Background. Alopecia areata (AA) has a significant impact on the quality of life and social interaction of those suffering from it. Our aim was to assess the impact of AA on the quality of life. Methods. Fifty patients diagnosed with AA seen in the Department of Dermatology of Hedi Chaker University Hospital, between March 2010 and July 2010, were included. Quality of life was measured by SF 36; severity of AA was measured by SALT. Results. Eighty percent had patchy alopecia with less than 50% involvement, 12% had patchy alopecia with 50–99% involvement, and 8% had alopecia totalis. Compared with the general population, AA patients presented a significantly altered quality of life, found in the global score and in five subscores of the SF-36: mental health, role emotional, social functioning, vitality, and general health. Gender, age, marital status, and severity of alopecia areata had a significant influence on patients’ quality of life. Conclusions. This study indicates that patients with AA experience a poor quality of life, which impacts their overall health. We suggest screening for psychiatric distress. Studies of interventions such as counseling, psychoeducation, and psychotherapeutic interventions to reduce the impact of the disease may be warranted. 1. Introduction Alopecia areata (AA) is a common disease with an incidence of 2-3% among the dermatoses and 0.1% in the population at large [1]. This disorder occurs in both sexes, at all ages [2], and is characterized by the sudden appearance of areas of hair loss on the scalp and other hair-bearing areas. Various factors, including immunologic and endocrine abnormalities [3], genetic factors [4], infections [5], and psychological/psychiatric disturbances, have been claimed to play a role in its etiopathogenesis [6]. Hence, it is suspected to be an autoimmune disease having a genetic predisposition and being influenced by environmental and ethnic factors. Epidemiological studies of AA are available from the USA, Japan, and European countries [7–9]. However, there is a paucity of data from Arab countries, with especially one published study from Kuwait done in the pediatric age group [10]. Hair loss significantly impacts an individual’s self image, and studies indicate that patients with both clinically apparent and clinically imperceptible hair loss may have significantly decreased quality of life [11, 12]. Quality of life is defined as the subjective perception of the impact on the health status and on the physical, psychological, and social functioning and well-being of the patients [13].
References
[1]
E. Healy and S. Rogers, “PUVA treatment for alopecia areata—does it work? a retrospective review of 102 cases,” British Journal of Dermatology, vol. 129, no. 1, pp. 42–44, 1993.
[2]
S. A. Muller and R. K. Winkelmann, “Alopecia areata: an evaluation of 736 patients,” Archives of Dermatology, vol. 88, pp. 290–297, 1963.
[3]
V. H. Price and B. W. Colombe, “Heritable factors distinguish two types of alopecia areata,” Dermatologic Clinics, vol. 14, no. 4, pp. 679–689, 1996.
[4]
J. Shapiro, “Alopecia areata: update on therapy,” Dermatologic Clinics, vol. 11, no. 1, pp. 35–46, 1993.
[5]
R. B. Skinner Jr., W. H. Light, G. F. Bale, E. W. Rosenberg, and C. Leonardi, “Alopecia areata and presence of cytomegalovirus DNA,” Journal of the American Medical Association, vol. 273, no. 18, pp. 1419–1420, 1995.
[6]
E. Arca and Z. Kurumlu, “Etiopathogenesis, clinical features, and diagnosis in alopecia areata,” Dermatose, vol. 2, pp. 83–89, 2003.
[7]
D. A. De Berker, A. G. Messenger, and R. D. Sinclair, “Disorders of hair,” in Rook's Textbook of Dermatology, T. Burns, S. Breathnach, N. Cox, and C. Griffiths, Eds., vol. 4, pp. 36–63, Blackwell Scientific Publications, Oxford, UK, 2004.
[8]
L. A. Drake, R. I. Ceilley, R. L. Cornelison et al., “Guidelines of care for alopecia areata,” Journal of the American Academy of Dermatology, vol. 26, no. 2, pp. 247–250, 1992.
[9]
V. H. Price, “Alopecia areata: clinical aspects,” Journal of Investigative Dermatology, vol. 96, no. 5, p. 68, 1991.
[10]
A. Nanda, A. S. Al-Fouzan, and F. Al-Hasawi, “Alopecia areata in children: a clinical profile,” Pediatric Dermatology, vol. 19, no. 6, pp. 482–485, 2002.
[11]
N. Hunt and S. McHale, “The psychological impact of alopecia,” British Medical Journal, vol. 331, no. 7522, pp. 951–953, 2005.
[12]
F. Poot, “Psychological consequences of chronic hair diseases,” Revue Medicale de Bruxelles, vol. 25, no. 4, pp. 286–288, 2004.
[13]
G. Kiebert, S. V. Sorensen, D. Revicki et al., “Atopic dermatitis is associated with a decrement in health-related quality of life,” International Journal of Dermatology, vol. 41, no. 3, pp. 151–158, 2002.
[14]
H. O. Beard, “Social and psychological implications of alopecia areata,” Journal of the American Academy of Dermatology, vol. 14, no. 4, pp. 697–700, 1986.
[15]
A. Firooz, M. R. Firoozabadi, B. Ghazisaidi, and Y. Dowlati, “Concepts of patients with alopecia areata about their disease,” BMC Dermatology, vol. 5, 2005.
[16]
M. A. Gupta and A. K. Gupta, “Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis,” British Journal of Dermatology, vol. 139, no. 5, pp. 846–850, 1998.
[17]
E. A. Olsen, M. K. Hordinsky, V. H. Price et al., “Alopecia areata investigational assessment guidelines—part II,” Journal of the American Academy of Dermatology, vol. 51, no. 3, pp. 440–447, 2004.
[18]
C. Allouche, L'indice SF36 de la qualité de vie: traduction en langue arabe et étude des qualités métrologiques. Doctoral dissertation in medicine. Sfax 2007. Number 2553.
[19]
E. Tan, Y.-K. Tay, C.-L. Goh, and Y. C. Giam, “The pattern and profile of alopecia areata in Singapore—a study of 219 Asians,” International Journal of Dermatology, vol. 41, no. 11, pp. 748–753, 2002.
[20]
A. Kavak, N. Ye？ildal, A. H. Parlak et al., “Alopecia areata in Turkey: demographic and clinical features,” Journal of the European Academy of Dermatology and Venereology, vol. 22, no. 8, pp. 977–981, 2008.
[21]
K. P. Kyriakis, K. Paltatzidou, E. Kosma, E. Sofouri, A. Tadros, and E. Rachioti, “Alopecia areata prevalence by gender and age,” Journal of the European Academy of Dermatology and Venereology, vol. 23, no. 5, pp. 572–573, 2009.
[22]
S. Madani and J. Shapiro, “Alopecia areata update,” Journal of the American Academy of Dermatology, vol. 42, no. 4, pp. 549–570, 2000.
[23]
D. Wasserman, D. A. Guzman-Sanchez, K. Scott, and A. Mcmichael, “Alopecia areata,” International Journal of Dermatology, vol. 46, no. 2, pp. 121–131, 2007.
[24]
N. Hunt and S. McHale, “Reported experiences of persons with alopecia areata,” Journal of Loss and Trauma, vol. 10, no. 1, pp. 33–50, 2005.
[25]
M. Dubois, K. Baumstarck-Barrau, C. Gaudy-Marqueste et al., “Quality of life in alopecia areata: a study of 60 cases,” Journal of Investigative Dermatology, vol. 130, no. 12, pp. 2830–2833, 2010.
[26]
A. T. Gulec, N. Tanriverdi, D. Dürü, et al., “The role of psychological factors in alopecia areata and the impact of the disease on the quality of life,” International Journal of Dermatology, vol. 43, no. 5, pp. 352–356, 2004.
[27]
A. Firooz, M. R. Firoozabadi, B. Ghazisaidi, and Y. Dowlati, “Concepts of patients with alopecia areata about their disease,” BMC Dermatology, vol. 5, 2005.
[28]
T. F. Cash, “The psychosocial consequences of androgenetic alopecia: a review of the research literature,” British Journal of Dermatology, vol. 141, no. 3, pp. 398–405, 1999.
[29]
T. F. Cash, “The psychology of hair loss and its implications for patient care,” Clinics in Dermatology, vol. 19, no. 2, pp. 161–166, 2001.
[30]
Assouly P. Pelade. Encycl Med Chir, Dermatologie. 2006, 37- 400-C-10.
[31]
L. Papadopoulos and R. Bor, Psychological Approaches to dermatology, BPS Books/in lived experience of AA, Leicester, UK, 1999.
[32]
N. Al-Mutairi and O. N. Eldin, “Clinical profile and impact on quality of life: seven years experience with patients of alopecia areata,” Indian Journal of Dermatology, Venereology and Leprology, vol. 77, no. 4, pp. 489–493, 2011.
[33]
D. Williamson, M. Gonzalez, and A. Y. Finlay, “The effect of hair loss in quality of life,” Journal of the European Academy of Dermatology and Venereology, vol. 15, no. 2, pp. 137–139, 2001.
[34]
N. Wolf, The Beauty Myth, William Morrow and Company, New York, NY, USA, 1991.
[35]
G. L. Patzer, “Psychologic and sociologic dimensions of hair: an aspect of the physical attractiveness phenomenon,” Clinics in Dermatology, vol. 6, no. 4, pp. 93–101, 1988.
[36]
F. M. Camacho and M. Garcia-Hernandez, “Psychological features of androgenetic alopecia,” Journal of the European Academy of Dermatology and Venereology, vol. 16, no. 5, pp. 476–480, 2002.
[37]
J. Y. M. Koo, W. V. R. Shellow, C. P. Hallman, and J. E. Edwards, “Alopecia areata and increased prevalence of psychiatric disorders,” International Journal of Dermatology, vol. 33, no. 12, pp. 849–850, 1994.
[38]
T. Cartwright, N. Endean, and A. Porter, “Illness perceptions, coping and quality of life in patients with alopecia,” British Journal of Dermatology, vol. 160, no. 5, pp. 1034–1039, 2009.
[39]
M. A. Gupta and A. K. Gupta, “Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management,” American Journal of Clinical Dermatology, vol. 4, no. 12, pp. 833–842, 2003.
[40]
G. G. Krueger, S. R. Feldman, C. Camisa et al., “Two considerations for patients with psoriasis and their clinicians: what defines mild, moderate, and severe psoriasis? what constitutes a clinically significant improvement when treating psoriasis?” Journal of the American Academy of Dermatology, vol. 43, no. 2 I, pp. 281–285, 2000.
[41]
E. E. Reid, A. C. Haley, J. H. Borovicka et al., “Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia,” Journal of the American Academy of Dermatology, vol. 66, no. 3, pp. e97–e102, 2012.
[42]
S. G. Consoli, M. Chastaing, and L. Misery, “Psychiatrie et dermatologie,” Encycl Med Chir. 2010, 98-874-A-10.
