Alopecia Areata, Stress and Psychiatric Disorders: A Review

Abstract

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.

Serum Cytokine Levels and Anxiety and Depression Rates in Patients with Alopecia Areata

“…The suspected causes include immune system dysfunctions, hereditary factors and infectious and psychological factors [5].…”

The Response of Skin Disease to Stress

“…Research [9][10][11][12] shows that stress significantly slows wound healing, increases pain intensity, and slows surgery recovery rates. Evidence [13][14][15][16][17] that psychological stress may influence the course of dermatological disease is also growing, especially in the settings of psoriasis, alopecia areata, and atopic dermatitis. Clearly, there are some psychological components to the etiology of acne, because treatments such as biofeedback relaxation and cognitive imagery have been shown to be effective.…”

La Alopecia Areata

“…Sin embargo, en la AA estas evidencias han sido circunstanciales (43). Hay autores que muestran relación entre estrés y AA (8,44), y otros que no le conceden significación (45). Existe un volumen importante de trabajos que se ocupa del estrés psicosocial como desencadenante de los brotes.…”

“…El estrés psicosocial puede actuar como desencadenante de los brotes (38). Los pacientes con altas puntuaciones en variables psicopatológicas presentan un peor ajuste a la enfermedad que aquellos con formas más extensas y graves (44), lo que señala la importancia del estrés generado intrapsíquicamente. Es posible que la morbilidad psiquiátrica existente en la AA se encuentre infradiagnosticada e infratratada.…”