Psychosocial and psychiatric comorbidities and health-related quality of life in alopecia areata: a systematic review

Alopecia areata (AA) is an immune-mediated disease resulting in non-scarring hair loss. Systematic reviews on the psychosocial and psychiatric comorbidities, health-related quality of life, and interventions targeting psychosocial well-being are limited. We conducted a systematic review of the psychosocial comorbidities, health-related quality of life, and treatment options targeting psychosocial well-being in adult and pediatric AA patients. Our systematic review was performed according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines within the PubMed database. Specific search terms included, but were not limited to, alopecia areata, psychosocial, psychiatry, and quality of life. Studies were then evaluated for their design and categorized into corresponding levels of evidence according to the guidelines adapted from the Oxford Center for Evidence Based Medicine. Seventy-three reports met inclusion criteria, involving approximately 414,319 unique participants. Alopecia areata patients were found to have psychiatric co-morbidities, particularly anxiety and depression. Health-related quality of life is reduced in AA patients, but data on pediatric AA quality of life is limited. Psychotherapy is often recommended as adjuvant treatment. We concluded that alopecia areata has substantial psychosocial impact on patients and results in reduced health-related quality of life. Addressing this should be an active part of treatment.