we believe that this observation might be a peculiarity of alopecia areata in Africa, given that certain pathologies may be clinically discovered. The clinical forms found were proportionally identical to those in the literature [3,4,6,7]. Treatment in our work context was based on locally applied topical remedies; these were mainly dermocorticoids and minoxidil solution, used in combination or not.…”

“…According to Salam et al, the most common etiology of nonscarring alopecia in African women is traction alopecia [5]. Several pathologies can be associated with alopecia areata, and these include thyroiditis, vitiligo, psoriasis, diabetes, lichen planus, atopic dermatitis, and numerous other diseases described in the literature [6][7][8][9]. However, our study found no pathologies associated with alopecia areata.…”

Lichen sclerosus: The 2023 update

“…There are also reports from vitiligo, alopecia areata, rheumatoid arthritis, pernicious anemia, systemic lupus erythematosus, Sjögren syndrome, and multiple sclerosis ( 110 , 111 , 113 – 116 ). In 5.7% of patients, morphea coexists with LS, especially the circumscribed and generalized types ( 117 ).…”