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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 125-128

Prevalence and treatment of Alopecia areata in Taif area, KSA


1 Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut; Department of Pharmacognosy, Faculty of Pharmacy, Taif University, Taif, Saudi Arabia
2 Department of Clinical Pharmacy, Faculty of Pharmacy, Taif University, Taif, Saudi Arabia

Date of Web Publication16-Jun-2015

Correspondence Address:
Ahmed Mohamed Ahmed Abd El-Mawla
Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut - 71526
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.157891

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  Abstract 

Background: Alopecia areata (AA) is one type of hair loss that typically causes patches of baldness. In some cases, total baldness develops. There are no adequate studies concerning AA on the Taif area residents, KSA. Aim: The present study conducted for the first time prevalence, causes and treatment of AA in Al-Taif area, KSA. Materials and Methods: A questionnaire employed to determine the prevalence of AA in patients attending dermatology clinics in Al-Taif area. The doctors questioned about the number of patients attend dermatology clinics and suffering from AA. Doctors also were asked about types, causes of AA and the treatment/responsiveness. The data collected and analysed statistically. Results: The obtained results showed a noticeable prevalence of AA in Al-Taif area; 6.750% in males and 6.375% in females. Localized AA was the most common (88.75%) as well as the most responsive to the treatment. The emergence of disease was mostly related to the immune system (85%). The Doctors preferred topical corticosteroids or minoxidil plus systemic vitamins and minerals treatment more than others due to its effectiveness (90%, 40% responsiveness in localized and diffused respectively). Conclusion: We concluded that, the incidence of AA disease in Al-Taif area, exceeded expectations and the autoimmune condition is the most predominance reason for its occurrence. The most effective treatment was topical corticosteroids plus systemic vitamins and minerals. Recommendations: We recommend a vitamin-rich diet as well as an increased emphasis on the use of topical rubefacient herbs in addition to the above mentioned treatments of AA.

Keywords: Alopecia areata, autoimmune, corticosteroids, minoxidil, prevalence, Saudi Arabia, taif, topical


How to cite this article:
Abd El-Mawla AM, Maghrabi IA. Prevalence and treatment of Alopecia areata in Taif area, KSA. Saudi J Health Sci 2015;4:125-8

How to cite this URL:
Abd El-Mawla AM, Maghrabi IA. Prevalence and treatment of Alopecia areata in Taif area, KSA. Saudi J Health Sci [serial online] 2015 [cited 2019 May 23];4:125-8. Available from: http://www.saudijhealthsci.org/text.asp?2015/4/2/125/157891


  Introduction Top


0Alopecia areata (AA) is a condition in which hair is lost from some or all areas of the body, usually from the scalp. Commonly, AA involves hair loss in one or more round spots on the scalp. Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse AA. [1] The prognosis of AA is difficult to predict. Few studies report long-term follow-up of AA patients. The long-term evolution of AA and the possible relationship between disease severity and treatment response with long-term prognosis was assessed. [1] A total of 50 Iraqi male patients with frictional hair loss were studied. [2] The treatment depends on the size of the affected region. If the affected region is small, it is reasonable just to observe the progression of the illness, as the problem often spontaneously regresses and the hair may grow back. In cases of severe hair loss, limited success has been shown from treating AA with the corticosteroids clobetasol or fluocinonide, corticosteroid injections, or cream.

The prevalence and characteristics of unconventional therapies used by dermatology outpatients in Turkey were determined. [3] The current understanding of the use of non-pharmaceutical botanical products in the management of hair loss was evaluated. [4] A muscular needling combined with local injection in the treatment of AA was studied. [5] A 23-year-old man with an 18-month history of patch-type AA of his scalp has failed to respond to topical clobetasol propionate and tacrolimus ointments. [6] A case of an unusual adverse drug reaction to diphenylcyclopropenone for the treatment of alopecia areata was described. [7] AA is an autoimmune disease associated with other autoimmune diseases such as thyroid disorders, anaemia, and other skin disorders. A case of AA associated with Graves' disease in a 41-year-old woman who had previously been diagnosed with Hashimoto's disease was reported. [8] The effectiveness of topical crude onion juice in the treatment of patchy AA in comparison with tap water was tested. [9] AA and Vitiligo-Partners in Crime or a Case of False Alibis, a correlation between AA and vitiligo was studied. [10] Three cases of AA treated with Scalp Roller therapy, which were resistance to both systemic and topical treatment for inducing hair on cosmetic region like scalp were reported. [11] A total of 481 North-American Caucasian AA patients (336 female, 145 male) were recruited to assess age of onset, autoimmune and atopic co-morbidity, nail involvement, family history of AA and autoimmune disease and disease subtype. [12] Forty patients with AA and a 40-volunteer random age-sex matched control group were enrolled. The study is based on anxiety and Beck Depression Inventory (BDI) and the Eysenck Personality Questionnaire (EPQ). Analytical evaluation was done by Mann-Whitney, Kruskal Wallis, and t-tests. [13] There are no adequate studies on the Taif area residents to determine the incidence, causes and suitable treatment of the disease. The present study was conducted for the first time. The present study aims to investigate the; the prevalence of AA in Al-Taif area, KSA in correspondence to the gender and type, the causes of the disease and the commonly used drugs for the treatment.


  Materials and methods Top


The study was conducted on 800 male and 800 female who accustomed dermatologist clinics in Al-Taif area, KSA. The doctors will be questioned about the number of patients attend dermatology clinics and suffering from AA. They also were asked about types, causes of the disease, and the treatments/responsiveness. The data will be collected and analysed statistically. The data were compiled from eight government hospitals and private clinics (100 male/female patients each) on the basis of a questionnaire have been prepared by the supervisor and dermatologists. The collected data was analyzed by using SPSS program (Statistical Package for Social Sciences; version 16).


  Results Top


The prevalence of AA in both males and females was almost equal [Table 1]. The localized type of AA is the most common [Table 2].
Table 1: The prevalence of Alopecia areata in Al-Taif area, KSA according to gender

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Table 2: The prevalence of Alopecia areata in Al-Taif area, KSA according to its type

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The autoimmune condition is the most predominance reason for the occurrence of disease followed by psychological, genetic and others factors [Table 3].
Table 3: The prevalence of Alopecia areata in Al-Taif area, KSA in accordance to cause

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The present study found that, the topical treatment is the most common among the others [Table 4]. In addition, the response rate to topical and topical + systemic is almost equal and the localized type was more responsive to treatment than diffused [Table 5] and [Table 6].
Table 4: The prevalence of the treatment type of the Alopecia areata in Al-Taif area, KSA

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Table 5: The response rate of Alopecia areata to the treatment type in Al-Taif area, KSA

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Table 6: Responsiveness of Alopecia areata patients to the most common treatment

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  Discussion Top


As a result of the negative psychological effect of the disease on patients, many researchers encouraged to study the disease in different part of the world to determine the causes and to reach an appropriate treatment. [14],[15],[16],[17] The obtained results noticed equal incidence of AA in both males (6.750%) and females (6.375%). AA is a non cicatricial alopecia with still unknown pathogenesis, but increasing evidence suggests that an immunologic process might be responsible for the disease. [15] The study showed that, the main reason for the occurrence of AA disease related to the immune system, and this complies with the previously reported results suggested that: 1) An immunologic process, apparently carried out by CD4 + lymphocytes and by dendritic CD1a + and CD36 + cells, may play a key role at least in the early phase of the disease involving primarily microvessels and later on the bulbar area; 2) the expression of adhesion molecule receptors is involved at the beginning of the disease by mediating the adherence of leukocytes to endothelial cells and subsequent trafficking into the dermis. [18] A case in whom the concomitant severe AA was associated with autoimmune thyroid disease and primary IgA deficiency-a quadruple complex which, to our knowledge, has never been previously described was reported. [19] Other causes of AA were related to psychological (7.5%), genetic (3.75%) and other factors (3.75%) as some types of drugs. The study revealed the importance of the use of topical immunosuppressant drugs (70% frequency and 70% response rate) which agreed with recently reported data; various immunosuppressant drugs have been shown to induce hair growth in normal hair as well as in AA and androgenic alopecia; however, the responsible mechanism has not yet been fully elucidated. The influence of mycophenolate (MPA), an immunosuppressant, on the proliferation of human dermal papilla cells (hDPCs) and on the growth of human hair follicles following catagen induction with interferon (IFN)-γ was investigated. [20] The use of both topical pharmaceutical products as corticosteroids or minoxidil plus systemic vitamins and minerals achieved the highest responsiveness in both localized (90%) and diffused (40%) types of AA. The use of topical corticosteroids or minoxidil alone recorded about 80% cure in localized AA. The study showed the extent of the importance of giving medications containing vitamins and minerals with topical medications and that increased significantly the response rate. The use of vitamins and minerals alone achieved the lowest responsiveness. Topical macrolide immunosuppressant, intralesional steroid injection and topical antiandrogen (dihydrotestosterone inhibitors) recorded about 70% cure. Some dermatological clinics preferred the treatment with Narrowband UVB Phototherapy (60% responsiveness). Systemic corticosteroids as triamcinolone acetonide suspension (Kenacort A injection ) reported lowest frequency (10%) although they recorded 50% responsiveness due to their undesirable side effects. Topical rubefacients or salicylic acid + betamethasone achieved about 40% responsiveness.


  Conclusion Top


The study showed that the incidence of AA disease exceeded expectations and therefore it must be taken into our considerations. Prevalence of the disease between males and females are almost equal. The localized type of the disease is the most common and the most responsive to treatment. It is clear that the most important reasons for the emergence of disease-related to the immune system (a systemic autoimmune disorder). The present study revealed that the use of topical pharmaceutical products of steroids more than others due to its effectiveness.

Recommendation

It is clear that there is no focus by the doctors on the need to pay attention to a vitamin-rich diet, and natural products characterised by scarcity side effects. We recommend a vitamin-rich diet as well as an increased emphasis on the use of topical rubefacient herbs in addition to the above mentioned treatments of AA. A good daily multivitamin containing zinc, biotin, vitamins B and D, folic acid, iron and calcium is a reasonable choice. Top 10 foods for healthy hair were required; salmon, dark green vegetables, beans, nuts, poultry, eggs, whole grains, oysters, low-fat dairy products and carrots.


  Acknowledgement Top


We would like to express our gratitude to all those who gave us the possibility to complete this subject. Our sincere thanks to final year students; Abdelkarem Mohammed Alsolimani, Waleed Abdelrahman Alamri, Abdulmajeed Ali Almalki and Abdelaziz Abdulah Alshehri, College of Pharmacy (Pharm D programme), Taif University in helping us to fill out the questionnaire. Greet and deep thanks for all doctors in Al-Taif Hospitals and Clinics, Saudi Arabia, who kindly helped us to compile information on the research project.

 
  References Top

1.
Tosti A, Bellavista S, Iorizzo M. Alopecia areata: A long term follow-up study of 191 patients. J Am Acad Dermatol 2006;55:438-41.  Back to cited text no. 1
    
2.
Sharquie KE, Al-Rawi JR, Al-Janabi HA. Frictional hair loss in Iraqi patients. J Dermatol 2002;29:419-22.  Back to cited text no. 2
    
3.
Gönül M, Gül U, Cakmak SK, Kiliç S. Unconventional medicine in dermatology outpatients in Turkey. Int J Dermatol 2009;48:639-44.  Back to cited text no. 3
    
4.
Abdullah F, Rashid RM. Alopecia: Botanical approaches in review. J Drugs Dermatol 2010;9:537-41.  Back to cited text no. 4
    
5.
Jin Z, Yang F, Wang YL. Muscular needling combined with local injection for treatment of alopecia areata. Zhongguo Zhen Jiu 2011;31:89-90.  Back to cited text no. 5
    
6.
Kassim JM, Shipman AR, Szczecinska W, Siah TW, Lam M, Chalmers J, et al. How effective is intralesional injection of triamcinolone acetonide compared with topical treatments in inducing and maintaining hair growth in patients with alopecia areata? A Critically Appraised Topic. Br J Dermatol 2014;170:766-71.  Back to cited text no. 6
    
7.
Buchanan R, Huynh G, Tanner J. Extensive scalp angioedema following high-dose diphenylcyclopropenone for alopecia areata. Hosp Pharm 2014;49:48-51.  Back to cited text no. 7
    
8.
Aþýk M, Binnetoðlu E, Sen H, Tekeli Z, Uysal F, Ukinç K. Graves′ disease associated with alopecia areata developing after Hashimoto′s thyroiditis. J Nippon Med Sch 2013;80:467-9.  Back to cited text no. 8
    
9.
Sharquie KE, Al-Obaidi HK. Onion juice (Allium cepa L.), a new topical treatment for alopecia areata. J Dermatol 2002;29:343-6.  Back to cited text no. 9
    
10.
Tobin DJ. Alopecia areata and vitiligo-partners in crime or a case of false alibis. Exp Dermatol 2014;23:153-4.  Back to cited text no. 10
    
11.
Deepak SH, Shwetha S. Scalp roller therapy in resistant alopecia areata. J Cutan Aesthet Surg 2014;7:61-2.  Back to cited text no. 11
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Lundin M, Chawa S, Sachdev A, Bhanusali D, Seiffert-Sinha K, Sinha AA. Gender differences in alopecia areata. J Drugs Dermatol 2014;13:409-13.  Back to cited text no. 12
    
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Aghaei S, Saki N, Daneshmand E, Kardeh B. Prevalence of psychological disorders in patients with alopecia areata in comparison with normal subjects. ISRN Dermatol 2014;2014:304370.  Back to cited text no. 13
    
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Tan E, Tay YK, Goh CL, Chin Giam Y. The pattern and profile of alopecia areata in Singapore-a study of 219 Asians. Int J Dermatol 2002;41:748-53.  Back to cited text no. 14
    
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Eudy G, Solomon AR. The histopathology of noncicatricial alopecia. Semin Cutan Med Surg 2006;25:35-40.  Back to cited text no. 15
    
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Sarifakioglu E, Yilmaz AE, Gorpelioglu C, Orun E. Prevalence of scalp disorders and hair loss in children. Cutis 2012;90:225-9.  Back to cited text no. 16
    
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D′Ovidio R. Alopecia Areata: News on diagnosis, pathogenesis and treatment. G Ital Dermatol Venereol 2014;149:25-45.  Back to cited text no. 17
    
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Ghersetich I, Campanile G, Lotti T. Alopecia areata: Immunohistochemistry and ultrastructure of infiltrate and identification of adhesion molecule receptors. Int J Dermatol 1996;35:28-33.  Back to cited text no. 18
    
19.
Castelli E, Fiorella S, Caputo V. Pili annulati coincident with alopecia areata, autoimmune thyroid disease, and primary IgA deficiency: Case report and considerations on the literature. Case Rep Dermatol 2012;4:250-5.  Back to cited text no. 19
    
20.
Ryu S, Lee Y, Hyun MY, Choi SY, Jeong KH, Park YM, et al. Mycophenolate antagonizes IFN-γ-induced catagen-like changes via β-catenin activation in human dermal papilla cells and hair follicles. Int J Mol Sci 2014;15:16800-15.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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Abstract
Introduction
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