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A retrospective study reports that when enrolling patients for alopecia areata clinical trials, Blacks are likelier to fail initial screening and have higher withdrawal or early termination rates. 

Hispanic and Black people have a higher incidence of alopecia areata (AA) during their lifetimes compared to White people. However, disease etiology and pathology differences between various ethnic groups remain poorly understood. Additionally, people of color are also less likely to be enrolled in various clinical trials. 

A retrospective study by researchers at the University of California Irvine’s productive AA clinical trial unit examined the enrollment characteristics of AA study participants. The study was published in the Journal of the American Academy of Dermatology. 

Significant Differences in Characteristics of Patient From Different Ethnic Backgrounds

The study enrolled a total of 115 patients. Of them, 52 were White, 28 were Hispanic, 19 were Asian, 14 were Black, and 5 were Pacific Islanders. Significant differences were noted between racial groups in terms of screening and completion of the study. Asians were most likely to successfully complete the initial screening process and had high enrollment rates of 84.2%. In contrast, Blacks had the lowest enrollment rates of 42.9% due to very high screening failure rates. Withdrawal and early termination rates were also highest among Blacks (33% and 16.7%, respectively).

The study also found differences in disease presentation among various ethnic groups. Patchy AA was more common in Asians and Pacific Islanders and least common in Whites. However, eyelash loss was highest in Whites at 65.4% but lowest in Blacks at 21.4%. 

Healthcare inequalities contributed to higher screening failure rates among Blacks. Some reasons for screening failure in Blacks were incorrect AA diagnosis, low severity of AA, pregnancy, malignancy, abnormal thyroid function, hepatitis B, anemia, and inability to attend visits. Black patients were more likely to not complete the study due to higher rates of severe side effects and inability to attend appointments.

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The Bottom Line

It is well known that enrollment of Blacks in AA clinical studies is low, often contributing to health disparities. However, this is among the few studies that have identified the reasons why Blacks are less likely to complete AA clinical trials. It shows that even if those carrying out clinical studies ensure that there is sufficient enrollment of Black people, there are still high screening failure rates. Further, Blacks are also least likely to complete studies for various reasons. All of these factors continue to contribute to health disparities and should be considered when designing clinical AA studies to ensure proper representation of Black people.


Elsanadi, R., Esse, I., Phong, C., Ortega, A., Yale, K., & Mesinkovska, N. A. (2023). Alopecia areata clinical trial enrollment and retention outcome factors among underrepresented ethnic and racial groups: A cross-sectional study. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2023.07.003