Rates of pediatric alopecia areata steadily increase during last decade

Recent results show that the prevalence of pediatric alopecia areata doubled compared with the previous decade, according to data published in JAMA Dermatology.

Paige L. McKenzie, BS, of the Children’s Hospital of Philadelphia, and colleagues developed their study to determine the prevalence and incidence of alopecia areata (AA) in the pediatric population across time, age, sex, race and ethnicity, and geographic areas within the U.S.

“We leveraged PEDSnet ... to produce what is to our knowledge the largest and most accurate epidemiological description of AA in children to date,” McKenzie and colleagues wrote. “This information can potentially assist clinicians in advocating for resources for children with AA and payers and health systems in planning for AA therapeutics.”

The researchers found 5,409,919 patients for the prevalence population, of which 5,801 were included in the AA cohort, and 2,896,241 for the incidence population, of which 2,398 were included in the incidence analysis.

Overall prevalence of pediatric AA was 0.11%, which increased steadily and represented a twofold increase from 2009 to 2019, then dropped slightly in 2020.

Prevalence rates were higher among older children and girls compared with boys, and was also most prevalent among children who identified as Hispanic (0.23%) and Asian (0.17%).

The overall incident rate for pediatric AA was 13.6 cases per 100,000 person-years. The incidence rate based on age was normally distributed and peaked at 6 years.

Similar to findings from the prevalence population, incidence rates were higher among girls (22.8%) and highest among those who identified as Hispanic (adjusted OR = 3.07; 95% CI, 2.76-3.42) and Asian (aOR = 2.02; 95% CI, 1.67-2.44), followed by children who are Black or white.

“One of the most remarkable findings in this study was the much higher AA incidence rates in patients who self-identified by race and ethnicity as Hispanic and Asian compared with those who identified as white,” McKenzie and colleagues wrote.

They also noted that while they are unaware of this factor being reported previously for AA, there have been similar findings recently of higher incidence and prevalence in systemic lupus erythematosus and autoimmune hepatitis for Hispanic and Asian populations.

“The higher incidence rates of AA among these populations in the present cohort study were found across all geographic locations, including in regions with smaller populations of Asian and Hispanic children,” the researchers wrote. “With these new data, efforts should be placed on increasing education in diverse communities to expand awareness about AA and access to care for children living with this disease.”