Comorbid anxiety and depression among black women with central centrifugal cicatricial alopecia: A retrospective study

Abstract

The published work suggests a higher risk for anxiety and depression among patients with alopecia areata (AA), 1 but less is known about central centrifugal cicatricial alopecia (CCCA), a primary scarring alopecia. CCCA occurs predominantly in black women, with a prevalence of 2.7-5.7%. 2 In a previous study, CCCA was strongly associated with low quality of life. 3 However, the psychiatric comorbidity burden among patients with CCCA has not been explored. We aimed to assess the risk of comorbid depression and anxiety among black female patients with CCCA compared with patients with AA and psoriasis. In this cross-sectional study, the medical records of black female patients aged 18 years and older with a diagnosis of CCCA, psoriasis or alopecia areata seen in the Dermatology Department of Perelman School of Medicine between July 2017 and July 2019 were reviewed. This study received an exemption from the institutional review board of the University of Pennsylvania. International Classification of Diseases, 10th Revision codes included L40.0 (psoriasis vulgaris), L66.9 (CCCA), L63.9 (AA), F32.1 (major depressive disorder, single episode, moderate), F32.2 (major depressive disorder, single episode), F33.0 (major depressive disorder, recurrent, mild), F33.1 (major depressive disorder, recurrent, moderate), F32.2 (major depressive disorder, recurrent, severe) and F41.1 (generalized anxiety disorder). Data was collected on patient demographics, and patients with a concomitant diagnosis of anxiety or depression were identified. Descriptive statistics were calculated, P-values were calculated using a two-tailed v 2-test with Yates' correction, and odds ratios were calculated with 95% confidence intervals by Stata version 16 software (StataCorp, College Station, TX, USA). There were a total of 270 black women with a diagnosis of CCCA. Of these, 27 (10.0%) had a diagnosis of anxiety or depression in their medical records. In the same period, 84 black women with psoriasis and 69 black women with AA were identified. In these groups, anxiety or depression was accounted for in 10 (11.9%) patients with AA, alopecia areata; CI, confidence interval; CCCA, central centrifugal cicatricial alopecia; OR, odds ratio.

Psychological Aspects of Hair Disorders: Consideration for Dermatologists, Cosmetologists, Aesthetic, and Plastic Surgeons

“…Similar to findings in other hair loss disorders, the extent of psychosocial impact in scarring alopecia does not appear to be influenced by severity of disease, which indicates the need for an individualized approach to each patient [58]. One study examining psychiatric comorbidities in patients with central centrifugal cicatricial alopecia, a scarring alopecia primarily affecting Black women, found a 10% prevalence of comorbid depressive or anxiety disorders [59]. Early assessment of patients with scarring alopecia should include illness perception, quality of life impact, and screening for mood disorders [57].…”

Risk factors and comorbidities associated with central centrifugal cicatricial alopecia

“…McKenzie et al 22 compared rates of anxiety or depression between Black women with CCCA to Black women with psoriasis or alopecia areata. They used a cross-sectional study design and pulled records of all Black women 18 years or older seen at Perelman School of Medicine between July 2017 and July 2019.…”

Psychological Aspect of Alopecia

“…Psychiatric comorbid conditions such as low quality of life, anxiety, depression, loneliness, social isolation and low self-esteem are found in women with scarred alopecia [47]. In a study examining psychiatric comorbidities in female patients with cicatricial alopecia, a 10% prevalence of comorbid depressive or anxiety disorders was found [48]. The psychological impact of scarred alopecia has been reported to be equally severe in both sexes, but concerns about appearance are more pronounced in female patients.…”