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

J Am Acad Dermatol. 2021 Jul;85(1):162-175. doi: 10.1016/j.jaad.2020.06.047. Epub 2020 Jun 17.


Background: Alopecia areata (AA) is an immune-mediated disease resulting in nonscarring hair loss. Systematic reviews on the psychosocial and psychiatric comorbidities, health-related quality of life, and interventions targeting psychosocial well-being are limited.

Objective: To conduct 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.

Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 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.

Findings: Seventy-three reports met inclusion criteria, involving approximately 414,319 unique participants. AA patients were found to have psychiatric comorbidities, particularly anxiety and depression. Health-related quality of life is reduced in AA patients, but data on pediatric AA quality of life are limited. Psychotherapy is often recommended as adjuvant treatment.

Conclusion: AA has substantial psychosocial impact on patients and results in reduced health-related quality of life. Addressing this should be an active part of treatment.

Keywords: alopecia areata; anxiety; depression; hypnosis; personality; psychiatry; psychosocial; quality of life; wigs.

Publication types

  • Systematic Review

MeSH terms

  • Alopecia Areata / epidemiology*
  • Alopecia Areata / psychology*
  • Anxiety / epidemiology
  • Child
  • Child Behavior Disorders / epidemiology
  • Comorbidity
  • Depression / epidemiology
  • Humans
  • Mental Disorders / epidemiology*
  • Mental Disorders / therapy*
  • Quality of Life / psychology*
  • Suicide