Late-Onset Alopecia Areata: A Retrospective Cohort Study

Abstract

Background: Alopecia areata is an immune-mediated disease presenting with sudden onset of nonscarring hair loss. Onset is more common earlier in life, and little is known regarding late-onset alopecia areata. Objectives: To describe the epidemiology, clinical patterns, disease course, and outcome of late-onset alopecia areata in Israeli patients referred to a tertiary medical center. Materials and Methods: This retrospective cohort study considered patients whose disease onset occurred at age ≥50 years. Patients were recruited from among all alopecia areata patients visiting a tertiary center between January 2009 and April 2015. Results: Of the 29 people included, 25 (86.2%) were female (female-to-male ratio, 6.2:1). There was a family history of alopecia areata in 17.2%, thyroid disease in 31%, atopic background in 6.9%, and 17/29 (58.6%) reported a significant stressful event. The most common disease pattern was patchy, and disease was mild in the majority of participants. Complete hair regrowth was observed in 82.8% of participants, and 37.9% relapsed. Conclusion: Late-onset alopecia areata is characterized by marked female predominance, less extensive disease, and a high incidence of complete hair regrowth.

Alopecia areata: a long‐term follow‐up study of 104 patients

“…In contrast to this and in agreement with our recent study, all patient subgroups showed considerably higher prevalence of a family history of AA . The prevalence of a family history of atopy significantly decreased with age, while the prevalence of thyroid disorders increased with age; this is in agreement with the reported literature …”

“…Several previous studies have demonstrated no association of late‐onset AA with atopy and thyroid disorders. However, similar to the present findings, a recent study conducted by us found such an association; this could be attributed to the differences in the definition of atopy and/or geographical differences …”

“…Several recent publications have described a subset of patients with an older age at onset (after 50 or 60 years), defined as late‐ or elderly‐onset AA and demonstrated that these patients exhibited different characteristics . Our AA patient population was similar to that described in the literature with respect to age and sex and we chose to divide the patients into three subgroups: childhood‐onset, adult‐onset and late‐onset AA Previous studies have shown that 3%–42% of AA patients report a family history of the disease, with a greater prevalence in those with early‐onset and very low or no prevalence in those with late‐onset AA . In contrast to this and in agreement with our recent study, all patient subgroups showed considerably higher prevalence of a family history of AA .…”

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

“…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].…”

“…Late-onset AA is characterized by a marked female predominance, and disease severity is inversely proportional to age [17, 18], which is supported by the clinical consensus that young patients are often afflicted with a rapid disease progression, more extensive involvement, and a worse prognosis [53]. The association between AA and atopy among the pediatric population is controversial considering that an early disease onset often signifies a worse prognosis, while an increased age of onset is associated with a more mild disease course [16].…”