Study of disease activity and its severity among patients of alopecia areata with the help of dermoscopic findings

 

Shilpa Pawar(Patil)^1*, H V Talanikar², Milind Patvekar³

 

¹Resident, ²Associate Professor, ³HOD, Department of Dermatology, Dr. D. Y. Patil Medical, College, Pimpri, Pune-411018, Maharashtra, INDIA.

Email: shilpapawar734@gmail.com

 

Abstract              Background: Alopecia areata (AA) is a common form of non-scarring alopecia involving the scalp and/or body, characterized by hair loss without any clinical inflammatory signs. Aims and Objectives: To Study disease activity and its severity among patients of alopecia areata with the help of dermoscopic findings. Methodology: After Institutional Ethical permission a cross-sectional study carried out at Dr D. Y. Patil Medical College, Pimpri, Pune during 2 years period i.e. January 2015 to December 2016 at Dermatology, Venereology and Leprology in 150 patients. The Statistical analysis done by ANOVA by SPSS software version 19. Results: The mean age in our study was 21.43 Yrs., the majority of the patients were in the age group of 30-40 i.e. 31.33% followed by 20-30- 24.67%, 40-50 were 18.67%, 10-20 were 10.67%, 50-60 were 8.00%, and >60 were 2.67%. The majority of the patients were Male i.e. 72.67% followed by Female i.e. 27.33%. The majority of the patients were having Patchy Single i.e. 41.33%, Followed by Patchy Multiple- 27.33%, Ophiasis in 10.67%, Sisaphio in 8.00%, Reticulate in 6.00%, Diffuse in 4.00%, Alopecia totalis in 2.67%, Alopecia universalis in 1.33%. Mean Yellow Dots per Field of Vision according to the type of Alopecia Areata Universalis Was 54.1±12.2, Ophiasis was 19.2±9.1, Diffuse - 13.1±9.2, Totalis-10.1±7.2, Patchy, localized-3.5± 2.1, Patchy, multiple-2.1±1.9 this was correlated significantly with disease activity (ANOVA, F=5.99,P<0.04). Conclusion: It can be concluded from our study that majority of the patients were having Patchy Single type of AA and Mean Yellow Dots per Field of Vision according to the type of Alopecia Areata was correlated significantly with disease activity.

Key Words: Alopecia Areata (AA), Dermoscopic findings, Alopecia totalis, Alopecia universalis.

 

INTRODUCTION

Alopecia areata (AA) is a common form of non-scarring alopecia involving the scalp and/or body, characterized by hair loss without any clinical inflammatory signs. It is one of the most common form of hair loss seen by dermatologists and accounts for 25% of all the alopecia cases. ¹ It was first described by Cornelius Celsus, and the term AA was coined by Sauvages in 1760. ² It accounts for 2-3% of the new dermatology cases in UK and USA, 3.8% in China, and 0.7% in India.^2,3,4 In general population, the prevalence was estimated at 0.1-0.2% with a lifetime risk of 1.7%. ^4] Both males and females are equally affected, ⁵ but some studies reported male preponderance. ^2,4,6,7  It can occur at any age. The youngest was 4-months-old, and the oldest was in late seventies. ⁸ Twenty percent of cases were children, and 60% of AA patients had their first patch before 20 years of age. ⁵ Highest prevalence was between 30-59 yrs of age. ¹ Family members are affected in 8.7-20% of cases. ^2,8

 

MATERIAL AND METHODS

After Institutional Ethical permission a cross-sectional study carried out at Dr D.Y.Patil Medical College, Pimpri, Pune during 2 years period i.e. January 2015 to December 2016 at Dermatology, Venereology and Leprology in 150 patients Written and informed consent was obtained from all patients. All AA patients attending Dermatology, Venereology and Leprology Department with dermoscopic findings, Age group – All age group, male and female, Patient willing to participate after taking written informed consent were included into the study. Patient with other diseases. Patient not willing to participate in the study were excluded from the study. The handheld dermoscope (Heine delta 20) has 20X magnification was used for Digital camera was used for dermoscopic study. The most common dermoscopic finding were yellow dots, black dots, broken hairs, short vellushair, tapering hairs. Dermoscopic findings will be collected in photographs, will show the diagnosis of alopecia areata, but yellow dots were mostly correlated with disease activity so they considered for analysis here.

 

RESULTS

Table 1: Distribution of the patients as per the age

The mean age in our study was 21.43 Yrs., the majority of the patients were in the age group of 30-40 i.e.31.33% followed by 20-30- 24.67%, 40-50 were18.67%, 10-20 were 10.67%, 50-60 were 8.00%, and >60 were 2.67%.

 

Table 2: Distribution of the patients as per the Sex

Sex	No.	Percentage (%)
Male	109	72.67
Female	41	27.33
Total	150	100.00

The majority of the patients were Male i.e. 72.67% followed by Female i.e. 27.33%.

 

Table 3: Distribution as per the Clinical types of Alopecia Areata

The majority of the patients were having Patchy Single i.e. 41.33%, Followed by Patchy Multiple- 27.33%, Ophiasis in 10.67%, Sisaphio in 8.00%, Reticulate in 6.00%, Diffuse in 4.00%, Alopecia totalis in 2.67%, Alopecia universalis in 1.33%.

 

Table 4: A Study Mean Yellow Dots per Field of Vision according to the type of Alopecia Areata

Mean Yellow Dots per Field of Vision according to the type of Alopecia Areata Universalis. Was 54.1±12.2, Ophiasis was 19.2±9.1, Diffuse - 13.1±9.2, Totalis-10.1±7.2, Patchy, localized-3.5± 2.1, Patchy, multiple-2.1±1.9 this was correlated significantly with disease activity (ANOVA, F=5.99,P<0.04).

 

DISCUSSION

In general, clinical diagnosis of AA is made based on typical pattern of hair loss, which can be supported by the presence of characteristic exclamation mark hair in microscopy. However, in some cases, the clinical diagnosis may not be straightforward, and in such cases, invasive (punch biopsy) techniques are often required, which are frequently not well accepted by patients, especially children.⁹ Acute diffuse AA, also known as alopecia areata incognita, presents like acute telogen effluvium causing great diagnostic difficulty.^10,11 Dermoscopy is a non-invasive procedure which was initially used to assess pigmented lesions. Recent studies have shown that dermoscopy can be a useful tool for the clinical diagnosis of AA by the presence of cadaverized hairs (black dots), exclamation mark hairs (tapering hairs), broken hairs, yellow dots and clustered short vellus hairs in the hair loss areas.¹¹ Clinically, the disease manifests as patchy alopecia, reticulate alopecia, ophiasis, ophiasisin versus (sisaphio), alopecia totalis or alopecia universalis.¹² A new subtype of AA is acute diffuse and total alopecia of the female scalp characterized by rapid progression of diffuse alopecia of the female scalp, marked female predominance and a favorable prognosis.¹³ In our study we have found that The mean age in our study was 21.43 Yrs. this was consistent with the previous studies.^{13, 14} the majority of the patients were in the age group of 30-40 i.e. 31.33% followed by 20-30- 24.67%, 40-50 were 18.67%, 10-20 were 10.67%, 50-60 were 8.00%, and >60 were 2.67%. The majority of the patients were Male i.e. 72.67% followed by Female i.e. 27.33%. The majority of the patients were having Patchy Single i.e. 41.33%, Followed by Patchy Multiple- 27.33%, Ophiasis in 10.67%, Sisaphio in 8.00%, Reticulate in 6.00%, Diffuse in 4.00%, Alopecia totalis in 2.67%, Alopecia universalis in 1.33%, this was also similar to The study by Inui et al.¹⁴ and Mane et al.,¹³ also noted patchy alopecia as the most common pattern involving 46.7% and 87.7% of patients respectively. Mean Yellow Dots per Field of Vision according to the type of Alopecia Areata Universalis Was 54.1±12.2, Ophiasis was 19.2±9.1, Diffuse - 13.1±9.2, Totalis-10.1±7.2, Patchy, localized-3.5± 2.1, Patchy, multiple-2.1±1.9 this was correlated significantly with disease activity (ANOVA, F=5.99,P<0.04). These findings are similar to the study done by Nishant GhodakeBapu et al¹⁵ they showed YD/FOV a significant correlation with the severity of disease. Dermoscopic assessment for the number of YD/FOV could be included in the evaluation of AA as it could serve as a guide to sub classify AA based on the severity and extent of involvement, and also to serve as a prognostic indicator. The high frequency of YDs in their study and the study by Mane et al. suggest that YDs are very important dermoscopic feature in south Indian patients with AA. YDs are a powerful new tool in the diagnosis of hair loss diseases initially proposed by Ross et al.^16,17 YDs are marked by a distinctive array of yellow to yellow-pink, round or polycyclic dots that vary in size and are uniform in color. They represent distention of the affected follicular infundibulum with keratinous material and sebum. In AA, degenerating follicular keratinocytes probably constitute the bulk of the YD. 17 In a study conducted by Inui et al.¹⁶

 

CONCLUSION

It can be concluded from our study that majority of the patients were having Patchy Single type of AA and Mean Yellow Dots per Field of Vision according to the type of Alopecia Areata was correlated significantly with disease activity.

 

REFERENCES

1. McMichael AJ, Pearce DJ, Wasserman D, Camacho FT, Fleischer Jr AB, Feldman SR, et al. Alopecia in the United States: Outpatient utilization and common prescribing patterns. J Am AcadDermatol 2007; 57:S49-51.
2. Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. Int J Dermatol1996; 35:22-7.
3. Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ 3rd. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc 1995; 70:628-33.
4. Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern of alopecia areata in Singapore – A study of 219 Asians. Int J Dermatol2002; 41:748-53.
5. Wasserman D, Guzman-Sanchez DA, Scott K, McMichael A. Alopecia areata. Int J Dermatol2007; 46:121-31.
6. Al-Mutairi N, Eldin ON. Clinical profile and impact on quality of life: Seven years experience with patients of alopecia areata. Indian J DermatolVenereolLeprol2011; 77:489-93.
7. Bhat YJ, Manzoor S, Khan AR, Qayoom S. Trace element levels in alopecia areata. Indian J DermatolVenereolLeprol2009; 75:29-31.
8. Muller SA, Winkelmann RK. Alopecia areata – An evaluation of 736 patients. Arch Dermatol1963; 88:290-7.
9. Inui S, Nakajima T, Itami S. Coudability hairs: A revisited sign of alopecia areata assessed by trichoscopy. ClinExpDermatol. 2010; 35:361–5. 
10. Peter D, George L, Pulimood SA. Trichoscopic features of various types of alopecia areata in India: Application of a hand-held dermoscope. Australas J Dermatol. 2013; 54:198–200. 
11. Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: Analysis of 300 cases. Int J Dermatol. 2008; 47:688–93. 
12. Mane M, Nath AK, Thappa DM. Utility of dermoscopy in alopecia areata. Indian J Dermatol. 2011; 56:407–11. 
13. Inui S, Nakajima T, Itami S. Significance of dermoscopy in acute diffuse and total alopecia of the female scalp: Review of twenty cases. Dermatology. 2008; 217:333–6.
14. Mane M, Nath AK, Thappa DM. Utility of dermoscopy in alopecia areata. Indian J Dermatol. 2011; 56:407–11.
15. Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: Analysis of 300 cases. Int J Dermatol. 2008; 47:688–93.
16. Nishant GhodakeBapu, Laxmisha Chandrashekar, MalathiMunisamy. Int J Trichology. 2014 Oct-Dec; 6(4): 156–159.
17. Inui S, Nakajima T, Nakagawa K, Itami S. Clinical significance of dermoscopy in alopecia areata: Analysis of 300 cases. Int J Dermatol. 2008; 47:688–93.
18. Ross EK, Vincenzi C, Tosti A. Videodermoscopy in the evaluation of hair and scalp disorders. J Am AcadDermatol. 2006; 55:799–806.