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Patients with alopecia areata experience a varied disease burden, with many mental health consequences. This article describes current research on the medical and psychological effects of the disease.

Alopecia areata (AA) is an autoimmune disease that causes hair loss, with severity correlating to degree of hair loss throughout the body. AA tends to have a very erratic and unpredictable course, suddenly worsening and then remaining stable for periods. Due to the stigmatizing effects of hair loss, alopecia can cause significant stress, anxiety, and other mental burdens. 

Although much progress has been made in understanding the pathogenesis of AA and other clinical factors related to treatment and diagnosis, the mental health burden remains poorly understood. This article, published in the journal Clinical, Cosmetic, and Investigational Dermatology, reviews more recent updates to our understanding of AA. It also describes current unmet needs of patients with AA, as well as concerns related to accessibility and management.

Understanding the Pathogenesis of AA: Genetic and Immunological Factors

Past research has established the pathogenesis of AA as involving the loss of immune privilege, but recently, research has clarified additional details about disease onset. Although the immune response is central to AA onset, a detailed account of AA pathogenesis involves various genetic and environmental concerns as well. The main mechanism of AA onset involves immune systems failing to protect hair follicles, which are then attacked by the immune system. 

One recent study found a heightened risk of AA in relatives of those dealing with the disease, and additional studies have isolated specific genetic details that may correlate with AA. These include human leukocyte antigen (HLA) alleles, and 139 single nucleotide polymorphisms that significantly associate with AA. A complete and detailed understanding of the genetic factors related to AA is not yet available, but active research in this area is promising.

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The Need for Better Mental Health Resources for Patients with AA

AA can be treated by a variety of means including steroids and medications like minoxidil. Even with treatment, many patients face unmet needs. These are caused by various disparate factors. The currently available medical therapies tend to be very limited in their efficacy, and come with severe side effects in many cases. Many patients that do get relief from treatments such as JAK inhibitors have their AA return later on. 

Patients with AA tend to experience significant mental health burdens. This can be aided by support groups, where patients can learn coping strategies and how to navigate life with their disease. Attending support groups can be both time- and resource-intensive, and many patients are not able to access them easily, which can lead to socioeconomic disparities in mental health disease burden. 

Although research has led to a better understanding of the pathogenesis of AA, which may lead to improved medical therapies for the condition, many patients are still underserved and face high mental health burdens. Increased patient advocacy and research into mental health interventions could be a useful way to improve the patient experience, even if the medical disease burden remains the same.

Source:

Alhanshali, L., Buontempo, M. G., Lo Sicco, K. I., & Shapiro, J. (2023). Alopecia Areata: Burden of Disease, Approach to Treatment, and Current Unmet Needs. Clin Cosmet Investig Dermatol, 16, 803-820. https://doi.org/10.2147/ccid.S376096