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Treatment of Alopecia Areata in the United States: A Retrospective Cross-Sectional Study
Abstract
Background:
Alopecia Areata (AA) is a non-scarring alopecia that affects millions of Americans, however the way it is treated and which patients seek treatment is not well characterized.
Objective:
To better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians treated them.
Methods:
We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA.
Results:
There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists (84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01).
Limitations:
The NAMCS and NHAMCS do not record severity of disease data.
Conclusions:
Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil.
J Drugs Dermatol. 2015;14(9):1012-1014.
... There have been few studies on treatments used for AA in the real-world setting in the USA. A retrospective study of 2.6 million US outpatient visits for AA in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) found that topical or injectable corticosteroids (61.0%), minoxidil (5.9%), and topical tacrolimus (5.7%) were the most common treatments (39). Another study of US insurance claims data (2011 to 2018) found high rates of topical (80.3%) and oral (30.0%) corticosteroid use in the first year after AA diagnosis (26). ...
... Most adult and adolescent patients with AA who initiated therapy were treated with corticosteroids, most commonly via injection in both 1L and 2L. This is consistent with ACE consensus study recommendations for 1L treatment of AA (38) and findings from other studies (39,41). Non-systemic therapies predominated in 1L and 2L, with just 2% of all patients and 11% of those with AT or AU receiving systemic therapies (defined as a regimen comprising oral corticosteroids or systemic immunomodulators) at any time (data not shown). ...
Alopecia areata is an autoimmune disorder characterized by hair loss, for which there are few treatment options. This claims-based study characterized recent real-world treatment patterns among patients in the USA with alopecia areata, including the subtypes alopecia totalis and alopecia universalis, in the first year after diagnosis of an episode of alopecia areata. Approximately 5% of all patients (adults (age ≥ 18 years), n = 7,703; adolescents (age 12-17 years), n = 595) had alopecia totalis or alopecia universalis. Corticosteroids were the most common first-line (1L) and second-line (2L) treatments. The mean time from diagnosis of alopecia areata to initiation of 1L treatment was 2.2 days for adults and 2.6 days for adolescents; mean 1L duration was 76.9 and 64.3 days, respectively. For adults (57.5%) and adolescents (59.7%) with 2L therapy, the mean time from 1L discontinuation to 2L initiation was 57.2 and 53.6 days, respectively; the mean duration of 2L treatment was 55.5 and 50.1 days, respectively. More patients with vs without alopecia totalis or alopecia universalis initiated 2L therapy (adults: 71.9% vs 56.8%; adolescents: 71.4% vs 58.9%). The proportion of days covered during the first year post-diagnosis was 36.7% (adults) and 34.1% (adolescents). These results highlight the substantial disease burden of alopecia areata and a need for more effective treatments.
... 13,14 However, a cross-sectional analysis of an estimated 2.6 million AA outpatient visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey revealed that males made fewer clinic visits per 1,000 capita compared to females. 15 Additionally, in a US study of 481 Caucasian patients from AA patient conferences, there was a female predominance of AA (female to male ratio 2.3:1), 16 and a Turkish study reported that 53.4% of patients diagnosed as having AA, AT, or AU were female and 46.6% were male. 17 Associations of AA with LGBTQIA+ status, physical disability, socioeconomic status, education level, or health insurance status have not been evaluated in prior epidemiological studies. ...
Background
Alopecia areata (AA) is an autoimmune condition characterized by patchy, nonscarring hair loss. Few studies of AA have adequately included participants from underrepresented groups when evaluating the burden of AA in the United States.
Methods and Results
We conducted a cross-sectional study of personal/demographic factors and AA using the ongoing All of Us (AoU) Research Program. AoU enrolls adults over 18 years either as direct volunteers or through participating Health Care Provider Organizations by prioritizing recruiting underrepresented groups. We linked data from surveys and electronic health records (EHRs) to estimate the prevalence of AA by race/ethnicity, physical disability, sexual orientation/gender identity (LGBTQIA+), income, and education. The latest AoU release (version 5) includes 329,038 participants. Average age was 51.8 years (standard deviation, SD 16.7), and 60.2% of participants were female. Of these, 251,597 (76.5%) had EHR data and 752 were diagnosed with AA (prevalence, 0.30%; 95% CI, 0.28–0.32). We used multivariate logistic regression adjusted for age and other factors to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for prevalence of AA. Compared to Whites, Blacks and Hispanics had higher odds of AA (OR, 1.72; 95% CI, 1.39–2.11 and OR, 2.13; 95% CI, 1.74–2.59, respectively). Lower odds of AA were observed in participants with less than a high school degree (OR, 0.80; 95% CI, 0.59–1.08), household income ≤$35,000 (OR, 0.67; 95% CI, 0.54–0.83), and no health insurance (OR 0.35; 95% CI, 0.20–0.56).
Conclusions
In this diverse population of US adults, participants with skin of color had higher prevalence of AA. Lower prevalence of AA among individuals with lower education and income levels and those lacking health insurance may reflect limited access to dermatologic care and potentially higher levels of undiagnosed AA in these groups.
... Однако существующие на сегодня методы борьбы с ней ограничены. В настоящее время Food and Drug Administration (FDA) разрешило местное применение только minoxidil finasteride для лечения андрогенетической алопеции [78,80,81], а для лечения очаговой алопеции используют местные инъекции кортикостероида, а также местные аппликации tacrolimus и minoxidil [82]. К сожалению, все эти препараты имеют определенные ограничения. ...
The review focuses on the possibilities and prospects of the use of fullerenes and their derivatives in cosmetics, the only industrial area where fullerenes have found practical application today. Based on the literary data and the results of their own experiments, the authors substantiate the safety of using fullerene for living organisms, as well as the usefulness of introducing fullerene as antioxidant in cosmetic compositions. Other useful properties of fullerene used in cosmetics and dermatology are discussed.
... Reassuring patients and stress control as well as iron supplementation in patients with deficiency can occasionally be helpful. Topical minoxidil and finasteride are the only FDA approved drugs in the treatment of androgenetic alopecia, 79,81,82 while topical corticosteroid and its injection, along with topical tacrolimus and minoxidil are used for treatment of alopecia areata 83 ; however, all these treatments have their own limitations. ...
Nanoparticles are equipped with exceptional properties which make them well suitable for diverse and novel applications. Fullerene is one of the nanomaterials that has valuable applications in the field of biomedicine. It possesses exceptional antioxidant capacity which has made it a promising core ingredient in many dermatological and skin care products. However, fullerene has the potentials to display a range of activities resulting in cell death or dysfunction. This review outlines the achievements made so far by reporting studies that have focused on incorporating fullerene in skin care products and cosmetics and assessed their beneficial effects. We have also documented reports that have assessed toxicity of this novel carbon allotrope toward skin cells and discussed its possible dermal reactions. Aside from pointing out the recent developments, areas that can benefit from further researches are identified.
Alopecia areata (AA) lifetime incidence is around 2%, with many patients first experiencing symptoms during childhood. However, ritlecitinib is the only FDA-approved treatment for pediatric patients 12 years and older. This review outlines reported topical, injectable, and oral treatment options for pediatric patients with AA. Clinical studies were obtained via a PubMed search using the following search terms: alopecia areata, areata, universalis, or totalis and medication, therapy, treatment, drug, or management. Only studies with pediatric patients were included in this review. Commonly used therapies, including corticosteroids, methotrexate, and minoxidil, newer promising medications, such as Janus kinase inhibitors, and less frequently used topical and systemic treatments are included. A summary of the drug development pipeline and ongoing interventional clinical trials with pediatric patients is provided. Treatments demonstrate variable efficacy, and many patients require combination therapy for maximal response. More robust clinical data is needed for many of the medications reviewed in order to provide better care for these patients.
Importance
Alopecia areata (AA) is characterized by hair loss ranging from patches of hair loss to more extensive forms, including alopecia totalis (AT) and alopecia universalis (AU). There is a lack of consensus for treatment. Understanding current practice patterns could help the identification of treatment needs and development of standards of care.
Objective
To review treatment patterns for adults with AA in the US between 2015 and 2020.
Design, Setting, and Participants
This retrospective cohort study used medicine and pharmacy claims for commercially insured individuals from the IBM MarketScan Research Database to assess adults (≥18 years) newly treated for AA between October 15, 2015, and February 28, 2020. Alopecia areata was identified based on having at least 1 diagnosis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code L63.x. Patients were required to have at least 365 days of continuous health plan enrollment before and after the cohort entry date. Patients were required to be free of AA diagnosis codes 365 days before the cohort entry date. Statistical analyses were conducted between 2019 and 2023.
Main Outcomes and Measures
Main outcomes were treatment patterns for all patients with AA and subgroups of (1) patients with AT or AU and (2) those cared for by a dermatologist on the cohort entry date. Longitudinal therapy course during the first year after the diagnosis was also examined.
Results
The study cohort consisted of 45 483 individuals (mean [SD] age, 43.8 [14.2] years; 29 903 [65.7%] female). During the year of follow-up, 30 217 patients (66.4%) received at least 1 AA treatment. The most common treatments were intralesional (19 014 [41.8%]), topical (18 604 [40.9%]), intramuscular (17 328 [38.1%]), and oral (9378 [20.6%]) corticosteroids. Compared with patients without AT or AU, patients with AT or AU a lower frequency of intralesional steroid (359 [11.1%] vs 18 655 [44.1%], P < .001) and higher frequency of topical corticosteroid (817 [25.4%] vs 17 787 [42.1%], P < .001) use. Almost half of patients (21 489 [47.2%]) received no treatment on the day of diagnosis. By 12 months, 32 659 (71.8%) were not receiving any treatment, making no treatment the largest study group.
Conclusions and Relevance
In this large cohort study of commercially insured individuals, corticosteroids were the most commonly used treatment for adults with AA between 2015 and 2020. At 365 days after diagnosis, more than two-thirds of patients were no longer receiving any AA treatment. Further studies are needed to understand the reasons for the absence of treatment.
Alopecia areata (AA) is an autoimmune condition characterized by patchy, nonscarring hair loss. Few studies of AA have adequately included participants from underrepresented groups when evaluating the burden of AA in the United States. We conducted a cross-sectional study of personal/demographic factors and AA using the ongoing All of Us (AoU) Research Program. AoU enrolls adults over 18 years either as direct volunteers or through participating Health Care Provider Organizations by prioritizing recruiting underrepresented groups. We linked data from surveys and electronic health records (EHRs) to estimate the prevalence of AA by race/ethnicity, physical disability, sexual orientation/gender identity (LGBTQIA +), income, and education. The latest AoU release (version 5) includes 329,038 participants. Average age was 51.8 years (standard deviation, SD 16.7), and 60.2% of participants were female. Of these, 251,597 (76.5%) had EHR data and 752 were diagnosed with AA (prevalence, 0.30%; 95% CI 0.28–0.32). We used multivariate logistic regression adjusted for age and other factors to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for prevalence of AA. Compared to Whites, Blacks and Hispanics had higher odds of AA (OR, 1.72; 95% CI 1.39–2.11 and OR, 2.13; 95% CI 1.74–2.59, respectively). Lower odds of AA were observed in participants with less than a high school degree (OR, 0.80; 95% CI 0.59–1.08), household income ≤ $35,000 (OR, 0.67; 95% CI 0.54–0.83), and no health insurance (OR 0.35; 95% CI 0.20–0.56). In this diverse population of US adults, participants with skin of color had higher prevalence of AA. Lower prevalence of AA among individuals with lower education and income levels and those lacking health insurance may reflect limited access to dermatologic care and potentially higher levels of undiagnosed AA in these groups.
La eritrodermia se define como el eritema y la descamación del 80 % de la superficie corporal. Se considera un signo clínico,
ya que puede tener múltiples etiologías, entre estas se encuentran la agudización de dermatosis de base, medicamentos,
infestaciones, entre otras. La dermatomiositis es una miopatía inflamatoria que puede ser una de las causas de eritrodermia,
siendo poco común como manifestación inicial. En el siguiente artículo presentamos el caso de una paciente con eritrodermia
secundaria a una dermatomiositis paraneoplásica, demostrando de esta manera que no se debe olvidar la dermatomiositis
como una de las causas de las eritrodermias con poca respuesta al manejo instaurado.
Dermatol Peru 2020; 30 (2): 139-143
ISSN 1028 - 7175
Alopecia areata (AA) is a sudden burst of hair loss on the scalp and other hair-bearing, its etiology is related to a mononuclear cell and an INF-y drove TCD8 autoimmune infiltration among bulb of the diseased hair follicles1,2.
Current treatment modalities available are only able to manage the disease, often with unsatisfactory results, treatment consists of topical, intralesional or oral corticotroph2,3. Topical Minoxidil is a well known used drug for male and female androgenetic alopecia, which mechanism of action is incompleted described. It does not make part of the standard treatment in AA and it´s effectiveness is not a consensus, reported case-by-case, effectiveness is improved by the combination of therapies use, rarely in monotherapy2,3,4. Moreover, according to Rai, 20175 topical Minoxidil use under childhood has been related to induce hypertrichosis as a possible side effect. Despite this, we described a case of a 16-years-old teenager successful use of topical 5% Minoxidil twice a day to treat an eyebrow patchy [FIGURE 1], hair growth has been recovered into 4 months [FIGURE 2]. Anti-inflammatory effect of Minoxidil, downregulating IL-1 cytokine6 may play a significant role in mild AA cases. Our case can be an open door to future trials and essays applying Minoxidil under AA treatment.
Topical minoxidil is a well-known and often-utilized drug in dermatological practice for the treatment of alopecia. It was approved by the United States Food and Drug Administration for the treatment of androgenetic alopecia in 1988. Since its approval, minoxidil has been used off-label for the treatment of many other types of alopecia, with minimal formal evidence of efficacy. Conditions for which the use of topical minoxidil has been reported include telogen effluvium, alopecia areata (AA), scarring alopecia, eyebrow hypotrichosis, monilethrix, and chemotherapy-induced alopecia (CIA). The evidence for the use of minoxidil in each condition is derived from a variety of studies, including clinical trials, case series, and case reports. A comprehensive review of the literature indicates that while minoxidil is routinely used in the management of many alopecic conditions, there is mixed evidence for its efficacy. For certain conditions, including AA and most scarring alopecias, the evidence seems to be inconclusive. For others, such as eyebrow hypotrichosis, monilethrix, early traction alopecia, and CIA, there is more support for the efficacy of minoxidil. Although the favorable safety profile of minoxidil is established in adults, its use in the treatment of pediatric alopecia may require heightened monitoring and patient education.
Pediatric alopecia areata is a spectrum of autoimmune non-scarring alopecia in which some patients lose small patches of hair from their scalp but others lose more or all of the hair from the scalp and body, including eyebrows and eyelashes. Few studies have looked at therapies for this disorder in children, so much of the data are derived from adult literature and describe off-label use of medication. Generally, topical therapies consisting of topical steroids and topical irritating compounds/contact sensitizers are used. Systemic therapies that block the immune system, including Janus kinase (JAK) inhibitors, have also been used in this disease. This paper reviews the data on therapy for alopecia areata in pediatric patients.
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