Clinical Characteristics and Prognostic Factors in Early-Onset Alopecia Totalis and Alopecia Universalis

Abstract

Alopecia totalis (AT) and alopecia universalis (AU), severe forms of alopecia areata (AA), show distinguishable clinical characteristics from those of patch AA. In this study, we investigated the clinical characteristics of AT/AU according to the onset age. Based on the onset age around adolescence (< or ≥ 13 yr), 108 patients were classified in an early-onset group and the other 179 patients in a late-onset group. We found that more patients in the early-onset group had a family history of AA, nail dystrophy, and history of atopic dermatitis than those in the late-onset group. These clinical differences were more prominent in patients with AU than in those with AT. In addition, significantly more patients with concomitant medical disorders, especially allergic diseases were found in the early-onset group (45.8%) than in the late-onset group (31.2%). All treatment modalities failed to show any association with the present hair condition of patients. In the early-onset group, patients with AU or a family history of AA showed worse prognosis, whereas this trend was not observed in the late-onset group. Systemic evaluations might be needed in early-onset patients due to the higher incidence of comorbid diseases. It is suggested that patients with AU or family history of AA make worse progress in the early-onset group than in the late-onset group.

The Immunological Association between Alopecia Areata and Respiratory Diseases: A Systematic Review

“…Three cross-sectional studies regarding asthma and hair loss with a total 1,600 patients reported the prevalence of asthma among AA patients of 1.34–14.5%; however there was no reported association with early onset of AA or development of alopecia totalis or universalis [20, 31, 32]. …”

“…Of note, a late age of AA onset (> 50 years) is a major confounding variable associated with a significantly reduced prevalence of AA and atopy [17, 18, 20, 21]. For example, one cross-sectional study of Taiwanese late-onset AA patients ( n = 73) reported no association with currently active disease or personal or family history of atopy [18], while another Israeli study ( n = 29) reported a prevalence of atopy in 6.90% of late-onset AA patients [17], Interestingly, juvenile AA (< 16 years) may be associated with a more severe disease course than that of patients with disease onset after 16 years of age [16].…”

Recurrent spontaneous abortions, Hashimoto thyroiditis and alopecia totalis: response to anticoagulation and intravenous immunoglobulin therapy

“…It is believed that AA onset before puberty implies its worse prognosis [23,24]. Accordingly, several studies reported that in comparison to patients with patch AA, patients with AT or AU were younger at the age of onset, had positive family history for AA and more likely had concomitant, autoimmune disorders [24,25]. Our patient had early-onset of AA with early progression to AT and concomitant autoimmune disease, but her family history was unremarkable.…”

“…Alopecia areata is a disease of very broad spectrum and only 10% of patients with its severe forms (alopecia totalis-AT and alopecia universalis-AU) could expect full recovery [23]. It is believed that AA onset before puberty implies its worse prognosis [23,24]. Accordingly, several studies reported that in comparison to patients with patch AA, patients with AT or AU were younger at the age of onset, had positive family history for AA and more likely had concomitant, autoimmune disorders [24,25].…”

Intravenous methylprednisolone pulse therapy in severe alopecia areata

“…[19] However, a study of patients with alopecia totalis and alopecia universalis found no statistically significant association between hair loss and treatment modalities in patients with disease onset below and above 13 years of age. [20] We did not find a statistically significant relationship between age of onset and treatment response.…”