Analysis Of Clinical Risk Factors In Children With Alopecia Areata Of Different Severity

Purpose:This research aimed to study the risk factors of different order of severities'childhood alopecia areata,analyze the differences of trichoscopic performance as well as the TCM syndromes,and then implement a background understanding of the epidemiology and TCM syndromes by investigating the clinical and epidemiologic features of northern China's children with alopecia areata.Method:All the children were included in this retrospective study,who was diagnosed as alopecia areata in China-Japan Friendship Hospital from January 1,2018,to September 3 1,2020.The diagnosis of alopecia areata was established based on patchy hair loss and trichoscopic markers such as black dots,empty follicular openings,and exclamation mark hairs et al.We collected the clinical and epidemiological data of the children,such as clinical photos,trichoscopic photos,gender,age,region,course of disease,predisposing factors,nail status,complications,etc.We identified TCM syndrome types according to the information of Wang,Wen,Wen,and Qie when the children first visited the hospital.We used SALT score to divide the severity of alopecia areata,and compared the clinical risk factors,TCM syndrome characteristics,and trichoscopic characteristics between the two groups.Results:A total of 281 children with alopecia areata were included in this study,including 111 mild cases and 170 severe cases.By binary logistic regression analysis,we found that the onset age of severe alopecia areata was younger(B=-0.168,P<0.001).By conducting the ROC curve,we found that if the first onset age of children is less than 3 years old,the clinical conversion to severe alopecia areata is more likely AUC:0.706,CI:0.646-0.707.In this study,we found that the number of boys suffering from alopecia areata was less than that of girls(1:1.21),but the relationship between mild and severe alopecia areata and gender was not significant(X2=0.002,P=0.967).Most of the children's weight was in the normal range,but there was a significant difference between mild and severe children(X2=7.563,P=0.023).Most of the patients were urban residents,mild patients were mainly from Beijing,and severe patients were widely distributed in Hebei,Beijing,Shandong,and other North China Plain,but there was no significant difference between urban and rural patients(X2=0.043,P=0.836).In this study,240 children with mild alopecia areata at the first attack,accounting for 85.41%of the total number.However,111 cases(39.5%)were mild and 170 cases(60.5%)were severe.Mild cases were mainly patch type(104 cases),while severe cases were mainly alopecia vulgaris(104 cases).Creeping type,central type,and reticular type was rare in 13(4.62%).At the time of data entry,there was no significant difference in the number of children with mild and severe alopecia areata who were in progressive,convalescent,and stable stages(X2=0.987,P=0.61)and the number of patients with nail damage(X2 = 2.608,P=0.106).There were significant differences in the course of disease(X2=81.559,P<0.001)and family history(X2=6.155,P=0.013)between the two groups.At the onset stage,there were 17 mild alopecia areata patients and 51 severe alopecia areata patients with complications.The number of severe alopecia areata patients with complications was significantly greater than that of mild alopecia areata patients(X2=7.894,P=0.005).Children with severe alopecia areata mostly had atopic dermatitis(13.1%),allergic rhinitis(4.7%),and urticaria(3.5%).Common complications of mild alopecia areata were eczema(8.1%),allergic rhinitis(3.6%),and thyroid disease(2.7%).There were 9 cases of mild alopecia areata and 37 cases of severe alopecia areata with eczema,and there was a significant difference between the two groups(X2=9.148,P=0.002).There were 39 children with mild alopecia areata caused by psychological stress compared to 43 children with severe alopecia areata.Among children with alopecia areata caused by unhealthy lifestyles,6 were mild and 13 were severe.There were 6 mild alopecia areata and 33 severe alopecia areata cases that were induced by illness.While with no obvious inductions,mild cases were 60 and severe cases were 81.There was significant difference in inducing factors(X2=12.769,P=0.005).The most common TCM syndrome was Gan Yu Pi Xu Zheng in both groups.The TCM syndromes of mild children were mainly Gan Yu Pi Xu Zheng(52 cases),Shi Re Yun Fu Zheng(19 cases),and Feng Han Shu Biao Zheng(14 cases),while severe children were mainly Shi Re Yun Fu Zheng(58 cases),Gan Yu Pi Xu Zheng(41 cases),and Qi Xue Kui Xu Zheng(23 cases).There was a significant difference between the two groups(X2=27.844,P<0.001).The most common dermoscopic performance was empty follicles with 106 mild cases(95%)and 168 severe cases(98%).By comparing the dermoscopic performance of the two groups,we found that black dots(mild 93/111,83.78%;heavy:118/170,69.41%),exclamation mark hairs(74/111,66.66%;84/170,49.41%),triangular hairs(42.41%)/41%),upright regrowing hairs(68/111,61.26%;60/170,35.29%),Candida like hairs(17/111,15.3 1%;8/170,4.71%)were more likely observed in mild children,while cluster yellow dots were more commonly observed in severe children(8/111,7.20%and 35/170,20.58%).There was no significant difference in the frequency of other trichoscopic features between mild children and severe children were detected such as single yellow dots,empty hair follicles,velvety hairs,conical hairs,white dots,and pigtail hairs(P>0.05).Conclusion:The clinical risk factors of severe alopecia areata include first onset age,predisposing factors,family history,and immune system complications.The possibility of severe alopecia areata in children is positively correlated with the clustered yellow dots which are one of the trichoscopic performances.The dialectical classification of TCM syndrome is mainly Gan Yu Pi Xu Zheng.In clinical treatment,children should be treated with emotional regulation,psychological intervention,Jian Pi He Wei and Shu Gan Jie Yu.