Alopecia Areata and Psychiatric Disorders: An Association Often Overlooked and Left Untreated

Alopecia areata is a multifactorial, chronic inflammatory disease of the hair follicles. The role of psychosocial factors in the course of the illness, and the psychiatric disorders resulting from the esthetic and social repercussions of hair loss, are analyzed and reviewed in this article. Psychiatric comorbidity is high; depressive episodes, generalized anxiety disorders, social phobia and adjustment disorders are frequently found. Alopecia areata often occurs after stress and critical life-events. Neuropeptides and psychoneuroimmunological factors may play a role in the development of the disease. Still, several studies do not support the pathogenic role of emotional variables, whereas others find that critical lifeevents may play an important role in triggering episodes of alopecia areata. The results of personality studies carried out in patients with alopecia areata are inconsistent; alexithymic traits, type-A behavior and normal personality traits have been reported. In severe forms of alopecia areata, psychotherapeutic approaches and social therapy have been documented as useful in the global management of disease. Anxiolytics or antidepressants may also be useful. The authors hold that consultation-liaison psychiatry is an appropriate setting for an integral, biopsychosocial treatment of these patients.