Drake Lara, Li Sara J, Reyes-Hadsall Sophia, Lee Karen, Huang Kathie, Mostaghimi Arash
Tufts University School of Medicine, Boston, MA, USA.
Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
Skin Appendage Disord. 2023 Oct;9(5):342-345. doi: 10.1159/000530356. Epub 2023 Jun 16.
Alopecia areata (AA) is an autoimmune condition that results in nonscarring hair loss. AA is comorbid with mental health disorders including anxiety and depression. This study aimed to evaluate the presence of post-traumatic stress disorder (PTSD) in relation to hair loss in patients with AA.
A cross-sectional national survey was distributed using the National Alopecia Areata Foundation's (NAAF) email list. This study was approved by the Mass General Brigham Institutional Review Board. Participants were asked to complete the PTSD Checklist for the DSM-5 (PCL-5), a validated screening tool for PTSD in the context of their AA.
Of the 1,449 completed surveys (completion rate 79.6%), most respondents were female (83.8%) and white (76.6%) with an average age of 50.6 ± 15.6 years. Respondents had AA for an average of 17.7 ± 15.8 years, with 91.4% experiencing current active hair loss. A total of 33.9% of respondents screened positively for PTSD, with an average score of 48.8 ± 12.3 on the PCL-5 in participants who screened positively. Participants with alopecia totalis have the highest average PCL-5 score of 30.1 ± 19.2, followed by participants with alopecia universalis with an average score of 26.0 ± 19.9, and lastly patchy AA with an average score of 24.5 ± 18.3 ( = 0.003). Feelings of intrusion and avoidance were the predominant reported symptoms. Total PTSD scores were significantly higher in respondents who were younger and identified as Black or African American and Hispanic when compared to white and non-Hispanic respondents, respectively.
These findings identify that one in 3 patients with AA in this cohort meet the screening criteria for PTSD specifically relating to their hair loss experience. These results further highlight the mental health comorbidities associated with AA and emphasize that these symptoms may persist even after hair regrowth. Limitations include the nonrandomized NAAF population with most participants being white females. Future studies should confirm these findings in other patient populations. Finally, respondent's baseline mental health was not assessed; therefore, a causal relationship between AA and PTSD cannot be deduced.
斑秃（AA）是一种自身免疫性疾病，会导致非瘢痕性脱发。斑秃常与包括焦虑和抑郁在内的精神健康障碍并存。本研究旨在评估斑秃患者创伤后应激障碍（PTSD）与脱发之间的关系。
使用国家斑秃基金会（NAAF）的电子邮件列表进行了一项全国性横断面调查。本研究获得了麻省总医院布莱根分院机构审查委员会的批准。参与者被要求完成《精神疾病诊断与统计手册》第5版创伤后应激障碍检查表（PCL-5），这是一种在斑秃背景下经过验证的创伤后应激障碍筛查工具。
在1449份完成的调查问卷中（完成率79.6%），大多数受访者为女性（83.8%），白人（76.6%），平均年龄为50.6±15.6岁。受访者患斑秃的平均时间为17.7±15.8年，91.4%的人目前正在经历活动性脱发。共有33.9%的受访者创伤后应激障碍筛查呈阳性，筛查呈阳性的参与者在PCL-5上的平均得分为48.8±12.3。全秃患者的PCL-5平均得分最高，为30.1±19.2，其次是普秃患者，平均得分为26.0±19.9，最后是斑秃患者，平均得分为24.5±18.3（P = 0.003）。侵入感和回避感是报告的主要症状。与白人和非西班牙裔受访者相比，年龄较小且被认定为黑人或非裔美国人以及西班牙裔的受访者的创伤后应激障碍总得分显著更高。
这些研究结果表明，在该队列中，每3名斑秃患者中就有1人符合与脱发经历相关的创伤后应激障碍筛查标准。这些结果进一步凸显了与斑秃相关的精神健康合并症，并强调即使在头发再生后这些症状可能仍然存在。局限性包括非随机的NAAF人群，大多数参与者为白人女性。未来的研究应在其他患者群体中证实这些发现。最后，未评估受访者的基线心理健康状况；因此，无法推断斑秃与创伤后应激障碍之间的因果关系。
