Late-onset alopecia areata: descriptive analysis of 30 cases

Alopecia areata is an autoimmune disease characterized by non-scaring hair loss. The onset in over 50-year-old patients is rare and has barely been studied. Cases of this disease have been retrospectively analyzed – according to clinical forms, extension, and associated diseases – to assess alopecia areata characteristics in a group of patients whose disease onset was after the age of 50. 30 patients were studied; a few of them presented with autoimmune-related diseases or family history. The disease onset after the age of 50 seems to have different characteristics from those found in young people.


©2016 by Anais Brasileiros de Dermatologia
Alopecia areata (AA) is a common disease whose clinical manifestations range from mild lesions (i.e. plaques) to total hair loss (universal). Of unknown etiology, AA is autoimmune and genetic-related, affecting people of all ages, but mostly under 30-yearold patients. Only 20% of cases started in patients over 40 years old, and is very unusual after 50. 1 The manifestations of the autoimmune lesions depend on age, gender, as well as clinical and lab findings, which are different from those found in young patients. 2 This study aims to assess the epidemiological and clinical characteristics of a group whose disease onset occurred after 50 years of age.
A retrospective observational study of AA was conducted in patients treated between January 2000 and December 2014.
No patient was classified as S4. As for gender, this group had more females than males (63%/37%).
In two epidemiological studies, men under 50 years of age were more affected, while women over 50 were slightly more affected, a fact confirmed in this group. 1,4 The median onset age of the disease was 65.7 years (50-82 years), while another similar study reported 57 years (50-78 years). 1 A 82-year-old patient skewed the figure in that study. In this study, only two cases (6.7%) showed family history, while the literature shows that family cases are present in 10-25% of AA patients. 5 The difference may be related to different factors, such as a missing diagnosis of the disease in the family.
Regarding the extension, most cases were classified as S1 and in plaques. This is consistent with the literature, as S1 is the most common form of AA, regardless of age. 2 However, this study sets apart from the others as it reported more patients with the universal form (7/23%). 1 This difference may be related to the fact that clinics treat more patients with the more severe forms of the disease.
Nail changes were present in three cases (10%). According to the literature, the most common changes are cupuliform depressions, which were absent in this study, probably due to the small sample size. The coexistence of other diseases occurred in 20 cases (66.7%), more than that observed by Wu et al., possibly due to the type of population studied. 1 Among the associated diseases, thyroid disease was observed in 7 patients (35%). The incidence ranges from 8-28% of cases in different studies, regardless of age. 2 A similar study found even less frequency (2.7%) 1 . In AR and hepatitis C patients, the disease was directly related to the treatment, in which hair regrowth occurred after medication withdrawal. This etiology should be taken into account when using drugs that affect the immune response. 6,7 Although this is a retrospective study with a small number of patients, peculiar characteristics of the disease have been observed, such as reduced association with autoimmune diseases and family cases. However, more studies are required to define the characteristics of AA in this group. q