Abstract
Introduction
The study aimed to evaluate recent trends in public interest regarding various alopecia-associated diagnoses using Google Trends.
Method
Data generated through Google Trends for the relative search volumes (RSVs) of the following diagnostic-related terms: “Alopecia,” “Alopecia areata,” “Androgenetic alopecia,” “Central centrifugal cicatricial alopecia,” “Folliculitis decalvans,” “Frontal fibrosing alopecia,” “Telogen effluvium,” “Traction alopecia” (disease).” Analysis has been performed worldwide from July 29th, 2018, to July 16th, 2023.
Results
Between 2018 and 2023, mean RSVs by 12-month period have remained stable for “alopecia” and “alopecia areata.” “Telogen effluvium” has increased peak search during 2020–2022. “Androgenetic alopecia” and “frontal fibrosing alopecia” display an increase for the past 5 years. There were differences in geographic distribution. For alopecia areata, all the countries were from the Middle East; for telogen effluvium, eight of the top 10 countries were Latin American or Spanish speaking, and Western countries had mainly searched for frontal fibrosing alopecia.
Conclusions
Google Trends is not a real epidemiological tool. It can be only used by individuals who have access to the Internet, but it does not presume the person or the reason for the search. We observed different geographical distribution according to the disease. Infodemiology provides a better understanding of alopecia needs in different countries and continents.
Keywords: Alopecia, Epidemiology, Hair loss, Internet, Google Trends
Introduction
Hair loss/alopecia feature among the top 5 complaints of European adult patients in dermatology [1]. Google Trends (GT) provides data on the relative search volume (RSV) of queries and topics over time and across geographical areas. GT analysis is a valuable tool for healthcare providers, offering insights into public interest and behavior related to health issues. By tracking search trends, providers can identify emerging health concerns, monitor disease outbreaks, and assess public awareness of various health topics. GT data can also uncover new patterns or correlations between search behaviors and health events, providing a deeper understanding of public health dynamics. We evaluated here the recent trends in public interest regarding various alopecia-associated diagnoses. It allows seasonal and long-term assessment of trends of public interest. A user can compare up to five terms or topics simultaneously. GT was used to assess various trends regarding alopecia and hair loss [2–7], such as seasonality [2, 3] or the impact of COVID-19 [4]. We evaluated here the recent trends regarding various alopecia-associated diagnoses.
Methods
Data generated through GT for RSVs of the following diagnostic-related terms were analyzed: “Alopecia,” “Alopecia areata,” “Androgenetic alopecia,” “Central centrifugal cicatricial alopecia,” “Folliculitis decalvans,” “Frontal fibrosing alopecia,” “Telogen effluvium,” “Traction alopecia” (disease).” Analysis has been performed worldwide from July 29th, 2018, to July 16th, 2023. Results are displayed as a set of time series. The values are not the actual search counts but percentages relative to the total searches across the specified geography and time. The resulting numbers are scaled from 0 to 100 based on the proportion for all searches on all topics. Raw data were collected on an Excel file as weekly SVIs, for a total of 262 SVIs. We calculated an annual average of 51 results to define the overall trend over the last 5 years. All data used in this study are publicly available and anonymous and cannot be traced back to identifiable individuals. The study did not require ethical approval by an Institutional Review Board.
Results
The past 5-year trends for alopecia and alopecia-associated diagnoses on Google are summarized in Figure 1. Between 2018 and 2023, mean RSVs by 12 months period have remained stable for “alopecia” (mean RSVs 28 ± 1.3 in 2018–19 to 34 ± 1.8 in 2022–23), “alopecia areata” (mean RSVs 5 ± 0.5 in 2018–19 to 5 ± 0.4 in 2022–23), and “traction alopecia” (TA, mean RSVs 26 ± 6 in 2018–19 to 35 ± 7 in 2022–23). “Telogen effluvium” (TE) has known a peak of increased search during 2020–2022. “Androgenetic alopecia” (AGA, mean RSVs 59 ± 12 in 2018–19 to 74 ± 4.0 in 2022–23) and frontal fibrosing alopecia (FFA, mean RSVs 47 ± 9.5 in 2018–19 to 65 ± 9.7 in 2022–23) both display an increase for the past 5 years. There was a very low increase in the searches for the mentioned period for folliculitis decalvans (mean RSVs 43 ± 7 in 2018–19 to 54 ± 9 in 2022–23) and central centrifugal cicatricial alopecia (CCCA, mean RSVs 35 ± 17 in 2018–19 to 63 ± 13 in 2022–23). There were differences in terms of geographic distribution of searches according to conditions. For AA, all top 10 countries were from the Middle East; for TE, eight out of the top 10 countries were Latin American or Spanish-speaking countries, while Western countries had mainly searched for FFA. Searches for CCCA and TA predominantly occur in African or Caribbean countries (Table 1).
Fig. 1.
RSVs for alopecia and alopecia associated diagnoses from 2018 to 2023 (remark: direct comparison between curves is not possible).
Table 1.
Top 10 countries regarding alopecia trends worldwide for the past 5 years (2018–2023)
| Alopecia | AA | AGA | FFA | TE | FD | CCCA | TA |
|---|---|---|---|---|---|---|---|
| South Korea (100) | Libya (100) | Japan (100) | The Netherlands (100) | Latvia (100) | Tanzania (100) | Barbados (100) | Trinidad and Tobago (100) |
| Iran (91) | Saudi Arabia (92) | Slovenia (86) | Belgium (74) | Bolivia (90) | Cuba (100) | Trinidad and Tobago (37) | Jamaica (88) |
| Singapore (78) | Jordania (91) | Italy (47) | Spain (62) | Colombia (65) | Ethiopia (100) | Jamaica (37) | USA (38) |
| USA (78) | Kuwait (91) | Norway (30) | Ireland (38) | Peru (62) | UAE (75) | South Africa (25) | UK (38) |
| Indonesia (74) | Syria (80) | Taiwan (24) | Brazil (37) | Spain (61) | Chili (75) | USA (12) | South Africa (33) |
| Irak (74) | Yemen (74) | Czech Republic (20) | Portugal (33) | Panama (61) | Sudan (75) | Cambodia (6) | Kenya (33) |
| UAE (72) | Palestine (73) | Poland (18) | UK (24) | Brazil (60) | Brazil (75) | Nigeria (6) | Ghana (27) |
| Kuwait (72) | Oman (72) | Brazil (16) | Australia (17) | Ecuador (58) | Qatar (75) | Ghana (6) | Canada (27) |
| Saudi Arabia (70) | Sudan (66) | Greece (14) | Chili (16) | USA (57) | Oman (75) | Kenya (6) | Nigeria (27) |
| Jordania (68) | Lebanon (64) | Sweden (14) | Canada (16) | Chili (54) | Colombia (75) | Ireland (27) |
AA, alopecia areata; AGA, androgenic alopecia; CCCA, central centrifugal cicatricial alopecia; FD, folliculitis decalvans; FFA, frontal fibrosing alopecia; TA, traction alopecia; TE, telogen effluvium; UAE, United Arab Emirates; USA, United States of America.
Discussion
There is a constant interest for hair loss and alopecia worldwide. The most frequent non-scarring hair loss is AGA, followed by AA and TE, while the most common scarring alopecias are lichen planopilaris and FFA. These data, however, have been retrieved only from specialist hair clinics in Europe, America, Australia, and Africa [8]. However, we found that 9 out of the top 10 countries that searched for “alopecia” on Google were Asian. There are no current epidemiological studies clarifying the prevalence of different types of alopecias in this continent.
There has been a growing interest for AGA the past 5 years. Seven out of 10 countries are European, but it is most frequently searched by people in Japan. We are also familiar that the onset of AGA in Japanese males occurs one decade later than in Caucasians [9]. We cannot draw any conclusion regarding the lead search in Japan [10]. We hypothesize that the reason for the increase in this interest relates to the aging of the Japanese population and the large distribution of the condition. Additional reasons may include ease of accessibility to technology and the Internet, as well as the multiple new therapies available for treating baldness [10].
Searches for AA have remained stable for the past 5 years. There was a slight peek in the interest during the 2022 Oscars [6, 7]. All the countries in the Top 10 are from the Middle East. A recent extensive study found that Kuwait, South Sudan, and Nigeria experienced the most significant rise in the incidence of AA [11]. In these countries, hair is often a crucial symbol of femininity, fertility, and attractiveness. Additional factors such as population growth, modernization, increased household income, and enhanced screening programs may also play a role [11]. Efforts in Africa and the Middle East to advance the diagnosis and treatment of AA [12] could also explain the increased awareness and interest reflected in GT.
Hair loss associated with COVID-19 infection has been reported extensively. Post-infection TE has been mostly seen in women. The infection can trigger exacerbation of AGA or flares of AA. These associations are most likely related to virus-induced immunologic responses [13]. Our analysis shows that TE has been a popular topic during the pandemic in Europe, North and South America, and Spanish-speaking countries especially.
Lichen planopilaris was not featured in our study because this term did not give a satisfying result on GT, most likely because laypeople are unfamiliar with this term. On the other hand, we found that the search for FFA has risen in the past 5 years, mostly in developed countries. Even though the true cause of FFA is unknown, exposure to one environmental factor or more such as facial sunscreens, anti-aging creams and occupation are suspected. Besides, FFA currently appears as a disease affecting mainly economically developed countries [14]. Our data support this aspect.
Without surprise searches for CCCA and TA occurring mainly among African, Afro-Caribbean, or Afro-American populations, reflecting the condition’s prevalence among those due to cultural hair practice and fragility of the hair structure [15]. The search for CCCA is very limited compared to the other searched topics, likely due to its specialized terminology, which is not widely recognized by the general public and typically requires evaluation by a dermatologist. Therefore, it is more likely that searches are conducted by physicians or individuals who have already received a diagnosis. This pattern is similarly observed for folliculitis decalvans.
Limitations of our study are well known. GT is not a real epidemiological tool. It can be only used by individuals who have access to the Internet, but it does not presume the person or the reason for the search. Our findings strongly suggest the necessity of researching the epidemiology of alopecia worldwide, especially in outside Europe and developed countries.
Infodemiology is scientific research dedicated to analyzing user-generated health-related content on the Internet, to inform public health and policy decisions. It focuses on understanding how information, including misinformation, spreads and impacts health behaviors and outcomes. We observed different geographical distribution according to the disease (AA/Middle East, AGA and FFA/Western countries). Social and cultural impact of hair loss, easiness of access to the Internet, COVID-19, strive to improve diagnosis, and development of new therapies are all factors that can explain the differences observed in our study. Infodemiology provides a better understanding of alopecia needs in different countries and continents.
Statement of Ethics
All data used in this study are publicly available and anonymous and cannot be traced back to identifiable individuals. The study did not require ethical approval by an Institutional Review Board.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Author Contributions
Both L.T. and N.K. contributed equally to the work for this study in terms of conceptualization, writing – original draft, and writing – review and editing. N.K. contributed to visualization and formal analysis.
Funding Statement
This study was not supported by any sponsor or funder.
Data Availability Statement
Publicly available datasets were used in this study. These can be found in Google via Google Trends through the searches made described in the methodology of the study. Further inquiries can be directed to the corresponding author.
References
- 1. Richard MA, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, et al. Prevalence of most common skin diseases in Europe: a population-based study. J Eur Acad Dermatol Venereol. 2022;36(7):1088–96. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Hsiang EY, Semenov YR, Aguh C, Kwatra SG. Seasonality of hair loss: a time series analysis of Google Trends data 2004-2016. Br J Dermatol. 2018;178(4):978–9. [DOI] [PubMed] [Google Scholar]
- 3. Buontempo MG, Ingrassia JP, Shapiro J, Lo Sicco K. Seasonal trends in hair loss: a big data analysis of Google search patterns and their association with seasonal factors. J Eur Acad Dermatol Venereol. 2023;37(12):e1458–60. [DOI] [PubMed] [Google Scholar]
- 4. Han J, Kamat S, Agarwal A, O'Hagan R, Tukel C, Owji S, et al. Correlation between interest in COVID-19 hair loss and COVID-19 surges: analysis of Google trends. JMIR Dermatol. 2022;5(2):e37271. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Gupta AK, Quinlan EM. Changing trends in surgical hair restoration: use of Google Trends and the ISHRS practice census survey. J Cosmet Dermatol. 2020;19(11):2974–81. [DOI] [PubMed] [Google Scholar]
- 6. Erickson KL, Vaccarello A, Rohr BR. The impact of celebrity influence on public interest in alopecia areata: a 10-year Google trends analysis. Aesthetic Plast Surg. 2023;47(Suppl 1):173–4. [DOI] [PubMed] [Google Scholar]
- 7. Lava CX, Hakimi AA. And the Oscar goes to. Alopecia? A Google trends analysis following the 94th academy awards. J Clin Aesthet Dermatol. 2022;15(12):40–1. [PMC free article] [PubMed] [Google Scholar]
- 8. Vañó-Galván S, Saceda-Corralo D, Blume-Peytavi U, Cucchía J, Dlova NC, Gavazzoni Dias MFR, et al. Frequency of the types of alopecia at twenty-two specialist hair clinics: a multicenter study. Skin Appendage Disord. 2019;5(5):309–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Tanaka Y, Aso T, Ono J, Hosoi R, Kaneko T. Androgenetic alopecia treatment in Asian men. J Clin Aesthet Dermatol. 2018;11(7):32–5. [PMC free article] [PubMed] [Google Scholar]
- 10. Ntshingila S, Oputu O, Arowolo AT, Khumalo NP. Androgenetic alopecia: an update. JAAD Int. 2023;13:150–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Wang H, Pan L, Wu Y. Epidemiological trends in alopecia areata at the Global, Regional, and National levels. Front Immunol. 2022;13:874677. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Al Hammadi A, Parmar NV, Aljefri K, Al Sharif O, Abdallah M, Ahmed HM, et al. Review on alopecia areata in the Middle East and Africa: landscape and unmet needs. Dermatol Ther. 2023;13(7):1435–64. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Nguyen B, Tosti A. Alopecia in patients with COVID-19: a systematic review and meta-analysis. JAAD Int. 2022;7:67–77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Barata AR, Castellanos-González M, Fernández-Pugnaire MA, Grimalt R, et al. Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study. Clin Exp Dermatol. 2019;44(4):404–10. [DOI] [PubMed] [Google Scholar]
- 15. Mahé A. Scarring alopecia and ethnicity. Arch Dermatol. 2001;137(3):374–5. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Publicly available datasets were used in this study. These can be found in Google via Google Trends through the searches made described in the methodology of the study. Further inquiries can be directed to the corresponding author.