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

June 2012
Anais Brasileiros de Dermatologia 87(3):412-7

DOI:10.1590/S0365-05962012000300010

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PubMed

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CC BY-NC 4.0

Authors:

Juliano Vilaverde Schmitt

São Paulo State University

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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.

: Bivariate comparison of the characteristics evaluated according to their association with the complaint of hair loss (n=157)

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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

Camila Ferrari Ribeiro

Fernanda Homem de Mello de Souza

Elisa Beatriz Dalledone Siqueira

Fernanda Regina Lemos Bebber

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.

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

Preceptor, Dermatology Unit, Evangelical Teaching Hospital of Curitiba, Evangelical Medical School of Paraná (HUEC-FEPAR), Curitiba, Paraná, Brazil.

Medical Resident, Dermatology Unit, Evangelical Teaching Hospital of Curitiba, Evangelical Medical School of Paraná (HUEC-FEPAR), Curitiba, Paraná, Brazil.

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.

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

Edition

(ICD-10) depression diagnostic criteria.

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

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.

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.

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.

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-

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.

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.

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.

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.

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-

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.

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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Receptor Antagonist Astressin-B Reverses and Prevents Alopecia in CRF Over-

Expressing Mice. PLoS One. 2011;6:e16377.

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Av. Sete de Setembro, 4713 Batel

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REFERENCES

Formulating, Optimizing and Evaluation of Dutasteride Loaded Insitu-Emulgel for Androgenetic Alopecia

Article

Jun 2024

delivery system, Dutasteride loaded Insitu-emulgel, that enhances the drug's skin penetration and reduces the dosage required to provide the targeted effect. Additionally, it decreases adverse effects and improves patient compliance. Dutasteride is BCS class-II drug with high permeability and lower solubility. Dutasteride is an antiandrogen medication, that reduces the action of androgens on the follicle. These androgens are responsible for androgenic alopecia, i.e. it inhibits the enzyme 5α reductase which is responsible for transforming testosterone into dihydroxy testosterone and markedly suppresses serum DHT levels. Due to the antiandrogenic effects, it is used to treat a variety of dermatological conditions in which androgens, such as testosterone and dihydrotestosterone (DHT), play a role. So, dutasteride used in treatment of alopecia. Insitu-emulgel is more effective than any other topical preparation. The Insitu-emulgel also have the better loading capacity as compared to those of the niosomes and liposomes. Insitu-emulgel is easily removable from skin. Insitu-emulgel give controlled release of hydrophobic drug through skin. For the preparation of dutasteride Insitu-emulgel – Liquid paraffin used as a vehicle, span 20, tween 80 as emulsifier, Propylene glycol used as a penetration enhancer, triethanolamine as a neutralizer and ethanol used as a solvent. Then the emulsion was incorporated into gel base in 1:1 ratio to prepare Insitu-emulgel. Standard graph was drawn for Dutasteride and it was found that the solution shows linearity (R2=0.9987 in Phosphate buffer pH 6.8) and obey Beer‟s - Lambert‟s law with in the range of concentration used (5 μg/ml – 25 μg/ml). The Chemical compatibility study of Dutasteride with excipients was carried out using IR and FTIR Spectrometer. It revealed that there is no interaction between the drug and excipients. Central composite design (Design Expert, version 13, Stat Ease, Inc.) was used to build the formulation research design, and the formulation design was predicted and statistically assessed. The formulation variables of dutasteride loaded Insitu-emulgel containing 2 factors and evaluated at 2 levels. Amount of Liquid paraffin (A, 1 ml2 ml), amount of carbopol 940 (B, 150 mg-250 mg) as independent variables and drug release (R1), viscosity (R2) and drug content(R3) were selected as dependent responses. A total of 13 formulations were designed by the software with 2 centre points. The selected 13 formulations were evaluated for drug release, viscosity and drug content. The drug release was found to be in the range of 49.63% to70.61 %, viscosity was found to bein the range of from 4428 to 4803 cps and drug content was found to be in the range of 97.69% to 99.01%. By setting the criteria in the central composite design, it suggested the Optimized formulations. The design predicted the values of optimized Dutasteride loaded Insitu-emulgel formulation which was then formulated and evaluated and the predicted value was compared with actual value. The optimized Dutasteride loaded Insitu-emulgel formulations was white in colour, free from presence of particles, and showed good homogeneity and consistency with no phase separation. The pH of the optimized Insitu-emulgel was found to be 6.5±0.05 pH, which lies in the normal pH range of the skin (5.5-6.5). Thus, indicating the skin compatibility. The Viscosity and spreadability of Optimized dutasteride Insituemulgel formulation were found to be 4561±3.50 cps and 5.45±0.04 cm respectively, which indicates that the formulation is neither too runny nor too sticky and spread easily over the surface. Drug content in the optimized Insitu-emulgel formulation was determined by UV spectrophotometric method. The drug content was found to be 99.01±0.08%. In vitro Release profile of optimized formulation showed 59.02±0.002% release upto 6 hrs. This confirms that the drug released form the optimized Insitu-emulgel in a controlled manner. Based on the findings, it was determined that the Zero order release kinetics model had the highest correlation coefficient, R 2 (0.9986),and was therefore the model that best fit the optimized dutaste ride loaded Insitu-emulgel. The fact that the value of "n" was calculated to be 0.1658 (0.45 < n < 0.89), suggests that the drug release from the polymeric matrix follows non-Fickian or anomalous transport. A dutasteride loaded Insitu-emulgel was developed for topical use. When compared to other traditional methods of administering topical medications, Insitu-emulgel seems to be a more sophisticated and efficient drug delivery technology. A large number of the formulations' components are extremely safe and stable for topical use. In order to treat androgenetic alopecia, the present study has succeeded in creating a topical Insitu-emulgel that is safe, economical, and efficient. To increase the effectiveness of treatment and patient compliance, more clinical research is being conducted in this area.

Prevalence of Hair Loss and Its Associated Factors among Medical and Paramedical Students of a Tertiary Care Hospital, Chennai.

Article

Full-text available

Nov 2024

Background: Hair plays an important role in a person’s physical health and its loss can be devastating and stressful especially if it occurs at a young age. It is important to differentiate whether Hair loss is physiological or pathological. Aim: To estimate the prevalence of hair loss and its associated factors among medical and paramedical students. Methods: This cross-sectional study was conducted among 276 medical and paramedical students in a tertiary care hospital, in Chennai. Hair pull test and wash test were used for evaluating hair loss. Anthropometric measurements were recorded and PHQ-9 was used to assess depression among students. Results: Although excessive hair loss was reported by a majority (73.6%) of the participants, when evaluated objectively using the hair pull test, only 27% of them have excessive hair loss. The prevalence of excessive hair loss evaluated by the wash test was 33.3% and 23.9% on washing and non-washing days. Among various factors tested for association with excessive hair loss using a hair pull test, a significant association was found with age, study course, depression, active dieting, and use of natural products. Conclusion: Three-fourths of participants self-report excessive hair loss, but when evaluated objectively by hair pull test only 27% have excessive hair loss. Evaluating hair loss by a simple non-invasive method like a hair pull test to differentiate between physiological and pathological shedding can prevent anxiousness among youngsters about their hair loss and help them to seek professional help when needed.

II Consensus of the Brazilian Society of Dermatology for the treatment of alopecia areata

Article

Dec 2024

Epidemiological Investigation of Disease Patterns, Accessibility, and Patient Characteristics Following the Introduction of Dermatology Specialty Clinics Within Primary Care Settings in Qatar

Article

Full-text available

Nov 2024

Introduction Dermatological diseases are commonly presented in primary care settings and are associated with health implications and psychiatric comorbidity, which has a negative impact on the overall quality of life of the patients. The service users’ characteristics and the prevalence of the different types of dermatological diseases are an under-researched area in the state of Qatar. The aim of the study is to investigate the prevalence of commonly presenting dermatological diseases such as diseases of the skin and subcutaneous tissues, dermatitis and eczema, and disorders of skin appendages within primary care settings and highlight patient characteristics accessing dermatological healthcare services at primary healthcare centers within its parent organization Primary Health Care Corporation (PHCC). Methods The study population included in the research was composed of both Qataris and non-Qataris registered at a PHCC health center between 1 January 2017 and 31 December 2020. The demographic and diagnosis data were extracted from the electronic medical records (EMR) for the defined population. A comparison analysis (reported as odds ratio and inverse odds ratio) was conducted to evaluate the frequency and distribution of cases at "Primary Care Dermatology Patients Care Services" before and after the introduction of dermatology specialty clinics services in PHCC. Results A total of 937,553 patients’ data was retrieved for the study registered at a PHCC health center between 1 January 2017 and 31 December 2020. Adults aged 18 to 59 constituted more than two-thirds of the study sample (68.3%, n=640313). The commonly occurring dermatological diseases that were diagnosed during this four-year time period after the introduction of dermatology specialty clinics were namely diseases of the skin and subcutaneous tissue (n=249197, 73%), dermatitis and eczema (n=91653, 27%) and disorders of skin appendages (n=67933, 20%). The probability of having a clinical encounter with neoplasm was increased by 2.17 times after introducing the specialized clinics within PHCC. Conclusion The disease pattern of dermatological diseases and patient characteristics present vital health information to better understand the workload and training needs of Family Physicians working in dermatology specialty clinics and to further improve the quality of service and target high-risk patient sub-groups. The findings of the study can also be utilized for future designing and re-designing of the service, particularly in the context of innovative strategies such as complex care management and patients presenting with co-morbidities including dermatological or cutaneous diseases.

A Prospective, Multi-Center Study to Evaluate the Safety and Efficacy of a Vegan Nutraceutical to Improve Hair Growth and Quality in Females Following a Plant-Based Diet

Article

Aug 2024

Hair thinning affects upwards of 50% of women by age 50, impacting their social-emotional wellbeing. It is a condition now thought to be driven by a multi-factorial etiology, including diet and nutrition. Women following vegan, vegetarian, or other plant-based diets have specific needs for nutrients traditionally sourced from animals, which could affect hair health. To support hair growth and quality in women following a plant-based diet, a novel vegan nutraceutical (Nutrafol Women's Vegan Capsules, Nutraceutical Wellness, Inc., New York, NY) was evaluated for its ability to support hair health. The objectives of this 6-month, multi-site, single-blind prospective clinical study was to evaluate the safety and efficacy of the nutraceutical to improve hair growth and quality in women consuming a plant-based diet. The primary endpoint in this study was an increase in terminal hair count at day 180 compared with baseline, as assessed through phototrichogram analysis. Ninety-five subjects completed the study. Daily intake of the nutraceutical resulted in a significant increase in the number of terminal hairs at day 90 (P<0.01) and day 180 (P<0.01). There was also an increase in total hair counts (P<0.01), the terminal-to-vellus ratio (P<0.01), and a decrease in shedding (P<0.01). Global Investigator Ratings revealed improved hair growth (P<0.00001) and overall quality (P<0.00001). In-person hair strength and brittleness assessments significantly improved as well (P<0.01 for both). A significant proportion of subjects reported improved hair quality, appearance, texture, and volume. Hair problems affecting the quality of life of the subjects were also reported as improved. This study demonstrated significant improvements in hair growth and quality in a plant-based population with a vegan nutraceutical. ClinicalTrials.gov Identifier: NCT05332743. J Drugs Dermatol. 2024;23(8):661-668. doi:10.36849/JDD.8421.

Type D Personality, Stress Levels, and Coping Strategies in Women with Androgenetic Alopecia and Polycystic Ovary Syndrome

Article

Full-text available

Jul 2024
MED SCI MONITOR

Background The study was aimed to determine level of stress and using of coping strategies and frequency of type D personality in women with androgenetic alopecia with polycystic ovary syndrome (PCOS), to correlate personality type with level of stress and coping strategies, and to correlate severity of alopecia with personality type, level of stress, and coping strategies. Material/Methods The study was conducted in 2023 and included 146 Polish women aged 18 to 45 years with androgenetic alopecia and PCOS. A questionnaire containing social-demographic data, gynecological and obstetric history, health history, history of diagnosis, and treatment of PCOS in the past and present. Three standardized questionnaires were used: the Type-D Scale (DS)-14, Perceived Stress Scale (PSS)-10, and Coping Orientation to Problems Experienced (COPE) inventory. Results Type D personality was found in 45% of patients. Most patients perceived high levels of stress (44%) and most frequently used active and supportive strategies, with avoidance strategies being less frequent. Women with type D personality experienced significantly higher levels of stress, used active strategies less often, and used avoidant strategies more often. Stages of androgenetic alopecia did not correlate with type D personality or levels of perceived stress. Conclusions In women with androgenetic alopecia, type D personality is determinative of a high level of perceived stress and more frequent use of dysfunctional coping strategies. The severity of the condition did not correlate with personality type and level of stress, while it was related to certain coping strategies.

Development and validation of a patient‐reported outcome measure for hair loss treatment: The HAIR‐Q

Article

Full-text available

Jul 2024
J Cosmet Dermatol

Background Patient‐reported outcome measures (PROMs) for hair loss focus mainly on Alopecia Areata. We created a PROM (i.e., HAIR‐Q) that is applicable to any hair loss condition. The HAIR‐Q measures satisfaction with hair. Patients/Methods Concept elicitation interviews were conducted and analyzed to develop a draft scale. Content validity was established through multiple rounds of patient and expert input. Psychometric properties of the scale were examined in an online sample (i.e., Prolific) using Rasch measurement theory (RMT) analysis. Test–retest reliability and tests of construct validation were examined. Results Content validity of a 22‐item draft scale was established with input from 11 patients, 12 experts and an online Prolific sample of 59 people who had a variety of hair loss treatments. In the RMT analysis (n = 390), 8 items were dropped. Data for the 14‐item scale fit the Rasch model (χ² = 89.85, df = 70, p = 0.06). All 14 items had ordered thresholds and good item fit. Reliability was high with person separation index and Cronbach alpha values ≥0.91, and intraclass correlation coefficient of 0.94 based on a sample of 97 participants. Higher (better) scores on the scale were associated with having more hair, looking younger than ones' age, satisfaction with hair overall, being less bothered by hair loss, and for those who had a hair loss treatment in the past year, being more satisfied with their hair now than before treatment (p < 0.001). Conclusion The HAIR‐Q evidenced reliability and validity and can be used in research and to inform clinical care to measure satisfaction with hair from the patient perspective.

Consenso sobre tratamento da alopecia areata − Sociedade Brasileira de Dermatologia

Article

Nov 2020

Bicalutamide 25 mg associated with minoxidil 1 mg versus minoxidil 1 mg for female-pattern hair loss: A randomized double-blind clinical trial

Article

Jan 2025

Background Antiandrogenic drugs are often used to treat female pattern hair loss (FPHL) despite limited evidence supporting their use. There is growing interest in bicalutamide for this purpose, but its efficacy in treating FPHL has not been evaluated in clinical trials. Objectives To assess the efficacy of 25 mg/d bicalutamide combined with 1 mg/d minoxidil compared to 1 mg/d minoxidil monotherapy over 24 weeks for FPHL treatment. Methods A randomized, controlled, double-blind clinical trial enrolled 74 participants into 2 groups: bicalutamide 25 mg/d plus minoxidil 1 mg/d or placebo plus minoxidil 1 mg/d for 24 weeks. The primary outcome was the change in total hair density in the target area. Result Sixty-four (86.5%) participants completed the study (32 per group). There was a mean increase of 18.1 hairs/cm² in the bicalutamide-minoxidil group and 21.5 hairs/cm² in the minoxidil group (P = .86). According to the global consensus analysis of clinical photographs, there was no difference in clinical improvement between the groups (P = .78). Limitations Single-center study and short follow-up period (24 weeks). Conclusion Bicalutamide 25 mg/d combined with minoxidil 1 mg/d did not provide additional improvement in FPHL treatment compared to minoxidil alone after 24 weeks.

Global Prevalence of Anxiety, Depression, and Stress Among Patients with Skin Diseases: A Systematic Review and Meta-analysis

Article

Full-text available

Jun 2024
J Primary Prevent

The changes in human lifestyle over the past few decades have impacted the prevalence of skin diseases within different societies. Skin diseases may result in various physical and mental disorders. The most common mental disorders observed among the patients are stress, anxiety, and depression. This study aims to investigate the global prevalence of anxiety, depression, and stress in patients with skin diseases. In this Systematic Review and Meta-Analysis study, the PubMed, Scopus, Science Direct, Embase, Web of science, and Google Scholar repositories were searched without a lower time limit. Heterogeneity among the identified studies was examined using the I² index, and accordingly random effects model was adopted for analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v. 2). In total, 113 studies were included for the final analysis. The overall pooled prevalence of stress, depression, and anxiety in skin disease patients was found to be 39.4%, 27.2% and 28.8%, respectively. Among patients with psoriasis, acne, vitiligo or atopic dermatitis diseases, the highest number of patients suffering from stress was related to patients with acne (75.7%). The highest prevalence of depression, and anxiety was reported in patients with vitiligo (38.3%) and acne (36.5%), respectively. Considering the high prevalence of mental disorders among patients with skin diseases and recognising the impacts of mental health challenges on patients’ well-being, the findings of this study provide valuable insights for identifying specific populations that require targeted interventions for the diagnosis, treatment, and prevention of mental illnesses. Accordingly, healthcare policymakers should incorporate psychological treatment and support measures as integral components of comprehensive care strategies for patients with skin diseases.

Prevalence of depressive and anxiety disorders in a Brazilian outpatient sample of menopausal women

Article

Full-text available

Aug 2006

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.

Prevalência de transtornos depressivos e ansiosos em uma amostra ambulatorial brasileira de mulheres na menopausa

Article

Full-text available

Aug 2006

Depressão na população idosa: os médicos estão investigando?

Article

Full-text available

Sep 2004

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.

CRF Receptor Antagonist Astressin-B Reverses and Prevents Alopecia in CRF Over-Expressing Mice

Article

Full-text available

Feb 2011
PLOS ONE

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.

Revisão das diretrizes da Associação Médica Brasileira para o tratamento da depressão (Versão integral)

Article

Full-text available

Jun 2003

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.

[Review of the guidelines of the Brazilian Medical Association for the treatment of depression (Complete version)]

Article

Full-text available

Jun 2009

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.

Nosologic profile of dermatologic visits in Brazil

Article

Nov 2006

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.

Psychological effects of androgenetic alopecia on women: Comparisons with balding men and with female control subjects

Article

Nov 1993
J AM ACAD DERMATOL

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.

Patient-Perceived Importance of Negative Effects of Androgenetic Alopecia in Women

Article

Nov 1999
J Wom Health Gend Base Med

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.

The psychosocial consequences of androgenetic alopecia: A review of the research literature

Article

Oct 1999

Thomas Cash

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.