Psychosocial Stress and Coping in Alopecia Areata: A Questionnaire Survey and Qualitative Study Among 45 Patients

Matzer, Franziska; Egger, J.; Kopera, Daisy

doi:10.2340/00015555-1031

Cited by 37 publications

(62 citation statements)

References 20 publications

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“…Some studies reported a clear prevalence of psychiatric co morbidity and personality traits in alopecia areata, particularly anxiety and depression, while others conclude that they are less important [39]. However, a questionnaire survey and qualitative study among 45 patients found that stress seems to play a role in the onset and aggravation of alopecia areata and the disorder has its impact on health-related QoL [40,41] .…”

Section: Alopecia Areatamentioning

confidence: 96%

The psychiatric aspects of skin disorders

Osman¹,

Mufaddel²,

Mugaddam

et al. 2011

Expert Review of Dermatology

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The skin is recognized as an important mode of communication between the external and the internal psychic and biological processes [1]. The skin and the psyche are closely related from historical, embryologic, biological, psychological developmental and cultural perspectives.The importance of the skin is that it is literally the initial point of contact between the external and internal environments. Exposure to external pollutants, toxins, allergens and other noxious environmental elements find symptomatic expression through the skin.Embryologically, the shared origins of brain and skin are well recognized. Both are developed from the same embryologic germ layer (ectoderm) and two-way communication influences seem to persist throughout the life cycle.Biologically, the contribution of stress to skin diseases is backed by neuroendocrine and immunologic sciences. Emotional factors influence many skin diseases, and the correlation between stressful life events and disease flares is well-recognized in dermatology [2]. Flares of psoriasis, herpes simplex and atopic eczema are influ enced by proinflammatory cytokines, which are also modulated by psychosocial stressors [3]. The cytokines regulate immunologic responses and also mediate inflammatory processes, with recurrent hormonal secretion leading to central biologic changes in mood, anxiety and vegetative conditions [4].Psychologically, the internal psychological factors and emotional suffer ing may eventually find the skin a suitable organ for a visible expression of turmoil. This close relationship between the skin and the psyche has long been recognized in the sci entific literature. On 7 July 1949, AW Watt read an article at the 25th annual meeting of the British Association for Dermatology and Syphilology in London (UK) in which he encouraged dermatologists to consider psycho logical factors related to dematologic conditions [201].In addition to Watt, there were many proponents of the concept of intercon nection between the skin and the psyche with proposed modelsThe skin and the psyche are linked from embryologic, biological, psychological and cultural perspectives. Both the skin and the brain are developed from the same ectodermic germ layer. New evidence in psychoneuroimmunology suggest that both the skin and the psyche are affected by immunologic vulnerabilities and endocrine reactions. Emotional stress may exacerbate many chronic dermatoses and can initiate a vicious cycle referred to as the 'itch-scratch cycle'; therefore, treatment of such cases may be difficult without addressing stress. The dynamic interaction between the skin and the psyche is also manifest in cosmetic behavior, whereby the psychological state of the individual is altered through the widely utilized cosmetics and cosmetic procedures. The motives for seeking cosmetic procedures may include a desire to enhance selfconfidence, body image and self-empowerment. Individuals of both genders are becoming concerned about their physical appearance and are increasingly seeking cosmetic procedure...

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Section: Alopecia Areatamentioning

confidence: 96%

The psychiatric aspects of skin disorders

Osman¹,

Mufaddel²,

Mugaddam

et al. 2011

Expert Review of Dermatology

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“…A recent genome-wide association study has shown an association with genomic regions containing genes controlling both innate and acquired immunity [1]. AA has a dramatic impact on quality of life [2] and affects several aspects of the patients’ life [3]. Treatment of disfiguring AA is one of the most challenging goals in dermatology, and there is no consensus for active management because of a lack of treatment options of demonstrated efficacy and limited evidence from good-quality randomized, double-bind, placebo-controlled trials [4].…”

Section: Introductionmentioning

confidence: 99%

Interest of High-Dose Pulse Corticosteroid Therapy Combined with Methotrexate for Severe Alopecia Areata: A Retrospective Case Series

Droitcourt

Milpied²,

Ezzedine³

et al. 2012

Dermatology

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Background: The combination of systemic pulse corticosteroids and methotrexate in the treatment of severe alopecia areata has never been reported. Objective: The objective of this work was to give arguments for the efficacy and safety of this combined treatment. Methods: This was a retrospective case series of patients treated with intravenous 500 mg methylprednisolone per day for 3 consecutive days monthly during 3 months plus methotrexate initiated at the end of the second pulse regimen. We reviewed all case notes of patients who received this regimen between January 1 2007 and December 1 2010. Results: Twenty patients were treated. Data on hair regrowth at month 12 were available for all patients; 14 patients were still receiving the treatment on December 1 2010, 2 patients were lost of follow-up, and 4 patients had stopped the treatment. Of the 14 patients who were still receiving the treatment regimen at month 18, 10 (10/20, 50%) had total hair regrowth and 4 (4/20, 20%) had incomplete but satisfactory hair regrowth. The treatment was well tolerated. Conclusion: The initial treatment by pulse intravenous corticosteroids may influence the overall response. This approach should be evaluated in a larger series of patients.

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“…6 Psychosocial stress may also play a role in alopecia areata, although this claim remains controversial. 7 Recently, a questionnaire survey and qualitative study of 45 patients concluded that "…psychological interventions in alopecia areata should focus on the training of general and alopecia areata-specific coping competences and techniques of regulating emotionality". 7 Hence, although the temporal association of alopecia areata in the present patient was consistent with a drug-induced etiology, psychosocial stress may also be a contributory factor in the new onset of alopecia areata in oncology patients.…”

Section: Discussionmentioning

confidence: 99%