Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Report
Case Report
Editorial
Focus
Images/Instrument in Dermatology/Dermatosurgery
Innovations
Letter to the Editor
Living Legends
Looking back in history
Original Article
Perspective
Resident Forum
Review Article
Spot the Diagnosis
Tropical Dermatology
Visual Treats in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Report
Case Report
Editorial
Focus
Images/Instrument in Dermatology/Dermatosurgery
Innovations
Letter to the Editor
Living Legends
Looking back in history
Original Article
Perspective
Resident Forum
Review Article
Spot the Diagnosis
Tropical Dermatology
Visual Treats in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Brief Report
Case Report
Editorial
Focus
Images/Instrument in Dermatology/Dermatosurgery
Innovations
Letter to the Editor
Living Legends
Looking back in history
Original Article
Perspective
Resident Forum
Review Article
Spot the Diagnosis
Tropical Dermatology
Visual Treats in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2024
:4;
69
doi:
10.25259/CSDM_60_2024

The demographic and clinical profile of patients with alopecia areata in Syria: A study letter

Cancer Research Center, Tishreen University, Latakia, Syrian Arab Republic
Department of Dermatology, National Hospital of Latakia, Latakia, Syrian Arab Republic
Department of Dermatology, Aleppo University Hospital, Aleppo, Syrian Arab Republic
Department of Medicine, Tartous University, Tartous, Syrian Arab Republic
Department of Dermatology, Damascus University, Damascus, Syrian Arab Republic
Department of Dermatology, Mamdouh Abaza Hospital, Al Qunaitra, Syrian Arab Republic

*Corresponding author: Jacob Al-Dabbagh, Cancer Research Center, Tishreen University, Latakia, Syrian Arab Republic. jacobaldabbagh0@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Al-Dabbagh J, Sliman R, Hanino A, Akabati K, Maaita L, Abou Khair S. The demographic and clinical profile of patients with alopecia areata in Syria: A study letter. CosmoDerma. 2024;4:69. doi: 10.25259/CSDM_60_2024

Dear Sir,

Alopecia areata (AA) is a chronic inflammatory disease that leads to non-scarring hair loss on the scalp and other areas bearing hair.[1,2] It is the second most common disorder leading to hair loss after androgenetic alopecia and affects up to 2% of the world’s population.[1,2]

Worldwide AA incidence varied from 2.1 and 0.7% to 3.8% in the USA, India, and Singapore (respectively), according to research by Fricke et al. (2015).[3] Regional studies conducted in Africa and the Middle East have shown AA prevalences ranging from 0.2 to 13.8%, depending on the specific treatment landscapes of each country.[4] However, no clinical or epidemiologic study of patients with AA in Syria has been published.

A Turkish study was conducted to investigate skin diseases and associated psychiatric illnesses in local populations and Syrian refugees (166 participants) in 2013.[5] 48 Syrian refugees were included in the study, which corresponds to 28.9% of all participants. Only 5 (2.6%) patients who were Syrian refugees were diagnosed with AA.[5] Nevertheless, this study did not provide detailed results (such as the demographic/clinical profile of the AA patients) or a link between the type of psychiatric illness and AA.

To assess the demographic and clinical characteristics of patients with AA in Syria, a cross-sectional study was conducted from July 3, 2023, to October 5, 2023, in six health care facilities in five governorates: Damascus (Dermatology Hospital of Damascus), Aleppo (Aleppo University Hospital), Latakia (Tishreen University Hospital and National Hospital of Latakia), Homs (Alarman Medical Clinic), and AlQuneitra (Mamdouh Abaza Hospital).

The number and percentage of the recorded AA cases are demonstrated in Figure 1. The demographic and clinical data of the patients included in the study are shown in Table 1.

The number/percentage of patients per health facility.
Figure 1:
The number/percentage of patients per health facility.
Table 1: The demographic and clinical data of the patients.
Characteristic Overall, n(%)
Gender
  Male 76 (76.76)
  Female 23 (23.23)
Age groups (years)
  Infants, toddlers, and preschoolers (0–5) 8 (8.08)
  School-aged children (6–12) 15 (15.15)
  Adolescents (13–19) 17 (17.17)
  Young adults (20–39) 37 (37.37)
  Middle age adults (40–59) 19 (19.19)
  Elderly persons (60+) 3 (3.03)
Settlement
  Rural 47 (47.47)
  Urban 52 (52.52)
Employment/educational status
  Unemployed 15 (15.15)
  Under school age 8 (8.08)
  School students 29 (29.29)
  Undergraduate students 7 (7.07)
  Soldier 7 (7.07)
  An office employee in a government institution 6 (6.06)
  Teacher 3 (3.03)
  Engineer 2 (2.02)
  Mechanic 2 (2.02)
  Electrician 1 (1.01)
  Accountant 1 (1.01)
  Nurse 1 (1.01)
  Doctor 2 (2.02)
  Farmer 3 (3.03)
  Carpenter 1 (1.01)
  Construction worker 5 (5.05)
  Salesperson 2 (2.02)
  Cleaning worker 1 (1.01)
  Taxi driver 1 (1.01)
  Tailor 1 (1.01)
  Baker 1 (1.01)
Alopecia areata type/subtype
  Patchy scalp 62 (62.62)
  Patchy beard 14 (14.14)
  Patchy eyebrows 3 (3.03)
  Ophiasis 1 (1.01)
  Totalis 3 (3.03)
  Universalis 2 (2.02)
  Patchy scalp+Patchy beard 8 (8.08)
  Patchy scalp+Patchy eyebrows 3 (3.03)
  Patchy scalp+Patchy eyelash 1 (1.01)
  Patchy eyebrows+Ophiasis 1 (1.01)
  Patchy beard+Reticularis 1 (1.01)
Family history
  Present 22 (22.22)
  Absent 77 (77.77)
Comorbidity
  Yes 25 (25.25)
  No 74 (74.74)
Associated diseases
  Vitiligo 5 (5.05)
  Asthma 5 (5.05)
  Hypothyroidism 4 (4.04)
  Allergic rhinitis 4 (4.04)
  Atopic dermatitis 3 (3.03)
  Diabetes mellitus 2 (2.02)
  Psoriasis 2 (2.02)

A total of 99 patients, who were examined in designated dermatology clinics, were enrolled in the study. Cases that were suspected or diagnosed in other departments were excluded. The diagnosis of AA was made clinically, by examining the patients’ hair and with a handheld magnifying device in some cases. More than three-quarters of the patients were males (76.76%). The average age of the patients was 27.37 and the young adults (20 – 39 years) were the most affected age group with over a third (37.37%). However, the prevalence of AA generally appears to be higher in women than in men and has an average onset at the age of 20 – 25.[1,4] Patients living in urban areas were slightly more (52.52%) compared to those living in rural areas (47.47%).

The incidence of developing AA was highest among students (29.29%). However, soldiers (7.07%) were most frequently affected by AA compared to other occupational groups. Various types/subtypes and localizations of AA were observed in the patients, which are listed in Table 1. Anyhow, patchy scalp was the most commonly reported (62.62%).

Studies have shown that the risk of AA in families of AA patients is significantly higher than in the general population.[6] A study conducted in Germany and Belgium on the familial clustering of AA found that about 20% of patients had at least one family member with AA.[6] In our study, 22.22% of patients reported that they had a family history of diagnosed AA.

Numerous comorbidities such as atopic diseases, thyroid diseases, metabolic syndrome, and psychiatric disorders are associated with AA.[1] Autoimmune thyroid disease and thyroid dysfunction are frequently reported as associations.[1] However, about three-quarters of the patients in our study (74.74%) had no concomitant diseases, while around a quarter of them (25.25%) reported suffering from concomitant diseases. Of the concomitant diseases, vitiligo and asthma were the most frequently reported, each accounting for 5.05%.

The size of the sample, the number of locations, where the samples were taken, and the duration of the study can be deemed as limitations for this study. More studies that include a larger number of patients to investigate AA in Syria should be conducted. To the best of our knowledge, this is the first study on AA from Syria.

Acknowledgements

We would like to acknowledge Mahmoud Dalloul, the Dean of the Faculty of Medicine of Tartous University, Sally Ibrahem, and Heba Wassouf for their help in obtaining ethical approval for the study. We would also like to thank Sara Helo for easing the data collection in the Alarman Medical Clinic, Homs.

Authorship

Jacob Al-Dabbagh: Concept, design, data analysis, statistical analysis, supervision, and manuscript review. Rasha Sliman, Abed Alrahman Hanino, Karina Akabati, Lama Maaita, and Siba Abou Khair: Data acquisition and data analysis.

Ethical approval

The study approved by the Faculty of Medicine of Tartous University in accordance with the third clause of document No. 1449, S. T., dated June 13, 2023.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Nil.

References

  1. . Alopecia areata: An updated review for 2023. J Cutan Med Surg. 2023;27:241-59.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , . Effects of age and sex on the comorbidities of alopecia areata: A cross-sectional hospital-based study. Health Sci Rep. 2023;6:e1444.
    [CrossRef] [PubMed] [Google Scholar]
  3. , . Epidemiology and burden of alopecia areata: A systematic review. Clin Cosmet Investig Dermatol. 2015;24;8:397-403.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , , et al. Review on alopecia areata in the Middle East and Africa: Landscape and unmet needs. Dermatol Ther (Heidelb). 2023;13:1435-64.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , , . Prevalence of dermatological and psychiatric diseases related to stress in Syrian refugees and local people: A cross-sectional study in Southeastern Anatolia, Turkey. Firat Tip Dergisi. 2019;24:31-6.
    [Google Scholar]
  6. , , , . Clinical and genetic aspects of alopecia areata: A cutting edge review. Genes (Basel). 2023;14:1362.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
56,324

PDF downloads
6,214
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections