Q&A: Effects of alopecia go beyond cosmetic complications
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Key takeaways:
- Patients with alopecia report high psychological trauma including depression and anxiety.
- Dermatologists must have sensitivity and empathy toward alopecia patients, according to Divya Sharma, MD, FAAD.
Many people often consider alopecia — a disease characterized by chronic and sudden hair loss — to be exclusively a cosmetic disorder. Unlike many other chronic conditions, the disease itself does not increase mortality, and it is often not accompanied by physical pain.
While this may be true, patients suffering from alopecia would call their condition anything but cosmetic. Due to their hair loss, this population tends to experience high rates of depression, anxiety and other forms of psychosocial trauma with some equating their fear of hair loss to that of having a heart attack.
To address this stigma, Healio spoke to Divya Sharma, MD, FAAD, dermatologist and hair specialist based in the San Francisco Bay Area, about why alopecia is more than a cosmetic condition and how dermatologists can best approach patients suffering from this debilitating disease.
Healio: Why is alopecia more than a cosmetic condition?
Any type of alopecia (hair loss) can certainly have an outward effect on appearance; however, alopecia is a medical condition. There are different types of alopecia with underlying etiologies such as autoimmune, genetic, hormonal, illness-associated and others.
As a result, a medical workup is indicated for any individual who experiences hair loss in order to understand why it is occurring and effectively guide treatment. Moreover, hair loss often impairs mental and emotional wellbeing. There are many research studies that have explored the negative psychosocial impacts of alopecia on individuals.
Healio: What types of psychological and emotional impacts does this condition have on patients?
Hair loss can be traumatic and life altering. Hair is considered intrinsic to self-identity and holds great significance in many cultures. Individuals with any type of alopecia often report decreased quality of life, describing impaired self-esteem and self-image. This can manifest with challenges in social interaction such as avoiding sports or romantic relationships.
The prevalence of depression and anxiety is higher in individuals with hair loss compared with in those without. In one study, the fear of losing all of one’s hair was comparable with an individual’s fear of suffering a myocardial infarction. Many individuals with cancer may even forego or consider foregoing chemotherapy due to the concern of losing their hair.
Healio: Which patient population may be most at risk for psychological trauma from alopecia?
Anyone who has experienced alopecia is vulnerable to psychological and emotional trauma. Alopecia-related stigma is a known issue that exists broadly in social and professional settings. From pediatric patients to young adults to older individuals, hair loss can be incredibly distressing.
I will say that minorities and socioeconomically underserved patients may be at greater risk for psychological trauma due to less awareness of alopecia as a medical condition and health care disparities. We as patient advocates are actively working on this issue.
In particular, another patient population I would like to mention are those treated with chemotherapy who experience alopecia. It can be unbelievably difficult to not only have a serious illness to treat, but also have a rapid change in self-image that is emotionally difficult and hard to disguise. Patients have reported hair loss to be the worst side effect of treatment.
Healio: In their practices, how should dermatologists approach the emotional aspect of this condition?
Dermatologists are urged to have great sensitivity and empathy toward patients with alopecia. We now know much more about the psychosocial and emotional impacts of alopecia than we did previously.
It is important to note that many individuals with hair loss who come to dermatologists have become discouraged over time. Often, they have tried to discuss their concerns related to hair loss with close family or friends or other providers, and these have been minimized or dismissed.
In addition, individuals have frequently tried multiple products that were ineffective, not to mention a significant expenditure of time and money. Many have also sought professional help only to have a long waiting period or to have seen multiple providers to no avail.
Dermatologists need to be aware of mental health and support resources to share with patients when appropriate. There are organizations that provide great assistance for patients such as the National Alopecia Areata Foundation and the Scarring Alopecia Foundation.
Healio: What is the take home message for clinicians?
As dermatologists, we have the opportunity to help a very vulnerable patient population. There is an astounding amount of misinformation and commercial activity directed to patients with alopecia and as dermatologists we are responsible for counseling patients and promoting evidence-based management.
For more information:
Divya Sharma, MD, FAAD can be reached at divsharmamd@gmail.com.
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