Alopecia natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD
Overview
Patients with alopecia are at increased risk of psychosocial complications such as anxiety and depression. In addition, these patients need to be evaluated for other medical conditions. Outcomes vary with the type of alopecia.
Alopecia natural history, complications and prognosis
Natural History
The progression of alopecia depends on the type of alopecia an individual has. In some cases, it is irreversible as in alopecia mucinosa, alopecia neoplastica, and long-standing cases of tinea capitis; other cases, it is reversible such as in anagen effluvium.
Complications
Psychological Effects
The psychological effects for individuals experiencing hair loss vary widely. Some people adapt to the change comfortably, while others have severe problems relating to anxiety, depression, social phobia, and in some cases, identity change.
Alopecia induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. Body image does not return to the previous state after regrowth of hair for a majority of patients. In such cases, patients have difficulties expressing their feelings (alexithymia) and may be more prone to avoiding family conflicts. Family therapy can help families to cope with these psychological problems if they arise.[1] Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms.[2]
Associated Medical Conditions
Patients with alopecia need to be assessed for other autoimmune conditions such as thyroid conditions, vitiligo, etc. People with alopecia areata may at increased risk of developing insulin resistance. [3]
Prognosis
Research has shown that about 8.5% of patients with alopecia totalis and universalis achieved a total recovery. Many of the patients will obtain at least a transient recovery of partial or total hair regrowth. Response to treatment is often unpredictable, and healthcare providers should be aware of the prognosis and its effects to properly counsel patients. [4] Many companies have built a successful business selling products that reverse baldness, by allegedly regrowing hair, transplanting hair or selling hairpieces. There is very little evidence that any of those which claim hair regrowth actually work. The Alopecia Areata Predictive Score is a trichoscopy-based assessment used to predict the treatment outcome in patients with patchy alopecia areata. [5]
References
- ↑ Poot F (2004). "[Psychological consequences of chronic hair diseases]". Rev Med Brux. 25 (4): A286–8. PMID 15516058.
- ↑ Passchier J, Erdman J, Hammiche F, Erdman R (2006). "Androgenetic alopecia: stress of discovery". Psychol Rep. 98 (1): 226–228. PMID 16673981.
- ↑ Shahidi-Dadras M, Bahraini N, Rajabi F, Younespour S (2019) Patients with alopecia areata show signs of insulin resistance. Arch Dermatol Res 311 (7):529-533. DOI:10.1007/s00403-019-01929-6 PMID: 31089876
- ↑ Burroway B, Griggs J, Tosti A (2020) Alopecia totalis and universalis long-term outcomes: a review. J Eur Acad Dermatol Venereol 34 (4):709-715. DOI:10.1111/jdv.15994 PMID: 31593606
- ↑ Waśkiel-Burnat A, Rakowska A, Sikora M, Olszewska M, Rudnicka L (2020) Alopecia areata predictive score: A new trichoscopy-based tool to predict treatment outcome in patients with patchy alopecia areata. J Cosmet Dermatol 19 (3):746-751. DOI:10.1111/jocd.13064 PMID: 31301100