ImportancePrevalences of alopecia areata (AA), alopecia totalis (AT), and alopecia universalis (AU) are poorly established.ObjectiveTo estimate overall and subgroup prevalences of AA and its subtypes.Design, Setting, and ParticipantsThis cross-sectional study using electronic records comprising the Explorys database (Watson Health, IBM Corporation) included children, adolescents, and adults seeking healthcare across the 4 census regions in the US between January 1, 2019, and December 31, 2019. The statistical analysis was conducted between July 21, 2022, and December 22, 2022.Main Outcomes and MeasuresPrevalent cases of AA, AT, and AU.ResultsOf the 1 093 176 patients who met inclusion criteria, 1812 had at least 1 code for AA, 1216 female (67%) and 596 male (33%) patients. Overall age-and-sex standardized prevalences among adults and among children and adolescents were observed to be 0.18% and 0.10%, respectively. The age-standardized prevalence ratio in women to men was 1.32. Standardized prevalence was highest in those aged 30 to 39 (297 per 100 000; 95% CI, 263-335) and 40 to 49 (270 per 100 000; 95% CI, 240-303) years. The highest standardized prevalence was observed among Asian patients (414 per 100 000; 95% CI, 306-548), followed by patients reporting another race or multiple races (314 per 100 000; 95% CI, 266-368), Black (226 per 100 000; 95% CI, 199-255), and Hispanic/Latino (212 per 100 000; 95% CI, 129-328) patients. White patients had the lowest standardized prevalence (168 per 100 000; 95% CI, 157-179) among racial and ethnic subgroups. Relative to White patients, standardized prevalence ratios for Asian, Black, and Hispanic/Latino patients were 2.47 (95% CI, 2.17-2.81), 1.35 (95% CI, 1.26-1.44), and 1.26 (95% CI, 1.03-1.55), respectively. Cases of AT and AU comprised approximately 9% of patients diagnosed with AA.Conclusions and RelevanceThe findings of this cross-sectional study suggest that there is a significant burden of AA, AT, and AU in the US in which people of color, particularly Asian Americans, appear to be disproportionately affected.
ImportanceVitiligo has substantial psychosocial consequences. Yet its burden is poorly established.ObjectiveTo estimate incidence and prevalence of diagnosed vitiligo across age, sex, and racial and ethnic subgroups in the US.Design, Setting, and ParticipantsThis analysis comprising a cohort study and cross-sectional study included electronic health records for health care–seeking children, adolescents, and adults across 4 US census regions. Data for the incidence analysis were obtained from January 1, 2015, through December 31, 2019, and data for the prevalence analysis were obtained from January 1 through December 31, 2019. Data were analyzed from December 13, 2022, to June 8, 2023.Main Outcomes and MeasuresThe main outcomes were incidence (per 100 000 person-years [PY]) and prevalence of diagnosed vitiligo overall and by age, race and ethnicity, and sex.ResultsA total of 2 980 778 patients with vitiligo were included in the incidence analysis (mean [SD] age, 41.5 [24.0] years; 57.0% female; 1.4% Asian American; 12.9% Black; 1.5% Hispanic/Latino; 77.3% White; 6.9% other or multiracial) and 1 057 534 in the prevalence analysis (mean [SD] age, 43.4 [24.7] years; 57.5% female; 1.7% Asian American, 14.7% Black, 1.4% Hispanic/Latino; 75.7% White; 6.6% other or multiracial). Age- and sex-adjusted overall incidence rate (IR) of diagnosed vitiligo was 22.6 per 100 000 PY (95% CI, 21.5-23.8 per 100 000 PY), and prevalence was 0.16% (95% CI, 0.15%-0.17%). Sex-adjusted IR was highest among patients aged 60 to 69 years (25.3 per 100 000 PY; 95% CI, 22.2-28.6 per 100 000 PY), and prevalence was highest among patients aged 70 years or older (0.21%; 95% CI, 0.19%-0.23%). The highest age-adjusted IR was observed among Asian American patients (41.2 per 100 000 PY; 95% CI, 28.2-58.2 per 100 000 PY), followed by Hispanic/Latino patients (37.3 per 100 000 PY; 95% CI, 25.7-52.4 per 100 000 PY), patients reporting other or multiple races (31.1 per 100 000 PY; 95% CI, 25.9-37.1 per 100 000 PY), Black patients (29.6 per 100 000 PY; 95% CI, 26.0-33.6 per 100 000 PY), and White patients (18.7 per 100 000 PY; 95% CI, 17.5-20.0 per 100 000 PY). The highest age-adjusted prevalence was observed among Hispanic/Latino patients (0.29%; 95% CI, 0.20%-0.39%), followed by Asian American patients (0.27%; 95% CI, 0.19%-0.35%), patients reporting other or multiple races (0.24%; 95% CI, 0.20%-0.28%), Black patients (0.22%; 95% CI, 0.19%-0.24%), and White patients (0.13%; 95% CI, 0.12%-0.14%).Conclusions and RelevanceThis cross-sectional study found that vitiligo diagnosis was more common in older patients, Hispanic/Latino patients, and Asian American patients.
Mohs micrographic surgery is a specialized surgical technique that involves serial excision of locally invasive, recurrent, or ill-defined skin cancers with complete histological examination of surgical margins. Originally developed by Dr. Frederic E. Mohs in the 1930s, it began as in situ tissue fixation with zinc chloride and healing by secondary intention and has evolved to fresh tissue surgical excision with subsequent reconstruction. Despite continuous advancements made in the field, the underlying principle of Mohs surgery remains the same: one surgeon acting as a pathologist to ensure complete tumor removal while minimizing the resection of healthy tissue. Mohs surgery is considered the gold standard for treatment of various cutaneous tumors and can be performed on an outpatient basis within a single day. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histological evaluation and subsequent surgical staging in the location of a positive margin. This article serves as a review of Mohs surgery for dermatology nurses and offers an overview of the history of the procedure, clinical indications, preoperative assessments, surgical technique, reconstructive modalities, and postoperative care.
This cross-sectional study compares the prevalence of Crohn disease among US pediatric patients with and without hidradenitis suppurativa.
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