Clinico-epidemiological and Therapeutic Aspects of Alopecia Areata in Children at the Dermatology Department, University Hospital of Antananarivo, Madagascar

Abstract

Introduction: Alopecia areata (AA) is an autoimmune disease of the hair follicles that causes non-scarring hair loss. We aim to describe the epidemiological, clinical, and therapeutic aspects of AA seen in Malagasy children. Materials and Methods: A descriptive retrospective study was conducted over a 71-month period in children <15 years old with AA, seen in the two dermatology departments of the University Hospital Joseph Raseta Befelatanana, Antananarivo Madagascar. Results: Twenty-five cases of AA in children were included. The sex ratio was 0.47. The mean age was 10.36 ± 3.7 years. Patchy alopecia was the most frequent presentation (n=12), then totalis alopecia (n=3), ophiasis alopecia (n=2), and finally alopecia universalis (n=1). An association of patchy and ophiasis alopecia was found in 7 cases. The first-line treatments used were very potent topical corticosteroids in 18 cases, combined with systemic treatment in 8 cases. Mini-pulse corticosteroid therapy was used in 10 cases. Corticosteroid boluses (5-10 mg/kg/day for 3 days) were used in 5 cases. As a second-line treatment, methotrexate (5-7.5 mg/week) was used in 3 cases. After first-line treatment, complete regrowth (≥80%) was observed in 3 patients, and partial regrowth (29 to 80%) in 14 patients. Conclusion: AA has a heterogeneous presentation and unpredictable clinical course. Our study shows the therapeutic difficulty of AA in children.