Clinical and demographic factors associated with nail involvement in adult alopecia areata patients at Al-Kadhmia teaching hospital, Baghdad, 2023

Background: Alopecia areata (AA) is an autoimmune condition often associated with nail changes, which may reflect disease severity and progression. This study aims to investigate the clinical and demographic characteristics linked to nail involvement in adult AA patients, explore the prevalence and types of nail changes, and assess associations with family history and comorbidities. Methods: This cross-sectional study investigated nail involvement in patients with alopecia areata (AA) at Al-Kadhmia Teaching Hospital, Baghdad, Iraq, from January to December 2023. The hospital’s high patient turnover and specialized dermatology clinic facilitated participant recruitment. The study included patients aged 18+ diagnosed with AA, excluding those with other alopecia types or unrelated nail disorders. A sample size of 100 was determined via power analysis to ensure 80% statistical power and a 0.05 significance level. Data were collected using structured questionnaires and clinical examinations, capturing demographics, AA severity (assessed via the SALT score), and nail changes. Ethical approval was obtained, and data were analyzed using statistical software to identify associations. Results: Nail involvement was observed in 44% of the study participants. Patients with nail involvement had a slightly higher mean age (33.1 ± 9.8 years) and longer AA duration (20.1 ± 11.8 months) compared to those without nail involvement, though these differences were not statistically significant (p = 0.56 and p = 0.18, respectively). Males constituted 60% of the cohort, with no significant gender difference between groups (p = 0.52). Multifocal AA had the highest nail involvement (68.2%), while focal AA showed none (p = 0.001). Pitting was the most common nail change (63.6%). Severe AA was more associated with nail involvement (p = 0.022). A positive family history was significantly linked to nail involvement (p = 0.041), while comorbidities like atopic dermatitis and thyroid disorders showed no significant association. Conclusion: Nail changes, particularly pitting, were associated with moderate to severe AA and a positive family history, suggesting genetic predisposition. While comorbidities like atopic dermatitis and thyroid disorders were more common, they lacked statistical significance. Nail evaluation in AA patients may aid in assessing disease severity and familial predisposition, enhancing clinical management.