Epidemiology, management and the associated burden of mental health illness, atopic and autoimmune conditions, and common infections in alopecia areata: protocol for an observational study series

Abstract

IntroductionAlopecia areata (AA) is a common cause of immune-mediated non-scarring hair loss. Links between AA and common mental health, autoimmune and atopic conditions, and common infections have previously been described but remain incompletely elucidated and contemporary descriptions of the epidemiology of AA in the UK are lacking.Methods and analysisRetrospective study series using a large population-based cohort (5.2 million) from the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database, exploring four themes: AA epidemiology, mental health comorbidities, autoimmune/atopic associations and common infections.In the epidemiology theme, we will describe the incidence and point prevalence of AA overall and by age, sex and sociodemographic factors. Healthcare utilisation (primary care visits and secondary care referrals) and treatments for AA will also be assessed. In the mental health theme, we will explore the prevalence and incidence of mental health conditions (anxiety, depressive episodes, recurrent depressive disorder, adjustment disorder, agoraphobia, self-harm and parasuicide) in people with AA compared with matched controls. We will also explore the mental health treatment patterns (medication and psychological interventions), time off work and unemployment rates. Within the autoimmune/atopic associations theme, we will examine the prevalence of atopic (atopic dermatitis, allergic rhinitis, asthma) and autoimmune conditions (Crohn’s disease, ulcerative colitis, coeliac disease, type 1 diabetes, Hashimoto’s thyroiditis, Graves’ disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, systemic lupus erythematosus (SLE), polymyalgia rheumatica, Sjögren’s syndrome, psoriasis, vitiligo, multiple sclerosis, pernicious anaemia) in people with AA compared with matched controls. We will also estimate the incidence of new-onset atopic and autoimmune conditions after AA diagnosis. Within the common infections theme, we will examine the incidence of common infections (respiratory tract infection, pneumonia, acute bronchitis, influenza, skin infection, urinary tract infection, genital infections, gastrointestinal infection, herpes simplex, herpes zoster, meningitis, COVID-19) in people with AA compared with matched controls.Ethics and disseminationThe Health Research Authority decision tool classed this a study of usual practice, ethics approval was not required. Study approval was granted by the RCGP RSC Study Approval Committee. Results will be disseminated through peer-reviewed publications.Observational study registration numberNCT04239521.

The associated burden of mental health conditions in alopecia areata: a population‐based study in UK primary care*

“…Time off work was defined by the issue of Med 3 certificates of fitness for work, 21 which are issued to provide evidence of a patient being medically unable to perform usual work activities, and thus indicate absenteeism. Unemployment was defined by the presence of a coded unemployment record or issue of forms indicating incapacity from work: IB113 (incapacity benefit) or ESA113 (Employment Support Allowance, which replaced IB113 from January 2011) 14 …”

“…AA was defined by the presence of an AA‐specific Read code, and no Read codes for an alternative diagnosis (any form of scarring alopecia, 16 traction alopecia, congenital alopecia, androgenetic alopecia, telogen effluvium, tinea capitis, trichotillomania or secondary syphilis of the scalp) in the subsequent 365 days 14 . People with these alternative diagnostic codes were excluded, as were people with a diagnosis of AA prior to the study period.…”

“…The study protocol was prespecified as part of an AA observational study series, 14 and was registered with http://clinicaltrials.gov (NCT04239521). The protocol includes detailed definitions and code lists for all study exposures and outcomes 14 . Clinical information was extracted from the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database.…”

“…Unemployment was defined by the presence of a coded unemployment record or issue of forms indicating incapacity from work: IB113 (incapacity benefit) or ESA113 (Employment Support Allowance, which replaced IB113 from January 2011). 14…”

The Role of Nutrition in Immune-Mediated, Inflammatory Skin Disease: A Narrative Review

“…Patients may experience anxiety as a result of AA, which raises their chance of having psychological and mental problems [129,130].…”