The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity

Abstract

Alopecia areata (AA) is a common inflammatory autoimmune disease of the hair which can have a significant negative impact on quality of life (QoL), mental health and productivity. The aim of this scoping review is to elucidate the burden of AA focusing on these three realms. Inclusion criteria included all original manuscripts with no restriction on study type or statistical method written in English (or having an English abstract). For QoL 40 articles were included, 85 for psychiatric comorbidities, and 9 for work/school absenteeism/presenteeism mostly consisting of cross‐sectional and observational cohort studies. QoL impairment was detected in over 75% of patients and up to one‐third reported extremely severe QoL impairments. Specific QoL dimensions with the greatest impact were embarrassment, social functioning, as well as shopping and/or housework. Cross‐sectional studies assessing the psychological burden of adult patients with AA found that the presence of signs of anxiety and/or depression ranged from 30% to 68% and affected all age groups. Rates of work absenteeism and unemployment were significantly higher in AA patients compared to healthy controls. Up to 62% reported making major life decisions including relationships, education and career based on their AA. Additionally, the extensive camouflage techniques and time lost from work led to a strong financial burden for patients and the numerous physician visits added to the healthcare costs. The overall impact of AA stretches much further than simply being an aesthetic concern and can negatively impact every part of an individual's life. An individualized approach and effective treatments will help reduce the psychosocial consequences and distress and return patients to their normal state of health.

Experiencing Workplace Bullying in Patients with Alopecia Areata: A Cross-Sectional Survey Study

“…One recent study demonstrated that employers feel less comfortable hiring individuals with AA [3]. These employer attitudes in combination with workplace bullying may contribute to the higher rates of work absenteeism, work productivity loss, and unemployment in patients with AA [6,7]. The culmination of psychosocial obstacles in the workplace and potentially lost income can compound the financial burden and distress experienced by this patient population [7][8][9].…”

Hair loss is a symptom of many complex medical and psychological problems

“…This issue of JEADV focuses on the burden of this immune-mediated disease that is manifested by hair loss, as well as its strong association with depression. [8][9][10] It was found that up to 62% of patients make significant life decisions including relationships, education and career based on their alopecia areata. 8 Moreover, children and adolescents with hair loss often experience bullying, including physical aggression.…”

“…[8][9][10] It was found that up to 62% of patients make significant life decisions including relationships, education and career based on their alopecia areata. 8 Moreover, children and adolescents with hair loss often experience bullying, including physical aggression. 10 For us, physicians and for our patients, a disease associated with hair loss goes far beyond 'only hair (shafts)'.…”

“…The introduction of a novel class of medications, targeting the dysregulated immune system in alopecia areata, has been long‐awaited by many patients. This issue of JEADV focuses on the burden of this immune‐mediated disease that is manifested by hair loss, as well as its strong association with depression 8–10 . It was found that up to 62% of patients make significant life decisions including relationships, education and career based on their alopecia areata 8 .…”

Economic burden of alopecia areata: A study of direct and indirect cost in Japan using real‐world data

“…3 Alopecia areata may significantly affect a patient's appearance and impact on their health-related quality of life (HRQoL). 4,5 Reduced…”