Abstract
Hair loss disorders may cause considerable distress to patients. Although many do not pose a significant medical risk, the sociocultural importance of hair is substantial. Often the extent of hair loss does not correlate to the impact on psychosocial function, thus necessitating an individualized approach. Hair loss disorders are interrelated with mental health and at times exert significant psychological percussions, and therefore, providers should address both medical and psychological aspects of treatment. This review contains a discussion of the impact on quality of life of common hair loss disorders and the psychological approaches that providers may utilize to improve care. The incorporation of psychodermatology and psychotrichology in dermatology and psychiatry residency programs is of vital importance. Dermatology and psychiatry liaison clinics may prove useful in the treatment of these patients.
References
1.
Ito
N
, Ito
T
, Kromminga
A
, Bettermann
A
, Takigawa
M
, Kees
F
, Human hair follicles display a functional equivalent of the hypothalamic-pituitary-adrenal axis and synthesize cortisol
. FASEB J
. 2005 Aug
;19
(10
):1332
–4
. .2.
Ito
T
. Hair follicle is a target of stress hormone and autoimmune reactions
. J Dermatol Sci
. 2010 Nov
;60
(2
):67
–73
. .3.
Ferreira
B
, Jafferany
M
, Patel
A
. Classification and terminology of psychodermatologic disorders
. The essentials of psychodermatology
. Switzerland AG
: Springer International Publishing
; 2020
. p. 37
–45
.4.
Harth
W
, Blume-Peytavi
U
. Psychotrichology: psychosomatic aspects of hair diseases
. J Dtsch Dermatol Ges
. 2013 Feb
;11
(2
):125
–35
. .5.
Jafferany
M
, Patel
A
. Trichopsychodermatology: the psychiatric and psychosocial aspects of hair disorders
. Dermatol Ther
. 2020 Jan
;33
(1
):e13168
. .6.
Christenson
GA
, Pyle
RL
, Mitchell
JE
. Estimated lifetime prevalence of trichotillomania in college students
. J Clin Psychiatry
. 1991 Oct
;52
(10
):415
–7
.7.
Grant
JE
, Chamberlain
SR
. Trichotillomania
. Am J Psychiatry
. 2016 Sep 1
;173
(9
):868
–74
. .8.
Gerstenblith
TA
, Jaramillo-Huff
A
, Ruutiainen
T
, Nestadt
PS
, Samuels
JF
, Grados
MA
, Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder
. Compr Psychiatry
. 2019 Oct
;94
:152123
. .9.
Woods
DW
, Houghton
DC
. Diagnosis, evaluation, and management of trichotillomania
. Psychiatr Clin North Am
. 2014 Sep
;37
(3
):301
–17
. .10.
Bouwer
C
, Stein
DJ
. Trichobezoars in trichotillomania: case report and literature overview
. Psychosom Med
. 1998 Sep-Oct
;60
(5
):658
–60
. .11.
Miteva
M
, Tosti
A
. Hair and scalp dermatoscopy
. J Am Acad Dermatol
. 2012 Nov
;67
(5
):1040
–8
. .12.
Woods
DW
, Flessner
CA
, Franklin
ME
, Keuthen
NJ
, Goodwin
RD
, Stein
DJ
, The trichotillomania impact project (TIP): exploring phenomenology, functional impairment, and treatment utilization
. J Clin Psychiatry
. 2006
;67
(12
):1877
. .13.
Odlaug
BL
, Kim
SW
, Grant
JE
. Quality of life and clinical severity in pathological skin picking and trichotillomania
. J Anxiety Disord
. 2010 Dec
;24
(8
):823
–9
. .14.
Farhat
LC
, Olfson
E
, Nasir
M
, Levine
JLS
, Li
F
, Miguel
EC
, Pharmacological and behavioral treatment for trichotillomania: an updated systematic review with meta-analysis
. Depress Anxiety
. 2020 Aug
;37
(8
):715
–27
. .15.
Grant
JE
, Odlaug
BL
, Chamberlain
SR
, Kim
SW
. Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: a Pilot Study
. Psychopharmacology
. 2011 Dec
;218
(3
):493
–502
. .16.
Pratt
CH
, King
LE
, Messenger
AG
, Christiano
AM
, Sundberg
JP
. Alopecia areata
. Nat Rev Dis Primers
. 2017
;3
(1
):17011
–7
. .17.
Ito
T
. Recent advances in the pathogenesis of autoimmune hair loss disease alopecia areata
. Clin Dev Immunol
. 2013 Sep
;2013
:348546
. .18.
Zhang
X
, Yu
M
, Yu
W
, Weinberg
J
, Shapiro
J
, McElwee
KJ
. Development of alopecia areata is associated with higher central and peripheral hypothalamic-pituitary-adrenal tone in the skin graft induced C3H/HeJ mouse model
. J Invest Dermatol
. 2009
;129
(6
):1527
–38
. .19.
Hunt
N
, McHale
S
. Reported experiences of persons with alopecia areata
. J Loss Trauma
. 2004 Dec
;10
(1
):33
–50
. .20.
Chu
SY
, Chen
YJ
, Tseng
WC
, Lin
MW
, Chen
TJ
, Hwang
CY
, Psychiatric comorbidities in patients with alopecia areata in Taiwan: a Case-Control Study
. Br J Dermatol
. 2012 Mar
;166
(3
):525
–31
.21.
Vallerand
IA
, Lewinson
RT
, Parsons
LM
, Hardin
J
, Haber
RM
, Lowerison
MW
, Assessment of a bidirectional association between major depressive disorder and alopecia areata
. JAMA Dermatol
. 2019 Apr 1
;155
(4
):475
–9
. .22.
Huang
KP
, Mullangi
S
, Guo
Y
, Qureshi
AA
. Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States
. JAMA Dermatol
. 2013
;149
(7
):789
–94
. .23.
Rencz
F
, Gulacsi
L
, Péntek
M
, Wikonkál
N
, Baji
P
, Brodszky
V
. Alopecia areata and health‐related quality of life: a systematic review and meta‐analysis
. Br J Dermatol
. 2016
;175
(3
):561
–71
.24.
Perini
G
, Zara
M
, Cipriani
R
, Carraro
C
, Preti
A
, Gava
F
, Imipramine in alopecia areata. A Double-Blind, Placebo-Controlled Study
. Psychother Psychosom
. 1994
;61
(3–4
):195
–8
. .25.
Cipriani
R
, Perini
GI
, Rampinelli
S
. Paroxetine in alopecia areata
. Int J Dermatol
. 2001 Sep
;40
(9
):600
–1
. .26.
Bilgiç
B
, Bilgiç
A
, Bahalı
K
, Bahali
AG
, Gürkan
A
, Yılmaz
S
. Psychiatric symptomatology and health‐related quality of life in children and adolescents with alopecia areata
. J Eur Acad Dermatol Venereol
. 2014
;28
(11
):1463
–8
.27.
Hankinson
A
, McMillan
H
, Miller
J
. Attitudes and perceptions of school-aged children toward alopecia areata
. JAMA Dermatol
. 2013 Jul
;149
(7
):877
–9
. .28.
Sinclair
RD
. Alopecia areata and suicide of children
. Med J Aust
. 2014 Feb 17
;200
(3
):145
. .29.
Willemsen
R
, Haentjens
P
, Roseeuw
D
, Vanderlinden
J
. Hypnosis and alopecia areata: long-term beneficial effects on psychological well-being
. Acta Derm Venereol
. 2011 Jan
;91
(1
):35
–9
. .30.
Messenger
AG
, McKillop
J
, Farrant
P
, McDonagh
AJ
, Sladden
M
, Hughes
J
, British association of dermatologists’ guidelines for the management of alopecia areata 2012
. Br J Dermatol
. 2012
;166
(5
):916
–26
. .31.
Abedini
H
, Farshi
S
, Mirabzadeh
A
, Keshavarz
S
. Antidepressant effects of citalopram on treatment of alopecia areata in patients with major depressive disorder
. J Dermatolog Treat
. 2014 Apr
;25
(2
):153
–5
. .32.
Krasowska
D
, Szymanek
M
, Schwartz
RA
, Myśliński
W
. Cutaneous effects of the most commonly used antidepressant medication, the selective serotonin reuptake inhibitors
. J Am Acad Dermatol
. 2007 May
;56
(5
):848
–53
. .33.
Grover
C
, Khurana
A
. Telogen effluvium
. Indian J Dermatol Venereol Leprol
. 2013 Sep–Oct
;79
(5
):591
–603
. .34.
Asghar
F
, Shamim
N
, Farooque
U
, Sheikh
H
, Aqeel
R
. Telogen effluvium: a review of the literature
. Cureus
. 2020 May 27
;12
(5
):e8320
. .35.
Harrison
S
, Bergfeld
W
. Diffuse hair loss: its triggers and management
. Cleve Clin J Med
. 2009 Jun
;76
(6
):361
–7
. .36.
Cline
A
, Kazemi
A
, Moy
J
, Safai
B
, Marmon
S
. A surge in the incidence of telogen effluvium in minority predominant communities heavily impacted by COVID-19
. J Am Acad Dermatol
. 2021 Mar
;84
(3
):773
–5
. .37.
Kivanç-Altunay
İ
, Savaş
C
, Gökdemir
G
, Köşlü
A
, Ayaydin
EB
. The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia
. Int J Dermatol
. 2003
;42
(9
):691
–3
.38.
McDonald
KA
, Shelley
AJ
, Colantonio
S
, Beecker
J
. Hair pull test: evidence-based update and revision of guidelines
. J Am Acad Dermatol
. 2017 Mar
;76
(3
):472
–7
. .39.
Hadshiew
IM
, Foitzik
K
, Arck
PC
, Paus
R
. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia
. J Invest Dermatol
. 2004 Sep
;123
(3
):455
–7
. .40.
Reid
EE
, Haley
AC
, Borovicka
JH
, Rademaker
A
, West
DP
, Colavincenzo
M
, Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia
. J Am Acad Dermatol
. 2012 Mar
;66
(3
):e97
–102
. .41.
Arck
PC
, Handjiski
B
, Peters
EM
, Peter
AS
, Hagen
E
, Fischer
A
, Stress inhibits hair growth in mice by induction of premature catagen development and deleterious perifollicular inflammatory events via neuropeptide substance P-dependent pathways
. Am J Pathol
. 2003 Mar
;162
(3
):803
–14
. .42.
Trüeb
RM
. Systematic approach to hair loss in women
. J Dtsch Dermatol Ges
. 2010 Apr
;8
(4
):284
–98
. .43.
Kanwar
A
, Narang
T
. Anagen effluvium
. Indian J Dermatol Venereol Leprol
. 2013 Sep–Oct
;79
(5
):604
–12
. .44.
Chon
SY
, Champion
RW
, Geddes
ER
, Rashid
RM
. Chemotherapy-induced alopecia
. J Am Acad Dermatol
. 2012 Jul
;67
(1
):e37
–47
. .45.
Yun
SJ
, Kim
SJ
. Hair loss pattern due to chemotherapy-induced anagen effluvium: a cross-sectional observation
. Dermatology
. 2007
;215
(1
):36
–40
. .46.
Lemieux
J
, Maunsell
E
, Provencher
L
. Chemotherapy‐induced alopecia and effects on quality of life among women with breast cancer: a literature review
. Psychooncology
. 2008
;17
(4
):317
–28
.47.
Tierney
AJ
, Taylor
J
, Closs
SJ
. Knowledge, expectations and experiences of patients receiving chemotherapy for breast cancer
. Scand J Caring Sci
. 1992
;6
(2
):75
–80
. .48.
Choi
EK
, Kim
IR
, Chang
O
, Kang
D
, Nam
SJ
, Lee
JE
, Impact of chemotherapy-induced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients
. Psychooncology
. 2014 Oct
;23
(10
):1103
–10
. .49.
Hilton
S
, Hunt
K
, Emslie
C
, Salinas
M
, Ziebland
S
. Have men been overlooked? A comparison of young men and women’s experiences of chemotherapy‐induced alopecia
. Psychooncology
. 2008
;17
(6
):577
–83
.50.
Cho
J
, Choi
EK
, Kim
IR
, Im
YH
, Park
YH
, Lee
S
, Development and validation of chemotherapy-induced alopecia distress scale (CADS) for breast cancer patients
. Ann Oncol
. 2014
;25
(2
):346
–51
. .51.
Shin
H
, Jo
SJ
, Kim
DH
, Kwon
O
, Myung
SK
. Efficacy of interventions for prevention of chemotherapy-induced alopecia: a systematic review and meta-analysis
. Int J Cancer
. 2015 Mar 1
;136
(5
):E442
–54
. .52.
Tan
E
, Martinka
M
, Ball
N
, Shapiro
J
. Primary cicatricial alopecias: clinicopathology of 112 cases
. J Am Acad Dermatol
. 2004 Jan
;50
(1
):25
–32
. .53.
Bolduc
C
, Sperling
LC
, Shapiro
J
. Primary cicatricial alopecia: lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and graham-little syndrome
. J Am Acad Dermatol
. 2016 Dec
;75
(6
):1081
–99
. .54.
Fanti
PA
, Baraldi
C
, Misciali
C
, Piraccini
BM
. Cicatricial alopecia
. G Ital Dermatol Venereol
. 2018 Apr
;153
(2
):230
–42
. .55.
Dlova
NC
, Salkey
KS
, Callender
VD
, McMichael
AJ
. Central centrifugal cicatricial alopecia: new insights and a call for action
. J Investig Dermatol Symp Proc
. 2017 Oct
;18
(2
):S54
–56
. .56.
Katoulis
AC
, Christodoulou
C
, Liakou
AI
, Kouris
A
, Korkoliakou
P
, Kaloudi
E
, Quality of life and psychosocial impact of scarring and non-scarring alopecia in women
. J Dtsch Dermatol Ges
. 2015 Feb
;13
(2
):137
–42
. .57.
Chiang
YZ
, Bundy
C
, Griffiths
CE
, Paus
R
, Harries
MJ
. The role of beliefs: lessons from a Pilot Study on illness perception, psychological distress and quality of life in patients with primary cicatricial alopecia
. Br J Dermatol
. 2015 Jan
;172
(1
):130
–7
. .58.
Pradhan
P
, D’Souza
M
, Bade
BA
, Thappa
DM
, Chandrashekar
L
. Psychosocial impact of cicatricial alopecias
. Indian J Dermatol
. 2011 Nov
;56
(6
):684
–8
. .59.
McKenzie
SA
, Roche
FC
, Onyekaba
G
, Williams
DM
, Ogunleye
TA
, Taylor
SC
. Comorbid anxiety and depression among black women with central centrifugal cicatricial alopecia: a Retrospective Study
. J Dermatol
. 2021 Jan
;48
(1
):e19
. .© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
