Background. Epidemiologic studies of alopecia areata (AA) are available from USA, Japan, and European countries, but there is a paucity of literature on AA from Asian countries, especially from the Indian subcontinent. Methods. In a prospective, hospital‐based study lasting for a decade (1983–1992), the epidemiology of AA was studied, including associated diseases and risk factors for development of severe AA. Simultaneously a similar study was carried out in age‐ and sex‐matched controls. Results. Eight hundred and eight patients (532 men, 276 women) and 572 age‐ and sex‐matched controls (370 men, 202 men) were studied. The incidence of AA was 0.7% of new dermatology outpatients. The majority of patients (712, 88%) were below 40 years of age, including 196 children < 16 years of age (24%). Almost half (46%) of the women patients had onset of AA in childhood, compared to only 19% in men (P < 0.001). Alopecia was total, universal, or extensive in 154 patients (19%). An onset in the first two decades was more often associated with severe alopecia (P < 0.001), especially in men (P < 0.01). Alopecia areata was recorded in family members of 70 patients (9%), being more frequent in the severe forms of AA (16%). Evidence of atopy was recorded in a total of 146 instances (18%). The frequency of atopy was the same in circumscribed alopecia (18.1%) and severe alopecia (18.2%). Nail changes were found in 162 patients (20%) and were more frequent in 76 (47%) with the severe form of AA (P < 0.001). On 39 occasions (5%), autoimmune‐related diseases were detected: vitiligo in 15 (1.8%), thyroid disorders in 8 (1%), lichen planus in 6 (0.7%), collagen vascular diseases in 5 (0.6%), diabetes mellitus in 4 patients (0.4%), and pemphigus foliaceus in 1 (0.1%) patient. Patients with family members having vitiligo (recorded in 5.9% of patients), were more frequently affected with severe alopecia (P < 0.001). Conclusions. Alopecia areata in North Indians showed a preponderance in men (M:F = 2:1) and the majority of persons with disease (88%) were below 40 years of age. Onset in childhood was more frequent in girls or women, but the incidence of severe alopecia was higher in boys or men with onset at an earlier age. Diseases associated with autoimmunity were seen in only 5% of patients. Atopy was found to be associated in 18% of patients, but its reported association with younger age of onset and severe alopecia was not confirmed. Presence of vitiligo in family members and onset before 20 years of age, especially in boys or men, were found to be risk factors for severe alopecia. Int J Dermatol 1996; 35:22–27

Our findings differ from those of previous studies in showing a delayed onset, equal sex distribution, less frequent facial involvement, uncommon guttate lesions, more frequent involvement of the soles, and a less frequent history of familial occurrence.

No abstract

All new cases of alopecia areata (AA) were studied during the years 1983-1993. Eight hundred forty-one cases were recorded, including 201 (23.9%) children less than 16 years of age. The female:male ratio was 1.4:1 (117 girls, 84 boys) for childhood AA. Alopecia was severe, that is, total, universal, or extensive, in 34 (16.9%) children. Onset occurred in 77 (38.3%) children between ages 6 and 10 years, in 67 (33.3%) before 5 years of age, and in 57 (28.4%) between 11 and 16 years. Onset before 5 years of age was more often associated with severe alopecia than onset at ages 11 to 16 years (p < 0.01). Onset before 2 years of age was commonly associated with severe alopecia, seen in 6 (55.5%) of 11 children. Twenty-five (12.4%) children had one or more family members with AA. Definite evidence of atopy was obtained in 35 (17.5%) children. Association of atopy with severe alopecia was not statistically significant at initial presentation (16% vs 23.5% for circumscribed and severe alopecia, respectively; p > 0.05). Nail changes were found in 60 (30%) children and were more frequent in severe alopecia (53%) than in circumscribed alopecia (25.2%, p < 0.001). Associated vitiligo was found in seven (3.5%) children, and one child was hypothyroid. Childhood AA in Chandigarh, India, is remarkably similar to that seen in Western countries, except that an association of atopy with younger age at onset and severe alopecia was not confirmed.

A retrospective analysis of patient's leprosy clinic records at PGIMER, Chandigarh, India for the period 1983 to 1998 was undertaken to study the frequency, time of onset, and risk factors for leprosy reactions. Of the 2600 cases analyzed, 1494 were multibacillary and 1106 had paucibacillary disease. Presentation with reaction was common with 30.9% of our patients having reactions at the time of first visit. The incidence of reversal reaction (RR) was highest during 6 to 12 months after starting multi-drug therapy (MDT), thereafter declining gradually. Late RR occurred in 9.5% of all cases and was noted up to 7 years after treatment. Female gender, widespread disease, and multibacillary disease were identified as risk factors for RR. Erythema nodosum leprosum (ENL) reactions were noted to occur mostly during second or third year after starting MDT. Of the total number of patients who experienced ENL, 64.3% had recurrent episodes which continued for up to 8 years after the start of treatment. Lepromatous leprosy, female gender, and high Bacterial Index (>/=3) were recognized as risk factors for developing ENL. Occurrence of recurrent and late reactions, even though of mild severity, highlights the importance of recognizing and treating them promptly to prevent or reduce morbidity, complications, and further deterioration in the disability status. Although it is hoped that leprosy will have been eliminated at all levels by 2005, the recognition and management of these reactions will continue to be the most essential/significant task in the post elimination era.