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Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic

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Background: Hair loss is a common complaint among women and may be associated with psychological disturbances. Objectives: This study investigated dermatology patients with respect to the prevalence of complaints of hair loss and the association between these complaints and symptoms of depression. Methods: A cross-sectional study was conducted with female outpatients over 20 years of age with no hair-related disorders. Patients were asked about hair loss and were evaluated with respect to symptoms of depression. The following variables were also analyzed: age, dermatological diagnosis, comorbidities, medications, family history of alopecia, hair length, the number of hairs extracted in the hair pull test and the presence of hair thinning or seborrheic dermatitis. Data were compared by bivariate analysis and multiple logistic regressions between groups of women with and without hair loss. Results: Of the 157 women interviewed, 54% reported hair loss and 29% reported at least two key symptoms of depression. The median (IQD) age of the women was 51 (20) years. Complaints of hair loss were associated with the presence of symptoms of depression even following adjustment for the other covariates (p=0.02; OR=2.79; 95%CI: 1.18-6.61). Statistically significant differences were also found between the patients with and without hair loss with respect to: age (p=0.03), family history of alopecia (p<0.01), hair length (p=0.01), number of hairs extracted in the hair pull test (p=0.02), hair thinning (p<0.01), seborrheic dermatitis (p<0.01) and problems with personal relationships (p=0.04). Discussion: Hair-related disorders are a common topic of interest in this population. The significant association found between this complaint and symptoms of depression indicates a relationship between the perception of hair loss and the psychological well being of the women evaluated. Conclusion: Complaints of hair loss were common and were associated with a greater prevalence of symptoms of depression among adult female outpatients at a public dermatology clinic.
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Hair loss perception and symptoms of depression in female
outpatients attending a general dermatology clinic
*
Percepção de queda de cabelos e sintomas depressivos em pacientes do sexo
feminino em ambulatório de dermatologia geral
Juliano Vilaverde Schmitt
1
Camila Ferrari Ribeiro
2
Fernanda Homem de Mello de Souza
2
Elisa Beatriz Dalledone Siqueira
2
Fernanda Regina Lemos Bebber
2
Abstract: BACKGROUND: Hair loss is a common complaint among women and may be associated with psychological disturbances.
OBJECTIVES: This study investigated dermatology patients with respect to the prevalence of complaints of hair loss and the association between
these complaints and symptoms of depression.
METHODS: A cross-sectional study was conducted with female outpatients over 20 years of age with no hair-related disorders. Patients were
asked about hair loss and were evaluated with respect to symptoms of depression. The following variables were also analyzed: age, derma-
tological diagnosis, comorbidities, medications, family history of alopecia, hair length, the number of hairs extracted in the hair pull test and
the presence of hair thinning or seborrheic dermatitis. Data were compared by bivariate analysis and multiple logistic regressions between
groups of women with and without hair loss.
RESULTS: Of the 157 women interviewed, 54% reported hair loss and 29% reported at least two key symptoms of depression. The median
(IQD) age of the women was 51 (20) years. Complaints of hair loss were associated with the presence of symptoms of depression even fol-
lowing adjustment for the other covariates (p=0.02; OR=2.79; 95%CI: 1.18–6.61). Statistically significant differences were also found
between the patients with and without hair loss with respect to: age (p=0.03), family history of alopecia (p<0.01), hair length (p=0.01),
number of hairs extracted in the hair pull test (p=0.02), hair thinning (p<0.01), seborrheic dermatitis (p<0.01) and problems with person-
al relationships (p=0.04).
DISCUSSION: Hair-related disorders are a common topic of interest in this population. The significant association found between this com-
plaint and symptoms of depression indicates a relationship between the perception of hair loss and the psychological well being of the
women evaluated.
CONCLUSION: Complaints of hair loss were common and were associated with a greater prevalence of symptoms of depression among adult
female outpatients at a public dermatology clinic.
Keywords: Alopecia; Depression; Hair; Women
Resumo: Fundamentos: Queda de cabelos é queixa frequente entre mulheres, podendo estar relacionada a comprometimento psicológico.
OBJETIVOS: Investigar a prevalência da queixa de queda capilar em pacientes dermatológicas e sua associação com sintomas depressivos.
M
ÉTODOS: Estudo transversal com pacientes femininas, ambulatoriais, maiores de 20 anos de idade, sem doenças capilares. Foram questionadas
quanto à presença de queda de cabelos e avaliadas quanto à presença de sintomas depressivos. Também analisaram-se: idade, diagnóstico derma-
tológico, comorbidades, medicações, história familiar de alopecia, comprimento capilar, número de fios obtidos à tração e presença de rarefação
capilar ou dermatite seborreica. Os dados foram comparados bivariadamente e por regressão logística múltipla entre os grupos com e sem quei-
xa de queda capilar.
RESULTADOS: Das 157 mulheres entrevistadas, 54% referiam queda capilar e 29%, ao menos dois sintomas depressivos fundamentais. A idade media-
na foi 51+20 anos. A queixa de queda capilar esteve associada à presença de sintomas depressivos, mesmo quando ajustada pelas demais cova-
riáveis (p = 0,02; OR = 2,79 [IC 95%: 1,18-6,61]). Pacientes com e sem queixa também diferiram, significativamente, quanto à idade (p = 0,03),
à história familiar de alopecia (p < 0,01), ao comprimento capilar (p = 0,01), ao número de fios obtidos à tração (p = 0,02), à rarefação capilar
(p < 0,01), à dermatite seborreica (p < 0,01) e a problemas de relacionamento pessoal (p = 0,04).
DISCUSSÃO: Alterações capilares configuram tema de frequente interesse nessa população. A significativa associação dessa queixa com sintomas
depressivos indica relação entre a percepção da saúde capilar e o bem-estar psicológico das mulheres avaliadas. Conclusão: A queixa de queda
capilar foi frequente e esteve associada a maior prevalência de sintomas depressivos entre as pacientes adultas de ambulatório dermatológico
público.
Palavras-chave: Alopecia; Cabelo; Depressão; Mulheres
Received on 30.03.2011.
Approved by the Advisory Board and accepted for publication on 16.05.2011.
* This study was conducted at the Dermatology Unit, Evangelical Teaching Hospital of Curitiba, Evangelical Medical School of Paraná (HUEC-FEPAR), Curitiba, Paraná, Brazil.
Financial Support: None
Conflict of Interests: None
1
Preceptor, Dermatology Unit, Evangelical Teaching Hospital of Curitiba, Evangelical Medical School of Paraná (HUEC-FEPAR), Curitiba, Paraná, Brazil.
2
Medical Resident, Dermatology Unit, Evangelical Teaching Hospital of Curitiba, Evangelical Medical School of Paraná (HUEC-FEPAR), Curitiba, Paraná, Brazil.
©2012 by Anais Brasileiros de Dermatologia
412
An Bras Dermatol. 2012;87(3):412-7.
INVESTIGATION
An Bras Dermatol. 2012;87(3):412-7.
Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic 413
INTRODUCTION
Hair loss is a common complaint in clinical der-
matology, with this complaint also being common in
the adult population in general when these indivi-
duals are specifically asked about it.
1
On the other
hand, it is relatively common in dermatology clinics to
find patients with no apparent abnormalities at physi-
cal examination who complain of hair loss. This inco-
herency between the complaint and the findings upon
examination may have various origins.
Although women are genetically less suscepti-
ble to pronounced alopecia, they are more sensitive to
minor capillary abnormalities, possibly due to cultural
and behavioral factors.
2-5
Few studies in the literature have evaluated the
profile of hair loss as perceived by the patient from a
behavioral point of view. Likewise, the reliability of
this impression and its relationship with psychological
and clinical aspects has seldom been reported.
A better understanding of this perception and
of the possible variables associated with it in women
may improve the management of these patients and
lead to improvements in clinical dermatology with
respect to this disorder.
The present study investigated the prevalence
of a perception of hair loss by the patient when speci-
fically questioned on the subject and the variables
associated with this perception, particularly the pre-
sence of depression symptoms. The study was carried
out in adult patients attending a public dermatology
clinic.
METHODS
A prospective, cross-sectional study was con-
ducted between April and August 2010 with female
patients of 20 years of age or more, who had presen-
ted spontaneously at the outpatient dermatology cli-
nic of a public reference institution in Curitiba,
Paraná. Patients who were being treated for capillary
disorders were excluded from the study.
After their dermatological consultation,
patients were asked the following question: “Do you
have any problem with hair loss?” A positive or nega-
tive answer to this question was then used to separa-
te the women into a group of complainers and a
group of non-complainers, respectively.
The following data were obtained from eligible
patients: age, phototype, principal dermatological
diagnosis, comorbidities, medication used, family his-
tory of hair loss or alopecia, and awareness that the
dermatologist treats hair loss. Specific hair features
included actual and current hair type (straight, wavy
or curly), actual and current hair color (dark or fair),
number of shampoos per week, number of colorings
per month, length in centimeters of the hair starting
from the posterior vertex, and the number of times
the hair is combed per day. The patient was examined
for the presence of clinical signs of hirsutism, clinical
signs of active acne, seborrheic dermatitis of the scalp,
and hair thinning at the sagittal midline. Finally, the
number of hairs extracted at the hair pull test was
recorded.
The hair pull test was performed during the
interview by firmly securing a clump of hair between
the fingers and gently pulling it from the vertex region
of the scalp. No normal limit was established for this
test, since the data were evaluated as a continuous
variable.
The eligible women were also questioned with
respect to the symptoms listed below, based on the
International Classification of Diseases – 10
th
Edition
(ICD-10) depression diagnostic criteria.
6
The first
three are considered key symptoms.
Persistent sadness or low mood?
Loss of interest or pleasure in performing rou-
tine activities?
Fatigue or low energy?
Feelings of guilt or worthlessness?
Poor concentration or indecisiveness?
Disturbed sleep on a practically daily basis?
The women complaining of hair loss were
asked about the duration of the problem, the rela-
tionship between the seasons and the severity of the
problem and the way in which the problem was per-
ceived, from the following options:
From progressive thinning on the scalp
When combing hair
When taking a bath
From hair on the floor at home
From hair on the pillow
Other people noticed the problem.
The investigator’s subjective evaluation regar-
ding the presence of hair thinning at the vertex was
validated by standardized photographs of this region
of the scalp and by a count of the number of hairs
found over an area of 9 mm
2
in the first 61 patients. A
significant correlation was found between the number
of hairs and the investigator’s impression of hair thin-
ning (Spearman’s rho = 0.34; p<0.01). After this ini-
tial evaluation, only the subjective impression at sub-
sequent examinations was taken into account.
Categorical variables were represented as abso-
lute numbers and percentages, while continuous
variables were expressed as medians (interquartile
deviations [IQD]). Comparisons were made using
bivariate analysis between the group of women who
complained of hair loss and the non-complainer
group using the chi-square test, Fisher’s exact test,
William’s test or the Mann-Whitney U test.
An Bras Dermatol. 2012;87(3):412-7.
414 Schmitt JV, Ribeiro CF, Souza FHM, Siqueira EBD, Bebber FRL
Correlations were determined using Spearman’s rank
correlation coefficient and the normal distribution of
data was determined using the Shapiro-Wilk test. In
the multivariate analysis, abnormal distributions were
ranked.
The variables with a two-tailed p-value < 0.30
in the bivariate analyses were included in the condi-
tional multiple logistic regression. Next, the model
was reduced using a backward stepwise algorithm,
maintaining the variables with two-tailed p-values <
0.30 in the final model.
The minimum sample size was calculated at 156
individuals for a multiple logistic regression with a
power of 80% and alpha level of 0.05 to detect an anti-
cipated effect size of 0.15 and include up to 20 cova-
riates.
The coefficients of the categorical and logistic
associations were represented by the odds ratios (OR)
and their respective 95% confidence intervals
(95%CI). Two-tailed p-values < 0.05 were considered
statistically significant.
RESULTS
The study interviewed 157 women with a
median (IQD) age of 51 (20) years. The five most com-
mon dermatoses were melasma (11%), solar lentigo
or solar melanosis (11%), actinic keratosis (10%), acne
(6%) and onychomycosis (6%).
Following specific questioning, 54% of the
women reported having a problem with hair loss. The
way in which the problem was perceived was, in
decreasing order: while combing the hair (41%),
while in the bath (40%), from the amount of hair
found on the floor (27%) or on the pillow (20%), hair
thinning (12%) and from observations made by others
(6%). There was a significant association between the
physician’s perception and the patient’s perception of
the presence of hair thinning (OR = 22.83; 95%CI:
5.44 – 95.77; p<0.01; Fisher’s exact test).
The length of the hair correlated significantly
with age, shorter hair being associated with older
women (Spearman’s rho = -0.48; p<0.01).
Overall, 55% of the women interviewed did not
associate the treatment of hair loss with the dermato-
logist and there was no statistically significant diffe-
rence in age between those who were aware of the
scope of this specialist and those who were not
(median [IQD] age 48 [21] years versus 52.5 [22]
years; p = 0.18; Mann-Whitney).
The median (IQD) number of hairs obtained in
the hair pull test was 1 (2) (range 0-12) and was cor-
related with hair length (Spearman’s rho = 0.26;
p<0.01).
Seventeen patients (11%) had chronic diseases
related to hair loss, the most common being hypothy-
roidism (14 women). These 17 patients were the ones
in whom the most hairs were obtained in the hair pull
test (median [IQD] number of hairs 2 [1] versus 1 [2],
p = 0.02; Mann-Whitney test).
At least 22% of the patients were in regular use
of medication associated with hair loss, the most com-
mon being beta-blockers and antidepressants.
Of the women interviewed, 29% reported at
least two key symptoms of depression and 20% had
symptoms compatible with dysthymia.
The patients who complained of hair loss
reported that the problem had been present for a
median (IQD) duration of 12 (30) months, with a cor-
relation between the patient’s age at the time of the
interview and the duration of hair loss (Spearman’s
rho = 0.26; p = 0.02).
In the bivariate comparisons between the two
groups, the women complaining of hair loss were
more likely to have a family history of alopecia, longer
hair, seborrheic dermatitis, and more hairs removed in
the hair pull test. Additionally, the complainers were
more likely to have symptoms of depression and per-
sonal relationship problems compared to the women
who had not complained of hair loss (Table 1).
No differences in median age were found bet-
ween the group of women complaining of hair loss
and the group of non-complainers. However, when
sub-groups of age were analyzed, women of 20-39
years of age were more likely to complain of hair loss
than those of 40-59 years of age (OR = 2.55, 95%CI:
1.11 – 5.82; p = 0.02; chi-square test).
In the multivariate analysis, there were statisti-
cally significant differences between the group of
women that had complained of hair loss and the
group that had not with respect to age, knowledge
regarding the scope of the dermatologist, family histo-
ry of alopecia, the presence of hair thinning and the
presence of symptoms of depression (Table 2).
The association between hair loss and the pre-
sence of two or more key symptoms of depression
appeared to be restricted to the younger half of the
sample (Table 3).
DISCUSSION
In this culture, hair plays a very significant role
in gender identification and often acts as a fashion
item, a reference of beauty and style. Long, volumi-
nous hair is thus representative of health and youthful-
ness. Based on this, we have found that a perception
of hair loss may lead to feelings of loss of health and of
senility, generating significant psychological stress that,
in turn, may be associated with causing hair loss, the-
reby increasing the amount of telogen hair.
7
When questioned, more than half the women
interviewed reported problems with hair loss, which
An Bras Dermatol. 2012;87(3):412-7.
Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic 415
was most often noticed during their regular hair-care
routine such as when washing or combing their hair.
Most of the patients were undergoing treatment for
mild skin disorders, some of which were almost enti-
rely cosmetic; therefore, there is a possibility that this
population may be more sensitive to hair-related pro-
blems than patients with more severe dermatological
disorders. It is important to emphasize that cosmetic
problems are currently routine in dermatology clinics
and it is important to recognize the profile of these
patients.
8
Surprisingly, the majority of these patients were
unaware that dermatologists treat hair loss and this
lack of information does not appear to be associated
specifically with older patients. This finding indicates
that, at least in the case of patients in the public
healthcare network, information should be provided
on the types of treatment available within the scope of
dermatology.
9
The presence of clinical conditions or the use of
drugs that could cause hair loss was rare in the
patients evaluated in this study. Nonetheless, more
hairs were obtained in the hair pull test in patients
with diseases associated with hair loss, the most com-
mon being hypothyroidism. It should be emphasized
that possible confounding factors related to this fin-
ding, such as whether these conditions were being
effectively treated at the time and the concomitant use
of other medications that could adversely affect the
hair, were not evaluated.
In the bivariate analyses, a significant associa-
tion was found between a complaint of hair loss and
the length of the hair or the number of hairs obtained
in the hair pull test. However, the multivariate analy-
sis failed to confirm these findings. This was probably
due to the significant correlation between these varia-
bles, as well as the significant correlation between hair
length and age, since only age was found to be inde-
pendently associated with hair loss in the final model.
These data show that the number of hairs obtained in
the hair pull test does not represent a good indepen-
dent predictor of the perception of hair loss by the
patient. On the other hand, the perception of hair
loss was independently associated with the presence
of hair thinning.
The above observations indicate that predefi-
ning an absolute normal limit for the hair pull test may
be difficult and that the length of the hair being tested
should be taken into consideration.
The multivariate analysis suggested that in the
age group evaluated, younger women are more likely
to complain of hair loss. Various factors may be asso-
T
ABLE 1: Bivariate comparison of the characteristics evaluated according to their association with the complaint
of hair loss (n=157)
Variable Total Complaint No OR (95% CI) p-value
complaint
Age* 51[20] 47[20] 52.5[18] - 0.11
Phototype** - - - - 0.35
Aware of the scope of the dermatologist** 71[45] 34[40] 37[51] 0.63 (0.33 - 1.19) 0.15
Family history of alopecia** 66[42] 44[52] 22[31] 2.44 (1.26 - 4.71) <0.01
Actual hair type** - - - - 0.89
Current hair type** - - - - 0.49
Actual hair color is dark** 108[69] 58[68] 50[69] 0.95 (0.48 - 1.86) 0.87
Current hair color is dark** 95[61] 53[62] 42[58] 1.18 (0.62 - 2.25) 0.61
Number of shampoos per week* 3[1] 3[1] 3[1] - 0.22
Number of times hair is combed per day* 2[2] 2[2] 2[2] - 0.82
Length* 27[25] 30[20] 22[26] - 0.01
Regular coloring** 54[34] 27[32] 27[38] 0.78 (0.40 - 1.50) 0.45
Number of hairs obtained in the hair pull test* 1[2] 1[2] 1[1] - 0.02
Current acne** 20[13] 15[18] 5[7] 2.87 (0.99 - 8.34) 0.06
Seborrhea of the scalp** 45[29] 32[38] 13[18] 2.74 (1.30 - 5.76) <0.01
Hirsutism** 4[3] 2[2] 2[3] 0.84 (0.12 - 6.14) 0.99
Two or more key symptoms of depression** 45[29] 32[38] 13[18] 2.74 (1.30 - 5.77) <0.01
Problems with personal relationships** 23[15] 17[20] 6[8] 2.75 (1.02 - 7.4) 0.04
Hair thinning on the vertex region of the scalp** 15[10] 11[13] 4[6] 2.56 (0.78 - 8.43) 0.17
Presence of pathologies associated with hair loss ** 17[11] 11[13] 6[8] 1.64 (0.57 - 4.67) 0.44
Use of drugs associated with hair loss** 34[22] 15[18] 19[26] 0.60 (0.28 - 1.29) 0.19
Use of antidepressants** 16[10] 7[8] 9[13] 0.63 (0.22 - 1.78) 0.43
* Data shown as medians and interquartile deviations and compared using the Mann-Whitney test.
** Categorical data shown as absolute numbers and percentages. Data compared using the chi-square test or Fisher’s exact test.
An Bras Dermatol. 2012;87(3):412-7.
416 Schmitt JV, Ribeiro CF, Souza FHM, Siqueira EBD, Bebber FRL
ciated with this finding, including cultural and psy-
chological aspects typical of different generations or
of different age groups of women.
10
Since a considerable proportion of the patients
would be in the menopausal transition, principally
those in the younger half of the sample, the effect of
this phase of hormonal changes on the association
between a complaint of hair loss and younger age,
cannot be excluded. However, these data indicate that
the younger adults were more likely to complain of
hair loss than those in the age group associated with
the perimenopause, suggesting that factors related to
this complaint may be more significant at the begin-
ning of adulthood in these patients.
The data show a significant association between
symptoms of depression and a complaint of hair loss,
principally with respect to the patients in the third
and fourth decades of life.
In general, there is a greater prevalence of
mood disorders in outpatients compared to the healt-
hy population; nonetheless, few studies have evalua-
ted the association between these symptoms and hair
loss.
11
Since 38% of the patients who reported hair
loss had at least two of the three key symptoms of
depression, it is probable than many of these patients
would have benefitted from psychological evaluation,
which does not generally form part of the typical clini-
cal management of dermatology patients.
There are numerous factors related to hair loss
and to the perception of hair loss that may not be
completely coincidental. The apparently higher fre-
quency of this complaint among young adults toget-
her with the greater association of the complaint with
symptoms of depression and with relationship pro-
blems suggest a close association between this per-
ception and the psychological well being of these
women.
9
The above-mentioned association was not
found among the patients over 50 years of age, possi-
bly because there are more comorbidities and condi-
tions that trigger symptoms of depression in this age
group, as well as a proven increase in the prevalence
of depression and organic cerebral syndrome, which
may present in a similar form in the elderly popula-
tion in general.
12
The present study does not permit causal rela-
tionships to be established between the perception of
hair loss and the presence of symptoms of depression.
Furthermore, the presence of uninvestigated under-
lying conditions that could be acting on a possible
hair loss and on the patient’s mood cannot be discar-
ded. However, they were not the objectives of the
present study.
Nonetheless, mood changes cannot be elimina-
ted as causes of hair loss. Some molecular studies and
studies in animal models have shown that psychologi-
T
ABLE 2: Final multiple logistic regression model according to the backward stepwise algorithm of the variables
associated with hair loss (n=157)
*
Variable Odds ratio 95% CI p-value
Aware of the scope of the dermatologist 0.44 0.20 0.95 0.04
Family history of alopecia 2.86 1.32 6.19 <0.01
Seborrheic dermatitis of the scalp 2.34 0.96 5.68 0.06
Problems with personal relationships 2.59 0.82 8.20 0.11
Thinning of the hair on the vertex region of the scalp 7.15 1.64 31.18 <0.01
Two or more key symptoms of depression 2.79 1.18 6.61 0.02
Use of drugs that could potentially cause hair loss 0.45 0.18 1.13 0.09
Number of shampoos per week** 0.99 0.98 1.00 0.05
Number of hairs obtained in the hair pull test** 1.01 0.99 1.01 0.28
Age** 0.99 0.98 0.99 0.03
Constant 1.92 0.00 0.00 0.42
*
Dependent variable: Complaint of hair loss; p-value (of the model) <0.001;
Correct classification = 71.3%; R2 Nagelkerke = 0.32.
**
Ranks.
TABLE 3: Association between a complaint of hair loss
and the presence of two or more key symptoms of
depression
Analysis Age < 51 years Age ≥ 51 years
(n=76) (n=81)
OR [95%CI] OR [95%CI]
Crude 5.00 [1.50 - 16.66] 1.63 [0.60 - 4.44]
Adjusted* 4.48 [1.07 - 18.82] 1.92 [0.54 - 6.85]
* Adjusted for age, family history, awareness of the scope of the
dermatologist, use of drugs associated with hair loss, seborreheic
dermatitis of the scalp, problems with personal relationships,
number of hairs obtained in the hair pull test and the number of
shampoos per week.
An Bras Dermatol. 2012;87(3):412-7.
Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic 417
cal stress may act on the hair follicle cycle, accelera-
ting the transition into the telogen phase and provo-
king miniaturization of the follicle. Suppression of
the hormones related to stress may reverse these
effects.
13
CONCLUSIONS
In the region in which this study was conduc-
ted, hair loss was present in a large percentage of the
adult female patients attending a public dermatology
clinic, even when this complaint was not the reason
for the patient to seek consultation at the clinic.
The most common ways in which the problem
was perceived by the patient were when combing the
hair or when bathing. Half the patients did not asso-
ciate the treatment of hair loss with dermatologists,
suggesting a need to inform the public on the scope
within this specialty.
Finally, the perception of hair loss was found to
be independently associated with a greater prevalence
of symptoms of depression, principally in adult
women up to the fifth decade of life. However, furt-
her studies with larger sample sizes and specific
designs should be conducted to define the association
between these observations.
How to cite this article: Schmitt JV, Ribeiro CF, Souza FHM, Siqueira EBD, Bebber FRL. Hair loss perception and
symptoms of depression in female outpatients attending a general dermatology clinic. An Bras Dermatol.
2012;87(3):412-7.
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M
AILING
ADDRESS
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Juliano Vilaverde Schmitt
Av. Sete de Setembro, 4713 Batel
80240-000 Curitiba, Paraná, Brazil
E-mail: julivs@gmail.com
REFERENCES
... In a Brazilian study by Schmitt et al that was restricted to 157 women attending a dermatology clinic, it was reported that 54% of the participants reported hair loss and 29% reported symptoms of depression, suggesting that perceived hair loss can be associated with mental health. 19 Although their sample was restricted to female subjects attending dermatology clinics, the findings are comparable. Higher depression levels were detected among female subjects in this sample, indicating the potential impact of perceived hair loss on increasing levels of depression, especially among female subjects. ...
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Purpose: This study aims to measure quality of life and the presence of depression among adults suffering from perceived hair loss. Methods: This study used a cross-sectional design that targeted adult subjects with perceived hair loss in the Jazan region of Saudi Arabia. Data were collected during interviews in selected primary healthcare centers. Data pertaining to the demography, quality of life, and presence of depression in participants were collected. Quality of life was assessed via a modified Arabic version of the Dermatology Life Quality Index (DLQI). The presence of depression was assessed via Patient Health Questionnaire-9 (PHQ-9). A chi-squared test was used to detect statistically significant differences between the levels of quality of life and depression and the measured demographic characteristics. Results: A total of 483 subjects reported having hair loss. The median age of the sample was 30 years. The majority of the respondents were female (74.5%) and had university-level education (71.4%). Only 169 (35%) reported seeking medical advice concerning their hair loss. The effect of hair loss on quality of life score varied between 2 and 29, with a median score of 6. The median depression level was 6, and the level varied between 0 and 27. Gender, education level, seeking medical care due to hair loss, and worsening of hair loss seem to have an impact on quality of life and depression levels (p values < 0.05). Conclusion: Nearly half of the sample experienced a more than moderate impact on their quality of life induced by their perceived hair loss. Additionally, more than half of the sample exhibited moderate or stronger levels of depression. Encouraging subjects with perceived hair loss to seek medical advice concerning their hair loss may result in early identification, appropriate diagnosis, and the use of curative measures, may consequently improving patients' quality of life and preventing depression.
... 24 This population is also at increased risk of centrifugal cicatricial alopecia (CCCA), marked by in ammation and progressive destruction of follicles through scarring. 25,32 Although not life-threatening, treating hair loss is important, as it can have detrimental psychosocial e ects resulting in symptoms of depression 33 and diminished quality of life among both sexes. 7,[34][35][36] While women appear to be a ected more due to societal expectations, 37,38 psychological stress can be more signi cant in younger men as well. ...
Article
Objective: The goal of this study was to assess the perceived efficacy of a standardized nutraceutical to improve hair growth and quality in men and women of various ethnicities with self-perceived hair thinning. Methods: This prospective, single-blind study enrolled healthy men aged 20 to 55 years (n=47) and premenopausal women aged 20 to 45 years (n=51) with self-perceived, mild-to-moderate hair thinning and included African American, Asian, Hispanic Caucasian and Non-Hispanic Caucasian participants. The nutraceutical supplement (Nutrafol® Men or Women Capsules, Nutraceutical Wellness Inc., New York, New York) was taken daily for six months. Subjects were evaluated in the clinic at baseline and Weeks 12 and 24 with two self-assessments at Weeks 4 and 8. Study endpoints were standardized digital imaging and investigator rated assessments. Self-assessment questionnaires rated hair growth, hair satisfaction, and lifestyle factors. Results: Investigator ratings for baseline hair growth, coverage, density, and volume were significant at Weeks 12 and 24 for all subjects (for each, p<0.001). These significant improvements were seen in 83.7 percent of men and 79.5 percent of women at Week 24. Results were similar across ethnic subgroups with significant benefit at Weeks 12 and 24 (for each, p<0.05). All subjects reported significant improvements in baseline hair appearance/quality, volume/fullness, scalp coverage, thickness, and shedding at Weeks 4, 8, 12 and 24 (for each, p<0.01). Conclusion: A standardized nutraceutical supplement improved visible hair growth with less notable shedding based on subjects' and investigators' overall perception of treatment benefit for men and women of various ethnic backgrounds.
... These results clearly suggest that the gender difference in depression risk is not due to the higher prevalence of other risk factors among women, such as low self-esteem, social anxiety, and social avoidance, but rather due to the effect of gender per se. By shedding light on the role of gender in the development of depression among women with alopecia resulting from childhood irradiation for tinea capitis, our results add to earlier reports documenting depression among women with different types of alopecia [32,35,[46][47][48] and higher rates of depression among women with androgenetic alopecia compared to men [24]. A plausible explanation for the important role that gender plays in the development of depression among women with alopecia is that hair symbolizes women's fertility, femininity, sexuality, and attractiveness in society [7,9,10]. ...
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Recent studies have linked hair loss due to childhood irradiation for tinea capitis, a fungal infection of the scalp, to adverse psychosocial and health outcomes in women. However, no study to date has examined gender differences in the outcomes of this type of hair loss. The current study aimed to investigate gender differences in health and psychosocial outcomes of hair loss resulting from childhood irradiation for tinea capitis, and to identify the risk factors associated with depression in both men and women. Medical records held at the archives of the Israel National Center for Compensation of Scalp Ringworm Victims were retrospectively reviewed for 217 women and 105 men who received maximum disability compensation due to severe hair loss resulting from irradiation for tinea capitis. We found that women were at increased risk of developing psychosocial symptoms, including depression. Gender emerged as a significant predictor of depression, distinct from other predictors, such as marital status, age at radiation, exposure to verbal and physical bullying, low self-esteem, social anxiety, and physical health problems. Thus, the psychosocial needs of patients, particularly female patients, who were irradiated for tinea capitis during childhood need to be taken into account by the healthcare professionals treating them.
... It can be associated with psychological features including low self esteem and depression. 1 The three most common causes of hair loss in women are androgenetic alopecia, alopecia areata and telogen effluvium. 2 Androgenetic alopecia is a common form of hair loss. 2 When females are affected, there is diffuse hair loss on mid-scalp, which is known as female pattern hair loss. 2 It primarily occurs due to increased levels and activity of androgens in genetically susceptible individuals. ...
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Introduction: Hair loss is one of the most frequent complaints for which patients see a dermatologist. The three most common causes of hair loss in women are telogen effluvium, alopecia areata and female pattern hair loss. Objectives The aim of this study was to investigate haemoglobin, iron profile and thyroid function tests in women with telogen effluvium, alopecia areata and female pattern hair loss. Materials and Methods: This was a hospital based cross sectional study conducted at the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital (NMCTH). We recruited female patients with telogen effluvium, alopecia areata or female pattern hair loss who presented to our outpatient department between June 2019 and July 2020. Clinical and demographic data were collected and haemoglobin, serum iron profile and thyroid function investigated. Results: A total of 80 patients were recruited in the study period. The most common diagnosis was telogen effluvium (49, 61.25%) followed by alopecia areata (18, 22.5%) and female pattern hair loss (13, 16.25%). Although mean haemoglobin levels were within normal limits, inadequate ferritin levels for normal hair cycle were found in 77.55% of patients with telogen effluvium, 88.89% with alopecia areata and 84.61% with female pattern hair loss. Thyroid abnormalities were less commonly observed with more than 75% of the patients being euthyroid. Conclusion: Haemoglobin levels are not representative of true iron status in females with acquired alopecia. We therefore recommend investigating iron profile in all females with telogen effluvium, alopecia areata or female pattern hair loss.
... Hair loss, or alopecia, is a significant problem that affects nearly 20% of the population. Studies measuring the impact of hair loss on quality of life reveal long-lasting negative effects, including low self-confidence, heightened self-consciousness, and an increased prevalence of depression (Marks et al., 2019;Schmitt, Ribeiro, Souza, Siqueira, & Bebber, 2012;Williamson, Gonzalez, & Finlay, 2001). Follicular unit extraction (FUE), in which individual follicular units are harvested from one region of a patient's scalp and transplanted into a different section of the same patient's scalp, provides a minimally invasive solution for hair transplantation (Rassman et al., 2002). ...
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The promise of human induced pluripotent stem cells (iPSCs) lies in their ability to serve as a starting material for autologous, or patient-specific, stem cell-based therapies. Since the first publications describing the generation of iPSCs from human tissue in 2007, a Phase I/IIa clinical trial testing an autologous iPSC-derived cell therapy has been initiated in the U.S., and several other autologous iPSC-based therapies have advanced through various stages of development. Three single-patient in-human transplants of autologous iPSC-derived cells have taken place worldwide. None of the patients suffered serious adverse events, despite not undergoing immunosuppression. These promising outcomes support the proposed advantage of an autologous approach: a cell therapy product that can engraft without the risk of immune rejection, eliminating the need for immunosuppression and the associated side effects. Despite this advantage, there are currently more allogeneic than autologous iPSC-based cell therapy products in development due to the cost and complexity of scaling out manufacturing for each patient. In this review, we highlight recent progress toward clinical translation of autologous iPSC-based cell therapies. We also highlight technological advancements that would reduce the cost and complexity of autologous iPSC-based cell therapy production, enabling autologous iPSC-based therapies to become a more commonplace treatment modality for patients. © 2021 The Authors.
... With women, the emotional and psychological concerns attributable to hair loss are amplified compared with men, as most have grown used to having good hair density, and the sudden occurrence of diminished density or hair loss can be very disconcerting, leading to decreased quality of life. [1][2][3][4][5][6] Over the past decade, we have seen an increase in younger patients with female pattern hair loss seeking hair restoration, many of whom are in high-stress social or professional situations (e.g., executives, patients undergoing financial difficulties); increased production of adrenal steroids and subsequent conversion to androgens in these patients may be a factor leading to hair loss. ...
Article
Background: Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options. Methods: A retrospective chart review was performed of the senior author's (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss. Results: A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients. Conclusion: Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low. Clinical question/level of evidence: Therapeutic, IV.
Article
Psychosocial implications and effect on the quality of life of individuals due to alopecia are underestimated. This article aims at highlighting its public health ramifications by assessing the quality of life and various factors influencing it. A descriptive cross‐sectional study was conducted among 800 adult patients visiting four dermatological clinics in Mumbai, Delhi, Kolkata and Bangalore. Dermatology Life Quality Index (DLQI) scale and the Hair‐Specific Skindex‐29 (HSS‐29) scale were used. Demographic characteristics affecting alopecia were noted and Hamilton–Norwood and Ludwig's classification was used for baldness classification in males and females respectively. SPSS software analyzed the data. Descriptive analysis through frequency distribution was calculated. χ2 test was computed. Unpaired t‐test compared the responses of males and females. p‐values < 0.05 were considered significant. The mean DQLI score were 14.57 ± 4.15 in females and 13.15 ± 3.18 in males. The mean HSS‐29 score for women (87.81 ± 15. 65) was significantly more than for men (77.81 ± 13. 28). The HSS‐29 index is further categorized into three domains. The “symptom” domain score for women was 19.89 ± 4.13 as opposed to 13.34 ± 2.86 of males. The “function” domain was more in males (34.71 ± 7.31) than females (32.74 ± 3.45). Women (35.18 ± 3.17) scored higher than men (29.76 ± 8. 83) in the “emotion” domain. The psychosocial impact of alopecia was greater in women than men. The mental health relevance and public health concern of alopecia need to be recognized and an inter‐disciplinary approach should be adopted for its resolution. Since women tend to be greatly influenced by pre‐determined beauty standards and outward appearance, alopecia tends to have a greater psychosocial impact on women than men. Alopecia being labeled as a “Cosmetic Concern” affects not only one's physical appearance but also self‐esteem, emotional well‐being, and social acceptability. Alopecia rather than being mainstreamed as a physical health concern should be considered broadly as to including its impact on one's mental health too. Since women tend to be greatly influenced by pre‐determined beauty standards and outward appearance, alopecia tends to have a greater psychosocial impact on women than men. Alopecia being labeled as a “Cosmetic Concern” affects not only one's physical appearance but also self‐esteem, emotional well‐being, and social acceptability. Alopecia rather than being mainstreamed as a physical health concern should be considered broadly as to including its impact on one's mental health too.
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For many years, clinical observations have suggested that there is an intrinsic connection between psychological state and skin diseases. Stress responses are typically mediated by several hormones, which are modulated via the hypothalamic‐pituitary‐adrenal axis. This typical stress response is not only one theory for psychiatry disorder pathophysiology, but it also modifies hair growth by altering the skin's inflammatory environment. Given that different forms of hair loss, such as androgenetic alopecia, alopecia areata, or telogen effluvium, and hair follicle cycling can be altered by immune cells within the follicle milieu, we hypothesized that specific forms of hair loss are correlated to psychiatric illnesses. To address this, we conducted a systematic review by searches in April and May 2021 through Ovid MEDLINE and PUBMED (ranging from 1951 to the present day), identifying 179 reports. A further 24 reports were identified through website and citation searches giving a total of 201 reports. After applying exclusion criteria, 21 papers were reviewed, and 17 were included for data analysis. It is undeniable that hair loss greatly affects Health‐related Quality of Life (HrQol) and it is heavily associated with major depressive disorder and anxiety. The correlation between hair loss and mental health disorders was significant, however, due to the low number of publications with quantitative data we were not able to identify correlations between each hair loss type with each psychiatric disorder. Further studies to better connect specific hair loss diseases to specific disorders are therefore critical in bettering the way both psychiatric disease, and hair loss, are managed. For many years, clinical observations have suggested that there is an intrinsic connection between psychological state and hair disorders. Here, we conducted a systematic review of the literature to assess the relationship between mental health and hair health.
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Androgenetic alopecia is the most common form of hair loss, affecting 85% of men and 40% of women. Androgenetic alopecia is a disease caused by multiple factors, such as genetics, hormones, and systemic diseases; however, the exact cause remains undetermined. Recent studies have found that it is associated with a high incidence of endocrine diseases and other comorbidities. It may not only be a skin disease but also an early signal of underlying systemic diseases. Effective management requires timely diagnosis and treatment initiation. However, in current clinical practice, androgenetic alopecia is still not fully understood or treated. Recognizing the true physical, social, and emotional burden of androgenic alopecia, as well as its associated comorbidities, is the first step in improving the prognosis of affected patients. This review aimed to gather the known pathological factors and provide a reference for clinical physicians to understand androgenetic alopecia and its comorbidities in depth, thereby enabling early recognition of the underlying systemic diseases and providing timely treatment.
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OBJETIVO: Determinar a prevalência dos transtornos depressivo-ansiosos entre mulheres atendidas em um ambulatório de menopausa. METODOLOGIA: Avaliamos, através da entrevista semi-estruturada Mini International Neuropsychiatric Interview, 86 mulheres que encontravam-se em tratamento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. RESULTADOS: A maioria das mulheres apresentava algum diagnóstico psiquiátrico (57%) sendo mais prevalentes o transtorno de ansiedade generalizada (34,9%) e a depressão maior (31,4%). O grupo com algum diagnóstico foi representado por mulheres mais jovens, casadas, com menor escolaridade e história familiar para transtornos psiquiátricos. CONCLUSÃO: Observamos uma grande prevalência de transtornos mentais entre mulheres em atendimento ambulatorial na menopausa em nosso estudo, em relação às mulheres em atendimento em outros ambulatórios segundo a literatura. Há também uma alta taxa de prevalência de comorbidades (55,5% dos pacientes com algum transtorno) complicadoras do transtorno primário, o que pode representar a evolução para pior prognóstico pela ausência de tratamento precoce e específico.
Article
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OBJETIVO: Determinar a prevalência dos transtornos depressivo-ansiosos entre mulheres atendidas em um ambulatório de menopausa. METODOLOGIA: Avaliamos, através da entrevista semi-estruturada Mini International Neuropsychiatric Interview, 86 mulheres que encontravam-se em tratamento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. RESULTADOS: A maioria das mulheres apresentava algum diagnóstico psiquiátrico (57%) sendo mais prevalentes o transtorno de ansiedade generalizada (34,9%) e a depressão maior (31,4%). O grupo com algum diagnóstico foi representado por mulheres mais jovens, casadas, com menor escolaridade e história familiar para transtornos psiquiátricos. CONCLUSÃO: Observamos uma grande prevalência de transtornos mentais entre mulheres em atendimento ambulatorial na menopausa em nosso estudo, em relação às mulheres em atendimento em outros ambulatórios segundo a literatura. Há também uma alta taxa de prevalência de comorbidades (55,5% dos pacientes com algum transtorno) complicadoras do transtorno primário, o que pode representar a evolução para pior prognóstico pela ausência de tratamento precoce e específico.
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OBJETIVO: Verificar se os médicos em geral estão investigando a depressão em idosos. MÉTODOS: Delineamento transversal, de base populacional, incluindo indivíduos com 60 anos ou mais, residentes na zona urbana da cidade de Pelotas (RS). A amostragem foi realizada em múltiplos estágios, tomando como referência os setores censitários do IBGE. RESULTADOS: Foram entrevistados 583 sujeitos (perdas e recusas: 4,7%). Observou-se que 76,6% dos idosos afirmaram que na última consulta o médico não perguntou se eles sentiam-se tristes ou deprimidos. A investigação de depressão foi significativamente maior em indivíduos do sexo feminino e que apresentaram maior média de sintomas depressivos. Entre as mulheres, a prevalência de investigação na última consulta médica foi de 28,7%,enquanto entre os homens o percentual foi de 14,8% (RP=1,93; p<0,001). CONCLUSÃO: Depressão nos idosos é pouco investigada em ambientes clínicos. Sugere-se que os médicos sejam alertados e recebam treinamento adequado no monitoramento de depressão neste grupo etário.
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Corticotropin-releasing factor (CRF) signaling pathways are involved in the stress response, and there is growing evidence supporting hair growth inhibition of murine hair follicle in vivo upon stress exposure. We investigated whether the blockade of CRF receptors influences the development of hair loss in CRF over-expressing (OE)-mice that display phenotypes of Cushing's syndrome and chronic stress, including alopecia. The non-selective CRF receptors antagonist, astressin-B (5 µg/mouse) injected peripherally once a day for 5 days in 4-9 months old CRF-OE alopecic mice induced pigmentation and hair re-growth that was largely retained for over 4 months. In young CRF-OE mice, astressin-B prevented the development of alopecia that occurred in saline-treated mice. Histological examination indicated that alopecic CRF-OE mice had hair follicle atrophy and that astressin-B revived the hair follicle from the telogen to anagen phase. However, astressin-B did not show any effect on the elevated plasma corticosterone levels and the increased weights of adrenal glands and visceral fat in CRF-OE mice. The selective CRF₂ receptor antagonist, astressin₂-B had moderate effect on pigmentation, but not on hair re-growth. The commercial drug for alopecia, minoxidil only showed partial effect on hair re-growth. These data support the existence of a key molecular switching mechanism triggered by blocking peripheral CRF receptors with an antagonist to reset hair growth in a mouse model of alopecia associated with chronic stress.
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OBJETIVO: A depressão é uma condição freqüente e crônica associada a níveis altos de incapacitação funcional. A Associação Médica Brasileira, através de seu projeto "Diretrizes", buscou desenvolver guias para diagnóstico e tratamento das doenças mais comuns. O objetivo deste trabalho é o de apresentar o documento original que serviu de base a uma versão abreviada disponível no endereço eletrônico da Associação Médica Brasileira. MÉTODOS: A metodologia utilizada foi a proposta pela Associação Médica Brasileira para o projeto Diretrizes. Assim, o trabalho foi baseado em diretrizes desenvolvidas em outros países, aliados a artigos de revisão sistemáticos, ensaios clínicos randomizados e na ausência desses, estudos observacionais e recomendações de grupo de experts. RESULTADOS: São apresentados dados referentes à prevalência, demografia, incapacitação, diagnóstico e sub-diagnóstico de depressão. Em relação ao tratamento, são mostrados dados sobre a eficácia do tratamento medicamentoso e psicoterápico das depressões, além do perfil de custos e de efeitos colaterais das diferentes classes de medicamentos disponíveis no Brasil, como o planejamento das diferentes fases do tratamento. CONCLUSÕES: A Diretrizes se propõe a servir de base para uma atitude fundamentada em graus de evidências da literatura, auxiliando na tomada de decisões clínicas.
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Depression is a frequent, recurrent and chronic condition with high levels of functional disability. The Brazilian Medical Association Guidelines project proposed guidelines for diagnosis and treatment of the most common medical disorders. The objective of this paper is to present a review of the Guidelines Published in 2003 incorporating new evidence and recommendations. This review was based on guidelines developed in other countries and systematic reviews, randomized clinical trials and when absent, observational studies and recommendations from experts. The Brazilian Medical Association proposed this methodology for the whole project. The review was developed from new international guidelines published since 2003. The following aspects are presented: prevalence, demographics, disability, diagnostics and sub-diagnosis, efficacy of pharmacological and psychotherapeutic treatment, costs and side-effects of different classes of available drugs in Brazil. Strategies for different phases of treatment are also discussed. The Guidelines are an important tool for clinical decisions and a reference for orientation based on the available evidence in the literature.
Article
BACKGROUND: Although crucial for health policies, there are few data on frequency of skin diseases in Brazil. OBJECTIVES: To generate data on the main dermatologic diagnoses in the country. METHODS: Diagnoses made at outpatient's visits were collected by a sample of dermatologists in their private offices and at 49 residency services, during one week (May 22-26, 2006). A form was filled in with clinical and demographic data, with no patient identification. RESULTS: The main diagnosis was acne accounting for 14% of visits, followed by superficial mycoses (8.7%), pigmentation disorders (8.4%) and actinic keratosis (5.1%). Actinic keratosis was the main reason for consultation in the group aged 65 years and over (17.2%), followed by basal cell carcinoma (9.8%). Leprosy ranked twentieth in the country as a whole and fourth in Central West region. CONCLUSION: The morbidity profile of dermatological outpatient's visits in Brazil is a pattern related to the specialty and not to primary healthcare. The findings stress the relevance of acne, skin cancer and leprosy as public health problems and point out to continuous investment in health education.
Article
Several studies have examined the psychological impact of androgenetic alopecia on men but scientific evidence is absent regarding its effects on women. Our purpose was to determine the psychosocial sequelae of androgenetic alopecia in women and, comparatively, in men. Subjects were newly referred patients with androgenetic alopecia (96 women and 60 men) and 56 female control patients. Subjects completed standardized questionnaires to assess their psychological reactions to their respective conditions and to measure body image, personality, and adjustment. Androgenetic alopecia clearly was a stressful experience for both sexes, but substantially more distressing for women. Relative to control subjects, women with androgenetic alopecia possessed a more negative body image and a pattern of less adaptive functioning. Specific correlates of the adversity of patients' hair-loss experiences were identified. The results confirm the psychologically detrimental effects of androgenetic alopecia, especially on women. The implications for patient care are discussed.
Despite the prevalence of androgenetic alopecia (AGA) and the acceptance of its associated psychological factors in women, few studies have directly queried women about which specific aspects of their lives are affected by hair thinning and the relative importance of such effects. Perceptions of such negative effects can influence patient satisfaction, health-related quality of life (HRQL) and the impetus to seek medical attention for hair loss. Women (n = 120) aged 22-66 years with at least mild (Ludwig I) AGA were recruited from two dermatology clinics and from a large worksite and asked to complete a questionnaire. The questionnaire solicited information about specific aspects of their lives potentially affected by AGA and the relative importance of those aspects. Inability to style their hair, dissatisfaction with their appearance, concern about hair loss continuing, and concern about others noticing their hair loss were most important to women. Emotional aspects also ranked high, including self-consciousness, jealousy, embarrassment, and feeling powerless to stop their hair loss. In summary, women with AGA report numerous ways in which their hair thinning affects their lives. Knowledge of these effects may be beneficial in counseling such patients and in designing clinical trials or epidemiological studies to evaluate hair loss in women.
Article
Androgenetic alopecia is a common dermatological condition, with potentially adverse psychosocial sequelae. The present review critically examines scientific evidence concerning the effects of androgenetic hair loss on social processes and psychological functioning, as well as the psychosocial outcomes of medical treatments. Research confirms a negative but modest effect of visible hair loss on social perceptions. More importantly, androgenetic alopecia is typically experienced as a moderately stressful condition that diminishes body image satisfaction. Deleterious effects on self-esteem and certain facets of psychological adjustment are more apparent among women than men and among treatment-seeking patients. Various 'risk factors' vis-à-vis the psychological adversity of androgenetic alopecia are identified. Medical treatments, i.e. minoxidil and finasteride, appear to have some psychological efficacy. A conceptual model is delineated to explain the psychological effects of hair loss and its treatment. Directions for needed research are discussed. Strategies are presented for the clinical management of psychological issues among these patients.