Alopecia areata: a long‐term follow‐up study of 104 patients

Background Alopecia areata (AA) is a common autoimmune disease that considerably affects the quality of life. Although several studies have investigated the epidemiology, clinical characteristics and treatment of AA, limited recent data are available regarding its long‐term course. Objectives To evaluate the long‐term course of AA in different age groups. Methods A retrospective evaluation of patients who were newly diagnosed with AA from 2008 to 2011 and had at least 7 years of follow‐up. Data regarding the initial episode, treatment given, disease‐free interval and relapses were analysed. Results A total of 104 cases were analysed: 31 childhood‐onset, 63 adult‐onset and 10 late‐onset. At first episode, 88.5% of patients had mild, 3.8% moderate and 7.7% severe AA. Full or significant re‐growth was observed in 74%, 94% and 100% of childhood‐onset, adult‐onset and late‐onset AA patients, respectively. There was no re‐growth in 13%, 3% and 0% of childhood‐onset, adult‐onset and late‐onset patients, respectively. The duration of the initial episode and the disease‐free interval negatively correlated with age. Systemic steroids were the most effective treatment for the primary episode. The frequency of relapses was high overall (52%, 44% and 30% in childhood‐onset, adult‐onset and late‐onset, respectively), but significantly declined over time with a majority (79%) occurring within the first 4 years. The disease‐free interval and relapse rate were not correlated with gender, disease severity at onset or treatment given. Conclusions The prevalence of severe disease, duration of an initial episode and the rate of relapses decreased with an older age at onset. In addition, the outcome and the disease‐free interval improved with age at onset. The frequency of relapses declined over time and most appear early on. The current treatment modalities do not seem to influence the long‐term outcome.