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Abstract

Background: Alopecia areata (AA) is an autoimmune, non-scarring hair loss disorder commonly affecting children and often characterized by a chronic or relapsing course. Early-onset AA has traditionally been associated with a poorer prognosis, although current evidence remains inconclusive. This evidence-based case report aims to evaluate the prognostic significance of early-onset AA by synthesizing available cohort data.

Methods: A structured literature search was conducted in PubMed, EMBASE, Scopus, ProQuest, and Cochrane databases using a population, intervention, comparison, and outcome framework. Keywords included “alopecia areata”, “child”, “pediatrics”, “early-onset”, “recurrence”, and “prognosis”.

Results: Five retrospective cohort studies (n = 760) were included. Some studies reported higher recurrence rates in early-onset AA; one reported a 52% recurrence rate (p = 0.025). Greater baseline scalp involvement (> 50%) was associated with a higher risk of disease progression over time (OR = 1.85–2.29). However, no consistent, statistically significant differences in long-term outcomes were observed between early- and late-onset groups. Notably, children younger than 4 years showed better short-term treatment responses in certain cohorts.

Discussion: Current evidence indicates that early-onset AA does not uniformly predict a poorer prognosis. Clinical outcomes are heterogeneous and appear to be more strongly influenced by baseline severity, extent of scalp involvement, and treatment response.

Conclusion: Early-onset AA is not an independent predictor of poor long-term outcomes. Prognosis is variable and multifactorial, underscoring the need for individualized assessment and further age-stratified studies.

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