Is there a male predominance in alopecia areata?

From the Guidelines

Alopecia areata does not show male predominance, affecting both males and females equally with no significant gender bias in its overall prevalence. The condition can develop at any age but often begins in childhood or early adulthood, with approximately 1-2% of the general population experiencing it at some point in their lives 1. While male pattern baldness (androgenetic alopecia) does predominantly affect men due to hormonal factors, alopecia areata has a different pathophysiology involving T-cell mediated autoimmune attack on hair follicles.

Key Points

• The autoimmune nature of alopecia areata explains why it affects both sexes equally, as the underlying mechanism involves the immune system mistakenly attacking hair follicles rather than being driven by sex-specific hormonal factors 1.
• Treatment options are the same regardless of gender and include topical or intralesional corticosteroids, topical immunotherapy, minoxidil, JAK inhibitors like tofacitinib or baricitinib for severe cases, and supportive care.
• The condition's impact on quality of life is significant, similar to other skin diseases such as psoriasis and atopic dermatitis 1.
• Current understanding of AA pathogenesis implicates a collapse of immune-privilege of the hair follicle, with infiltration of CD4+/CD8+ T cells, and an autoimmune mechanism involving melanogenesis-associated peptides as autoantigens 1.

Considerations

• The role of micronutrients in alopecia areata is an area of ongoing research, with potential implications for prevention and treatment 1.
• A better understanding of the role of micronutrients could yield breakthroughs in the prevention or treatment of AA, highlighting the need for further investigation into the relationship between diet, nutrition, and alopecia areata 1.

From the Research

Male Predominance in Alopecia Areata

• There is no direct evidence in the provided studies to support the claim of male predominance in alopecia areata 2, 3, 4, 5, 6.
• The studies focus on the treatment and pathogenesis of alopecia areata, but do not provide information on the gender distribution of the disease.
• Some studies mention that alopecia areata affects both children and adults of both sexes, but do not provide specific data on the gender distribution 3, 5.
• Therefore, there is no conclusive evidence to support the claim of male predominance in alopecia areata based on the provided studies.

Treatment of Alopecia Areata

• The treatment of alopecia areata is dependent on the age of the patient, extent and duration of scalp involvement, and may include steroids, topical immunotherapy, topical minoxidil, anthralin, and immunosuppressants 2.
• Minoxidil has been shown to be effective in the treatment of patchy alopecia areata, with a significant difference in favor of 5% minoxidil compared to placebo 3, 5.
• The use of systemic steroids with or without 2% topical minoxidil has also been studied, with results showing that a 6-week taper of prednisone can lead to more than 25% regrowth in 30% to 47% of patients with alopecia areata 6.