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Alopecia areata: A long term follow-up study of 191 patients

https://doi.org/10.1016/j.jaad.2006.05.008Get rights and content

Background

The prognosis of alopecia areata (AA) is difficult to predict. Few studies report long-term follow-up of AA patients.

Objective

The purpose of this study is to better assess the long-term evolution of AA and the possible relationship between disease severity and treatment response with long-term prognosis.

Methods

One hundred ninety-one patients with AA who presented with a new diagnosis of AA between 1983 and 1990 were subsequently contacted by phone. Patients were queried regarding current disease status, treatments, and disease course.

Results

Severity of AA at first consultation ranged from mild (128 patients) to severe (63 patients). Fifty-five of 191 patients were affected by concomitant autoimmune or related inflammatory disease. Sixty-six of 191 patients were presently disease free (follow-up duration, 15-22 years; mean 17.74 years). These include 41 of 60 patients with S1 disease (68.3%), 22 of 68 patients with S2 disease (32.3%), 1 of 11 patients with S3 disease (9%), 1 of 14 patients with S4 disease (7.1%), and 1 of 11 patients with alopecia totalis (AT) (9.1%). Sixty-nine of 191 patients (36-1%) were presently affected by AT or alopecia universalis. There was a statistically significant tendency of severe patterns of AA to worsen over time. In children, 18 of 39 (13 with ≤S2 disease and 5 with ≥S3 disease) with AA had developed AT or alopecia universalis at long-term follow-up. In children, however, this trend was not statistically significant. Patients with severe AA who responded to topical immunotherapy seem to have a better prognosis than nonresponders.

Limitations

Follow-up was only performed by phone.

Conclusions

Severity of AA at time of first consultation is an important prognostic factor. Response to therapy (topical immunotherapy) may be associated with better prognosis. In children, the prognosis is worse; our study found that AA worsens over time.

Section snippets

Patient population

One hundred ninety-one subjects with AA were enrolled in this study, 87 male and 104 female subjects. The age range of the patients was 2 to 69 years (mean 29.2 years), including 152 adults (>14 years old) and 39 children (14 years old). All presented as new consultations between 1983 and 1990 (mean follow-up 17.74 years). Duration of AA at time of first consultation was less than 2 years (mean 17 months) in all patients. The extent of AA at the time of first consultation was evaluated in

Results

Among 60 patients with S1 disease, 41 were free of disease, 13 maintained S1 disease, and 6 worsened. Among 68 patients with S2 disease, 22 were free of disease, 21 maintained S2 disease, and 25 worsened. Among 11 patients with S3 disease, 5 developed AT and 2 AU. Similarly, 7 of 14 patients with S4 disease worsened (5 developing AT and 2 AU). Among the 11 patients with AT, 5 still had AT and one developed AU. Interestingly, among the 27 patients with AU, 23 maintained their disease, while 2

Discussion

AA is an unpredictable disease for which treatment has minimal impact on long-term prognosis. There are few data about the long-term outcome of AA. Most studies using therapeutics have a 1- or 2-year follow-up period after discontinuance of therapy. This present study showed a direct relationship between severity of AA and long-term prognosis. In adults the more severe the disease is at onset, the more severe the prognosis. Severity of AA at onset of treatment is perhaps the most important

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Conflicts of interest: None identified.

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