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

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.

The results are consistent with the hypothesis that circulating basophils may be recruited from blood into urticarial weals during disease activity. Automated counts are not suitable for assessing basophil numbers in chronic urticaria. The relevance of reduced lymphocyte numbers in chronic urticaria needs to be explored.

Post-menopausal frontal fibrosing alopecia (PFFA) has become an increasingly recognized distinct clinical entity in recent years. Most cases have been reported from Australia; however, it seems likely that the condition is under-recognized. PFFA has similarities to lichen planopilaris but is differentiated by a distinctive symmetrical fronto-temporal distribution and progressive course. We report two cases from the UK and review the literature.

81 t61 [ I ] Kennedy BJ, Yarbro JW. Metabolic and therapeutic effects of hydroxyurea in chronic myelogenous leukemia. Trans Assoc [ 2 ] Boyd AS, Neldner KH. Hydroxyurea therapy. J Am Acad [3] Layton AM, Sheehan-Dare RA, Goodfield MJ, et al. Hydro-Am Phys 1965;78:391-399. [91 Dermatol 1991;25:5 18-524. long-term hydroxyurea therapy. Aust J Dermatol 1 9 9 4 3 : 61 -64. Kennedy BJ, Smith LR, Goltz RW. Skin changes secondary to hydroxyurea therapy. Arch Dermatol 1975; I 1 1 : 183-187. Renfro L, Kamino H, Raphael B, et al. Ulcerative lichen planus-like dermatitis associated with hydroxyurea. J Am Acad Dermatol 1991;24:143-145. Beers B, Kalish R, Kage VN, et al. Unilateral linear lichenoid eruption after bone marrow transplantation: an unmasking of tolerance to an abnormal keratinocyfe clone? J Am Acad Dermatol 1993;28:888-892. Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol 1991;25:593-619, xyurea in the management of therapy resistant psoriasis. Aust J Dermdtol 1989; 121 547-653. [4] Weber L, Schick E, Merkel M, et al. Dermatoniyositis-like skin changes with long term hydroxyurea (Litalir) therapy.