Treatment of Alopecia Areata in the United States: A Retrospective Cross-Sectional Study

September 2015 | Volume 14 | Issue 9 | Original Article | 1012 | Copyright © 2015

Michael E. Farhangian BA,a Amy J. McMichael MD,a Karen E. Huang MS,a and Steven R. Feldman MD PhDa,b,c

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
cDepartment of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC

Abstract

BACKGROUND: Alopecia Areata (AA) is a non-scarring alopecia that affects millions of Americans, however the way it is treated and which patients seek treatment is not well characterized.
OBJECTIVE: 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.
METHODS: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2010. We tabulated patient characteristics, the physicians who treated AA and what treatments were prescribed for AA.
RESULTS: There were an estimated 2.6 million outpatient visits for AA. Patients with AA were most commonly treated by a dermatologists (84.8%). Patients were most commonly treated with topical and injected corticosteroids (61.0%) followed by minoxidil (5.9%) and topical tacrolimus (5.7%). Males made fewer visits per 1,000 capita compared to females (P=0.01).
LIMITATIONS: The NAMCS and NHAMCS do not record severity of disease data.
CONCLUSIONS: Topical and injected corticosteroids are the mainstay of treatment for AA, however the use of steroid sparing agents such as minoxidil is low. Despite no studies demonstrating efficacy, topical tacrolimus was used almost as frequently as minoxidil.

J Drugs Dermatol. 2015;14(9):1012-1014.

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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

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