INTRODUCTION
Alopecia areata (AA) is an immune-mediated, non-scarring alopecia with a lifetime prevalence ranging from 1.7-2.1% that affects both sexes equally.1 Although
there is a spectrum of disease severity, most patients who suffer from AA experience patchy, well circumscribed hair loss in the scalp.2 Unfortunately, the current treatment modalities available are only able to manage the disease, often
with unsatisfactory results. Currently, there are no Food and Drug Administration approved treatments for AA. This can be partly attributed to the relapsing, remitting nature of AA which makes assessing treatment efficacy particularly challenging, as it is difficult to determine whether a medication
truly worked or if the patient spontaneously improved in spite of receiving treatment.3 Furthermore, due to the paucity of randomized controlled studies, the ideal treatment
of AA has not been established.4 Although the British Association of Dermatologists (BAD) have published guidelines
for the management of AA,5 there has been no such equivalent guideline published in the United States. Because of the lack of a standard of care in treating AA, we sought to better understand how AA was being treated in the United States, what type of patients are seen for AA, and what physicians
treated them by utilizing data from two nationally
representative surveys.
METHODS
We performed a retrospective cross-sectional analysis using
data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey
(NHAMCS).6 These two surveys are annually conducted by the National Center for Health Statistics branch of the Center for Disease Control and Prevention in order to gain national estimates
of outpatient health care utilization. For this analysis, we included visits between 2001 and 2010 where a diagnosis of AA, using the International Classification of Diseases, 9th Revision Clinical Modification (ICD-9) code: 704.01 was recorded. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA. Localized corticosteroid
treatments that did not specify that they were injectable were assumed to be topical. SAS 9.3 (SAS Institute Inc., Cary, NC) was used to manage and analyze the data. Continuous variables
were compared using the t-test and categorical variables using the Chi-square test.
RESULTS
Patient Demographics
From 2001 to 2010, there were an estimated 2.6 million alopecia areata (AA) outpatient visits (95% CI: 2.2, 2.9 million visits). This equated to an average 260,000 yearly visits for AA. At these
