title: Clinical-epidemiologic study of alopecia areata.
abstract: BACKGROUND
  Alopecia areata is a common disease and may be associated with autoimmune disease, atopy, Down syndrome, emotional stress, and foci of sepsis.
  
  
  METHODS
  Seven cases of alopecia areata were diagnosed among workers in the Water and Effluent Treatment Sector (WETS) of a paper factory, representing a 0.6% incidence, when the value for the population at large is 0.1%. Three of these workers are assigned to the WETS on a permanent basis and four provide maintenance services. One of the latter patients had alopecia areata that fully regressed. Because biologic treatment of water and effluents involves saprophytic bacteria and fungi as well as chemical substances such as acrylamide, a clinical examination and laboratory tests were performed on all workers assigned permanently to the WETS (N = 9) and on 25% of the workers, selected at random providing services to the sector (N = 14).
  
  
  RESULTS
  There was no association between alopecia areata and atopy, dermatophytosis, or bacteria isolated. Toxicologic evaluation revealed an acrylamide-like substance in 7 workers with alopecia areata, with a statistically significant correlation. Measures were taken at the workplace to decrease worker contact with the mists (probably containing acrylamide) in the pulp-pressing room; no other cases of alopecia areata had been detected 1 year after the study.
  
  
  CONCLUSIONS
  A survey of the literature did not show reports of alopecia areata as an occupational dermatosis, but our conclusion is, that this dermatosis could be due to the professional activities of the workers at the paper factory studied.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Ribeiräo Preto, University of Säo Paulo, SP, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Roselino
authors.forename: A M
authors.initials: AM
authors.lastname: Almeida
authors.forename: M A
authors.initials: MA
authors.lastname: Hippolito
authors.forename: B C
authors.initials: BC
authors.lastname: Cerqueira
authors.forename: C M
authors.initials: CM
authors.lastname: Maffei
authors.forename: J B
authors.initials: JB
authors.lastname: Menezes
authors.forename: R E
authors.initials: RE
authors.lastname: Vieira
authors.forename: S L
authors.initials: SL
authors.lastname: Assis
authors.forename: S A
authors.initials: SA
authors.lastname: Ali
mesh_terms: D000328:Adult; D000506:Alopecia Areata / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009783:Dermatitis, Occupational / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007221:Industry; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010209:Paper; D012307:Risk Factors