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Mortality risk from self-harm, psychiatric diseases higher in patients with alopecia areata

Researchers found a greater risk for mortality from self-harm, psychiatric diseases and smoking-associated malignant diseases in patients with alopecia areata in Korea.

Using a database search of the National Health Insurance Service of Korea and the National Death Registry of Korea, researchers identified participants who were 18 years or older and alive at the end of 2006. The patients were followed until the end of 2016.

Participants with alopecia areata had at least three documented visits to a dermatologist from 2002 to 2006 and an ICD-10 code of L63. Those with alopecia totalis/universalis were included in a subgroup analysis.

A total of 73,107 patients with alopecia areata and 731,070 age- and sex-matched controls were included in the study; 6,023 of those had alopecia totalis/universalis.

A self-reported medical history of hypertension, diabetes and cancer was slightly higher in control participants, whereas patients reported a higher subjective stress level.

Mortality associated with intentional self-harm/psychiatric diseases was greater in patients than in control participants (HR = 1.21; 95% CI, 1.04–1.41).Patients younger than 35 years had an increased risk (HR = 1.84; 95% CI, 1.38–2.46), according to the age group-stratified analysis, particularly those younger than 25 years (HR = 2.35; 95% CI, 1.53–3.60). Adults 35 years and older showed no difference from control participants.

The risk of associated intentional self-harm/psychiatric diseases was significantly increased in patients with alopecia totalis/universalis (HR = 1.85; 95% CI, 1.25–2.75).

Mortality due to lung cancer was greater in patients with alopecia totalis/universalis (HR = 2.16, 95% CI, 1.41–3.33). However, mortality associated with endocrine diseases including diabetes was significantly lower in those with alopecia areata.

Limitations of the study include misclassification bias in the database and allocation biases.

“To improve outcomes, clinicians are encouraged to provide more appropriate treatment for unmet needs, including psychological interventions, in addition to providing therapeutic regimens for hair regrowth in patients with [alopecia areata],” Solam Lee, MD, from the department of dermatology and institute of hair and cosmetic medicine, Yonsei University Wonju College of Medicine, South Korea, and colleagues wrote. – by Abigail Sutton

Disclosures: Lee reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.