Alopecia Areata Tied to Higher Mortality From Self-Harm, Psychiatric Illness in Korea

By Marilynn Larkin

June 06, 2019

NEW YORK (Reuters Health) - Patients with alopecia areata had a higher mortality risk associated with intentional self-harm and psychiatric diseases than those without hair loss, a Korean registry study found.

Dr. Won Soo Lee of the Yonsei University College of Medicine and colleagues studied data on 73,107 patients with alopecia areata (6,023 with alopecia totalis/universalis) and at least three documented visits to a dermatologist from 2002 to 2006, and 731, 070 age- and sex-matched controls. Mortality data were gathered through 2016.

As reported online May 29 in JAMA Dermatology, no differences were seen in all-cause mortality risk between the cohorts (HR, 0.97). However, mortality associated with intentional self-harm or psychiatric diseases was greater in alopecia areata patients than in controls (HR, 1.21). Patients ages 18-35 (HR, 1.68) and the subgroup with alopecia totalis/universalis (HR, 1.85) were particularly affected.

Further, in a subgroup analysis, mortality associated with lung cancer was greater in those with alopecia totalis/universalis (HR, 2.16) compared with controls. However, mortality associated with diabetes mellitus was significantly lower in those with alopecia areata (HR, 0.53).

"Although the importance of treatment for psychiatric illnesses in patients with alopecia areata has been consistently emphasized, these may eventually lead to a substantial increase in mortality associated with intentional self-harm/psychological diseases compared with the general population," the authors state. "In addition, higher mortality from smoking-associated cancers may also be associated with a higher degree of severe stress and the higher proportion of current smokers."

Dermatologist and hair disorders specialist Dr. Lindsey Bordone of ColumbiaDoctors in New York City said in an email to Reuters Health, "Dermatologists who specialize in treating patients with alopecia areata have always been aware of the psychological burden this condition places on patients."

"For example, my teenage patients who lose all the hair on their head and body over a one-week period (experience) tremendous emotional stress," she noted. "Some become reclusive and isolated as a result of their appearance and this can lead to a downward spiral. It devastates their families as well."

"Further," she said, "some insurance plans label any type of hair loss as cosmetic and do not cover treatments, and the medication that successfully treats the majority of alopecia areata patients is very expensive."

Richard Torbeck, a dermatologist in private practice in New York City, noted, "Correlation does not equal causality. Some of the disease states like diabetes and malignant cancers appear to have multifactorial components that I feel play into the associations."

"This study is in line with previous studies showing the effect of stress and mental health being effected by alopecia areata and more so by totalis and universalis," he said in an email to Reuters Health. "Additionally, stress and mental health have their own effects on our health and well being, which makes definitive statements on alopecia's isolated effect difficult."

"Ideals for hair content, configuration, and quality can vary greatly in different ethnic groups," he added. "Ethnic hair styles are very important to their respective groups and alopecia areata can have a far more significant impact than on groups where hair is not a central role of identity."

Dr. Suzanne Friedler, a clinical instructor of dermatology in the Mount Sinai Health System in New York City, told Reuters Health by email, "While I have not seen an increase in psychiatric disorders, self harm and suicidality in my patients, a psychologic toll of these conditions exists and practitioners should be mindful of this when they talk with these patients. Part of a routine alopecia visit should include inquiring about the patient's quality of life and overall mental state. "

Dr. Lee did not respond to requests for a comment.


JAMA Dermatology 2019.