Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis

Authors

Harrison H. Lee, Northwestern University Feinberg School of Medicine
Eran Gwillim, Northwestern University Feinberg School of Medicine
Kevin R. Patel, Northwestern University Feinberg School of Medicine
Tammy Hua, Northwestern University Feinberg School of Medicine
Supriya Rastogi, Northwestern University Feinberg School of Medicine
Erin Ibler, The University of Chicago
Jonathan I. Silverberg, Northwestern University Feinberg School of Medicine

Document Type

Journal Article

Publication Date

3-1-2020

Journal

Journal of the American Academy of Dermatology

Volume

82

Issue

3

DOI

10.1016/j.jaad.2019.08.032

Keywords

alopecia areata; alopecia ophiasis; alopecia totalis; alopecia universalis; epidemiology; meta-analysis; prevalence; systematic review

Abstract

© 2019 American Academy of Dermatology, Inc. Background: Alopecia areata (AA) is a common autoimmune alopecia with heterogeneous severity and distribution. Previous studies found conflicting results about AA epidemiology. Objective: To determine the prevalence, incidence, and predictors of AA, alopecia totalis, alopecia ophiasis, and alopecia universalis. Methods: A systematic review of all published cohort and cross-sectional studies that analyzed AA and its subtypes. MEDLINE, Embase, LILACS, Scopus, Cochrane Library, and GREAT were searched. At least 2 reviewers performed study title/abstract review and data extraction. Random-effects meta-analysis was used because of significant heterogeneity (I2 = 99.97%). Results: Ninety-four studies met the inclusion criteria. The pooled prevalence (95% confidence interval, N) of AA overall was 2.11% (1.82-2.42, N = 302,157,365), with differences of population-based (0.75% [0.49-1.06%], N = 301,173,403) and clinic-based (3.47% [3.01-3.96], N = 983,962) studies. The prevalences of alopecia totalis, ophiasis, and universalis were 0.08% (0.04-0.13, N = 1,088,149), 0.02% (0.00-0.06, N = 1,075,203), and 0.03% (0.01-0.06, N = 1,085,444), respectively. AA prevalence (95% confidence interval) increased over time (<2000: 1.02% [0.85-1.22]; 2000-2009: 1.76% [1.51-2.03]; >2009: 3.22% [2.59-3.92]; P < .0001) and differed by region. AA prevalence was significantly lower in adults (1.47% [1.18-1.80]) than children (1.92% [1.31-2.65]; P < .0001). Conclusions: AA affects 2% of the global population. AA prevalence is lower in adults than children, is increasing over time, and significantly differs by region.

APA Citation

Lee, H., Gwillim, E., Patel, K., Hua, T., Rastogi, S., Ibler, E., & Silverberg, J. (2020). Epidemiology of alopecia areata, ophiasis, totalis, and universalis: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 82 (3). http://dx.doi.org/10.1016/j.jaad.2019.08.032