Accurate reporting about alopecia areata states a lifetime risk of 1.7%. It means that 1.7% of the population has a chance of having some form of AA at some time…it could have been a patch 50 years ago or it could be a patch 50 years from now. It does not mean that 1.7% of people living today currently have a form of alopecia areata. That’s why reports that 5 million Americans have alopecia areata are not correct.

Where does that statistic from from? From data gathered in Olmstead County, Minnesota. Here’s the journal reference from the Mayo Clinic:

Safavi KH, Muller SA, Suman VJ, Moshell AN, Melton LJ, 3rd. Incidence of alopecia areata in Olmsted County, Minnesota, 1975 through 1989. Mayo Clin Proc 1995;70:628-33.

With AA in the mainstream and blogosphere news a lot lately, good time to talk more about numbers. The data source is the February, 2010  “Alopecia areata update” by Alkhalifah et al. in the Journal of the American Academy of Dermatology.

In the USA, AA is estimated to occur in 0.1% to 0.2% of the general population.
The lifetime risk is 1.7% of the population (any occurrence at some point over a lifetime). This number is often emphasized by advocacy groups because it’s the biggest number. For example, when cancer advocacy groups say ” 1 in 9 women…” that’s also a  life time risk number,  not the prevalence of the disease in the population.

It’s a common disease encountered by dermatologists, with a frequency from 0.7% to 3.8% of patients seen in dermatology clinics. This is higher than the “general population” percent because people with a skin disease are more likely to go to a dermatologist than people without a skin disease.

With great pleasure we announce that Dr. Mark G. Lebwohl, Professor and Chairman of Dermatology at the Mount Sinai Medical Center in New York City joins Bald Girls Do Lunch as our Medical Advisor.  Dr. Lebwohl has a distinguished career in dermatology and has authored or co-authored over 400 publications. Dr. Lebwohl has written or edited several books including the first atlas devoted entirely to cutaneous manifestations of systemic disease, and the leading book on dermatologic therapy, Treatment of Skin Disease. He is actively involved in clinical trials of many new dermatologic treatments.

While the NAAR page on the MD Anderson website states “Nearly 2% of people in the United States, many of them children, suffer from alopecia areata, a skin disorder that causes hair to fall out in patches….” this very recent  update (February 2010, Journal of the American Academy of Dermatology) makes it clear that the prevalence of the condition is 0.1% 0.2% in the United States.

It would be more accurate for the MD Anderson site to say that the lifetime risk is 2%.

We never ask you to send money for research and leave you stranded with no follow up. In fact, we don’t ever ask you to send your money to research at all.

What do we do? Bald Girls Do Lunch is the leader in providing primary sources and tools so you really know what dermatological science is learning about AA,where it’s headed, and where it has totally dead ended.

A terrific new knowledge tool:

February, 2010, Journal of the American Academy of Dermatology ( Vol 62, Issue 2, Pages 191-202)
Alopecia Areata Update: Part II: Treatment.

Click here for the abstract.

Ask your dermatologist or medical librarian to make you a copy of the full article including Part I.

(Click on ‘research’ and ‘treatment’ tags to see more updates in the blog)

In 2008 the news releases were afire including coverage on the  network morning talk shows that a baldness cure was “right around the corner” courtesy of the start-up Follica using a novel scientific discovery by Dr. George Cotsarelis at UPenn.  Standing by our advice then, we still say “Don’t hold your breath.”

Here’s the latest.

Topical tacrolimus (Protopic) has FDA approval and is commonly used for dermatitis and psoriasis. It’s action on T-cells  (types of white blood cells known as lymphocytes) made it a natural for trials on alopecia areata patients, AA also being a T-cell mediated condition. Dr. Kevin McElwee summarizes the results on an AA study and describes where research might next look to further test its effectiveness. Read more…..

User friendly, 22 pages and free (your tax dollars at work).  Order the newly revised Questions & Answers About Alopecia Areata from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH).

The incidence of vitilgo is estimated to be 1% of the US population.
The incidence of people with alopecia areata who also have vitiligo is 3%-8%

Source: Majumder, PP, Das, SKLICC: A genetic model for vitiligo. Am J Hum Gen 43: 119–125, 1988

In December, this blog said “Lumigan a Hot Topic….” following the FDA approval for this glaucoma medication to be used in cosmetic use for growing longer, fuller lashes. I have seen it work for alopecians who have some lashes, albeit very thin and short.

Have I used it? No. I have blue eyes and I like them a lot. One of the side effects of Lumigan (bimatoprost ophthalmic solution) is permanently turning blue eyes to brown along with the risk of skin hyper-pigmentation at the application site which may be reversible. Great care must be taken in maintaining sterility of the applicator to avoid contamination and infections. Safe and effective pediatric use has not been established.

The active ingredient is bimatoprost ophthalmic solution 0.03%. Prescribed as a glaucoma med it’s known as Lumigan. Recently approved by the FDA for lash enhancement, the product is called Latisse.

The future dims further for treatments - another reason why BGDL is passionately helping women live beautifully and successfully today.

Dermatology Times reports on the study by Dr. Bruce Strober of the  New York University Medical Center’s Department of Dermatology who conducted a randomized, double-blind, placebo-controlled 12-week trial with alefacept (Amevive) in patients with chronic severe alopecia areata.

“According to Dr. Strober, trial results were resoundingly unsuccessful. There was no difference between the treated group and the placebo group, and there was a very low level response in both groups.” Click here to read more.

Raptiva ( efalizumab) a treatment for moderate to severe plaque psoriasis was the drug to be tested by a Northwestern University clinical trial for use on patients with severe alopecia areata.

No more.

The trial has been cancelled. These warnings on Raptiva for ties to a rare brain infection , PML, (progressive multifocal leukoencephalopathy) were issued by the FDA today.

Incredibly, a prominent alopecia organization website was still as of March 3, 2009  encouraging alopecia areata patients to sign up to be in this now aborted Raptiva clinical trial. It was funded by Genentech with no funding from the NIH.

You gotta ask: how does a clinical trial get that far that it gets approval to proceed with a drug like this on healthy people just wanting to grow hair?  What if it had recruited and someone with alopecia areata had become irreversibly ill?

Update April 8, 2009

Genentech announces the removal of  all Raptiva from the US market.

Click here for Reuters report in the New York Times

From the Cochrane Skin Group, University of Nottingham ( UK)

Authors: Delamere FM,Sladden MM, Dobbins HM, Leonardi-Bee J.

“Authors’ Conclusions: Few treatments for alopecia areata have been well evaluated in randomised trials. We found no RCTs on the use of diphencyprone, dinitrochlorobenzene, intralesional corticosteroids or dithranol although they are commonly used for the treatment of alopecia areata.

Similarly, although topical steroids and minoxidil are widely prescribed and appear to be safe, there is no convincing evidence that they are beneficial in the long-term. Most trials have been reported poorly and are so small that any important clinical benefits are inconclusive. There is a desperate need for large well conducted studies that evaluate long-term effects of therapies on quality of life.”

Abstract of conclusions from  “Interventions for alopecia areata”, Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004413

The clinical trial using alefacept for alopecia areata is completed and the results have been summarized in Skin & Allergy News:  September 2008 ( vol 39, issue 9, page 2). Principal research collaborator is Maria K. Hordinsky, MD.

The purpose of this study was to examine prospectively the safety and efficacy of alefacept in the treatment of subjects with severe alopecia areata of the scalp. Common features between psoriasis and alopecia areata, including immunologic and therapeutic aspects, suggested that alefacept, which has been shown to be a safe and statistically significant beneficial therapeutic modality for the treatment of psoriasis, may have therapeutic value in alopecia areata.

Full text reported in Skin and Allergy News:  Alefacept Fails Alopecia Areata Test

Results abstract:— Alefacept fared no better than placebo in treating chronic, severe alopecia areata in a 12-week double-blind, randomized study of 45 adults. Patients with at least a 6-month history of alopecia areata with 50%–95% scalp involvement were randomized to receive a single weekly intramuscular injection of either placebo or 15 mg of alefacept (Amevive) for 12 weeks, followed by a 12-week observation period.

 It was announced in a press release by Allergan Inc. on 12/3/08 that the drug Lumigan, currently approved to treat glaucoma, is close to FDA approval for cosmetic use as an eyelash growth enhancer for upper lashes - but don’t get excited if you have extensive loss due to AA. It had been discovered in clinical studies that a side effect in glaucoma patients was the growth of longer, darker and fuller lashes. The FDA posted a review of the drug on its Web site Wednesday ahead of a Friday review by an outside panel of medical experts. The advisory panel is being asked to vote on whether it thinks Latisse ( the proposed brand name) should be approved. The FDA usually follows its panels’ advice. If approved, the product would be the first FDA-approved product sold for eyelash enhancement.

Two pilot studies were done with alopecia areata volunteers at the  University of California San Francisco using Lumigan or Xalatan on patients with greater than 50 percent eyelash loss and concluded that it was not effective. No study has yet been done on AA patients with less than 50 percent loss. These pilot studies were a joint effort of the UCSF departments of dermatology and opthalmology with principal investigators Drs. Price and Stamper.

And as with all drugs, there will be risks and the potential for serious side effects in some people.

Click here for FDA briefing documents.

A valuable and highly comprehensive resource of evidence based guidance for treatment from the British Association of Dermatologists.

Guidelines for the Management of Alopecia Areata