A researcher at Ajou University Hospital has identified that patients with alopecia areata, also known as circular hair loss, have worse symptoms if the patient is aged 15 or younger or the bold spot covers more than half of the scalp.

Alopecia areata is an autoimmune disorder in which cytotoxic T-cells attack a person's own hair follicles (the roots of the hair), causing round or oval bald patches of varying sizes. Relapses are common, and severe cases can lead to frontal and total hair loss.

Steroids are usually applied when the bald patches are small, but if the area of baldness is large, a short course of oral steroid tapering, which is the process of slowly decreasing steroid dosage over time, is used to induce hair regeneration initially.

However, prognostic factors for these treatments have been poorly understood.

As a result, the team identified prognostic factors for treatment and recurrence in 136 patients with alopecia areata who were treated with eight-week methylprednisolone tapering between Jan. 1, 2017, to May 31, 2022. Methylprednisolone is an allergy treatment that also treats hair loss.

The researchers analyzed demographic characteristics, various laboratory results, and changes in the severity of alopecia areata from baseline at the first clinic visit after eight weeks of treatment.

The results showed that the average age of all subjects was 36.7 years and that 75 percent of patients achieved a good treatment response, with more than 50 percent improvement in hair loss compared to baseline.

Notably, multivariate analysis of various factors identified young age (15 years or younger) and extensive hair loss (more than 50 percent of the scalp) as poor prognostic factors.

Among the poor prognostic factors, the researchers explained that young age might be related to an individual's genetic sensitivity, making them more resistant to treatment and that severe alopecia areata is caused by more severe perifollicular inflammation, which reduces the effectiveness of oral steroids as well as other treatments.

Also, the team found that other blood test levels of autoimmune disease-related antinuclear antibodies, neutrophil-to-lymphocyte ratio, hemoglobin, iron, and vitamin D were not significant predictors of bad prognosis.

However, low vitamin D levels were the only predictor of relapse, with 28.4 percent of patients who responded well experiencing a relapse within an average of 5.5 months after stopping treatment, and acne was the most common side effect of oral steroid treatment.

"We have newly identified young age and severe hair loss as poor prognostic factors in the treatment of alopecia areata," Professor Choi said. "Oral steroids should be administered cautiously in these patients, and vitamin D levels can be used to predict recurrence in patients with alopecia areata treated with steroids."

The Journal of the American Academy of Dermatology published the study results.