New alopecia areata snapshot offers national insights

Data includes incidence, state-by-state breakdown, comorbidities and medications.

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In an Australian first, researchers have used primary health data to create a snapshot of common demographic characteristics, comorbidities and treatment patterns among Aussies living with alopecia areata.

They found the incidence of new-onset AA (0.278 per 1000 person-years) and AA prevalence on the 31 December 2020 (0.13%) were consistent with earlier estimates from other regions around the world.

AA prevalence was highest in the 19- to 34-year age range (0.19%) and while there was no significant overall difference between males and females, there were some variables. For example, in the 19-34-years age group incidence was higher in males, while in those aged greater than 60 years old, females had more than double the incidence of new-onset AA compared to males.

Researchers, including world hair loss expert, dermatologist and editor of Dermatology Republic Professor Rod Sinclair, analysed electronic health record data captured from a national clinical practice management software over a 10-year index period between 2011 and 2020. Their research has been published in the Australasian Journal of Dermatology.

“Adding considerable value, this is the first population-based investigation that is specific to the Australian setting,” the authors wrote.

“The study uncovers real-world insights on patient demographics, AA medications and comorbidities.”

In addition to the incidence of new-onset AA and the prevalence of active records with AA being estimated, the researchers also evaluated differences in incidence by sociodemographic groups, and patterns of treatment.

“This is the first study to describe the epidemiology [incidence and point prevalence] and management of AA in the Australian primary health-care population through large-scale database analysis,” the authors concluded.

“Incidence and prevalence findings were consistent with earlier estimates from other regions.”

AA incidence in NSW was significantly higher than Queensland (IRR 0.483, p < 0.001, 95% CI 0.392–0.592) and compared to the other states combined (the ACT, Northern Territory, South Australia, Tasmania and Western Australia; IRR 0.448, p < 0.001, 95% CI 0.328–0.598).

AA incidence in Victoria was similar to that of NSW (IRR 0.922, p = 0.264, 95% CI 0.800–1.063).

Comorbidities affecting more than 10% of new-onset AA records included pharyngitis (14%), lower respiratory tract infections (13%), vitamin D deficiency (13%), asthma (12%), shingles (11%) and dermatitis (11%). Comorbid depression was seen in 9% and comorbid anxiety was seen in 2% of new-onset AA records.

Glucocorticosteroids were the most prescribed medications (78% used topical glucocorticosteroids; 23% oral; 11% local injection) for new-onset AA.

Within a year of diagnosis, 29% were referred to a specialist dermatologist.

The proportion of new-onset AA records showed patients were prescribed antidepressants (17%) and anxiolytics (9%). There were 413,573 active records in the eligible study cohort on 31 December 2020. Of these, 520 were prevalent AA records (252 male, 268 female).

The age at diagnosis among prevalent AA records included 0–18 years (78) 19–34 years (165); 35–60 years (16); and over 60 years (61).

Professor Sinclair said the research was a major step for Australia, both in identifying how common the condition was and from a public health perspective.

“It will become useful from a public health campaign when the government is asked to fund high-cost medications to treat alopecia areata,” he told Dermatology Republic.

“One of the questions they want to know is how many people have this condition, so to actually get some Australian data is very useful.”

In May this year, the TGA approved the JAK inhibitor baricitinib for use in patients with severe alopecia areata, following similar approvals in the US, Europe and Japan.

Professor Sinclair is currently recruiting for a trial of baricitinib in children aged 12 to 17 years and plans another trial for children aged five to 11 years next year.

“Baricitinib has already been tested in adults with alopecia areata, so we know it works, and it is used for children with arthritis – so we already know it is safe in kids,” he said.

“This is important as AA disrupts the lives of teens and affects their confidence, their school performance, their social development and their ability to form relationships.”

To be eligible, patients need to have more than 50% hair loss and have not had previous treatment with baricitinib. Professor Sinclair said it was an important study.

“The peak age of incidence for alopecia is often about 12 or 14,” he said.

“About half of them go from nothing to 100% loss in a space of two to three months. So there’s a lot of kids out there with no hair.

“And the younger you get it the worse the prognosis is. So there is a lot of benefit in treating people at an early age.”

Professor Sinclair said the longer people had AA without treatment the worse their prognosis would be.

“The idea of waiting and waiting to see how they go is not necessarily a good strategy because you actually reduce the chance of successful treatment,” he said.