Stigmatization caused by hair loss - a systematic literature review

"Hair is your crown and glory" - Black women's experiences of living with alopecia and the role of social support

BACKGROUND

Alopecia is an autoimmune condition that results in hair loss, mainly from the scalp. There are three specific types of autoimmune alopecia: alopecia areata (AA; small patches of hair loss), alopecia totalis (AT; total hair loss from the scalp) and alopecia universalis (AU; total hair loss from the scalp and body). Whilst research has explored the experiences of White women living with alopecia, there is a lack of research exploring the impact of alopecia on women in the Black community. The current study aimed to explore Black women's experience of living with autoimmune types of alopecia with a focus on the cultural importance of hair within the Black community and the impact of social support.

PARTICIPANTS AND PROCEDURE

Seven Black women (age range: 37-68 years; mean age: 51 years) were recruited purposively through alopecia support group organisations and social media to participate in a semi-structured interview; four participants were diagnosed with AA, two participants were diagnosed with AU, and one participant was diagnosed with AT. One-to-one interviews were conducted online, and interpretative phenomenological analysis was used to guide data collection and analysis.

RESULTS

Participants discussed the significance of hair specifically within the Black community and the complex relationship between psychological wellbeing, coping and seeking support.

CONCLUSIONS

This novel area, specific to Black women's psychological experience of alopecia, acknowledges the influence of cultural and ethnic differences. The findings suggest that proactive awareness from health professionals and social support groups are needed due to the nuances of Black women's alopecia experience to provide better support and to enhance the quality of life for Black women to manage their alopecia.

Automatische Körperteil-Identifikation in dermatologischen klinischen Bildern durch maschinelles Lernen

Hintergrund

Dermatologische Erkrankungen sind in allen Bevölkerungsgruppen weit verbreitet. Das betroffene Körperteil ist für ihre Diagnose, Therapie und Forschung von Bedeutung. Die automatische Identifizierung der abgebildeten Körperteile in dermatologischen Krankheitsbildern könnte daher die klinische Versorgung verbessern, indem sie zusätzliche Informationen für klinische Entscheidungsalgorithmen liefert, schwer zu behandelnde Bereiche aufdeckt und die Forschung durch die Identifizierung neuer Krankheitsmuster unterstützt.

Patienten und Methodik

In dieser Studie wurden 6219 annotierte dermatologische Bilder aus unserer klinischen Datenbank verwendet, womit ein neuronales Netz trainiert und validiert wurde. Als Anwendung wurden mit diesem System qualitative Heatmaps für die Verteilung von Körperteilen bei häufigen dermatologischen Erkrankungen erstellt.

Ergebnisse

Der Algorithmus erreichte eine mittlere balancierte Genauigkeit (Accuracy) von 89% (74,8%–96,5%). Die Fotos von nichtmelanozytärem Hautkrebs betrafen vor allem das Gesicht und den Oberkörper, während die größte Häufigkeit der Ekzem‐ und Psoriasis‐Bildverteilung den Oberkörper, die Beine und die Hände umfassten.

Schlussfolgerungen

Die Genauigkeit dieses Systems ist vergleichbar mit den besten bisher veröffentlichten Algorithmen für Bildklassifizierungsaufgaben, was darauf hindeutet, dass dieser Algorithmus die Diagnose, Therapie und Forschung bei dermatologischen Erkrankungen verbessern könnte.

Automatic body part identification in real-world clinical dermatological images using machine learning

BACKGROUND

Dermatological conditions are prevalent across all population sub-groups. The affected body part is of importance to their diagnosis, therapy, and research. The automatic identification of body parts in dermatological clinical pictures could therefore improve clinical care by providing additional information for clinical decision-making algorithms, discovering hard-to-treat areas, and research by identifying new patterns of disease.

PATIENTS AND METHODS

In this study, we used 6,219 labelled dermatological images from our clinical database, which were used to train and validate a convolutional neural network. As a use case, qualitative heatmaps for the body part distribution in common dermatological conditions was generated using this system.

RESULTS

The algorithm reached a mean balanced accuracy of 89% (range 74.8%-96.5%). Non-melanoma skin cancer photos were mostly of the face and torso, while hotspots of eczema and psoriasis image distribution included the torso, legs, and hands.

CONCLUSIONS

The accuracy of this system is comparable to the best to-date published algorithms for image classification challenges, suggesting this algorithm could boost diagnosis, therapy, and research of dermatological conditions.

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

BACKGROUND

Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients.

METHODS

The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap.

RESULTS

The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence.

CONCLUSION

Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction.

LEVEL OF EVIDENCE

Level III, case-control study.

Out-of-Pocket Costs in Alopecia Areata: A Cross-Sectional Study in German-speaking Countries

Alopecia areata is a common skin disease which is associated with psychosocial and financial burden. No curative therapy exists and, hence, affected persons resort to self-financed cosmetic solutions. However, studies on the economic impact of alopecia areata on individuals are limited. To estimate annual individual out-of-pocket costs in persons with alopecia areata, a cross-sectional study using a standardized online questionnaire was performed in Germany, Austria and Switzerland. A total of 346 individuals (95.1% women, mean age: 38.5 ± 11.6 years) with alopecia areata participated between April and August 2020. Mean additional spending on everyday necessities was 1,248€ per person per year, which was significantly influenced by the duration of the illness, the treatment provider, and disease severity. Hair replacement products and cosmetics accounted for the highest monthly costs, followed by costs for physician visits, hospital treatments, and medication. Most participants (n = 255, 73.7%) were currently not undergoing treatment, due to lack of efficacy, side-effects, costs and acceptance of the disease. Sex differences in expenses were observed, with women having higher expenditures. Alopecia areata-related out-of-pocket costs place a considerable financial burden on affected individuals, are higher compared with those of other chronic diseases, and should be considered in economic assessments of the impact of this disease.

Alopecia Areata: Burden of Disease, Approach to Treatment, and Current Unmet Needs

Alopecia areata is an autoimmune hair loss disorder with variations in distribution, duration, and severity. The disease is chronic and often follows an unpredictable course, frequently leading to stress and anxiety for those who suffer from it. Throughout the years more knowledge has been gained regarding pathogenesis, diagnostic tools, impact on quality of life, as well as treatment strategies for alopecia areata. However, challenges in treating and alleviating the burden of disease remain. In this article, we discuss updates regarding the pathogenesis and treatment of alopecia areata and highlight unmet needs of the condition, including a review of limitations of current treatments, accessibility to management strategies, and the need for disease awareness and advocacy.

The impact of stigmatization of psoriasis, atopic dermatitis and mastocytosis in different areas of life-A qualitative interview study

BACKGROUND

Stereotypes and false assumptions about chronic and visible skin diseases can determine the behaviour towards affected individuals and result in stigmatization or discrimination.

OBJECTIVE

The aim of this study was to analyze the perceived disease-related stigmatization of individuals with psoriasis, atopic dermatitis (AD) or mastocytosis. The study also aims to broaden people-centred knowledge of the effects of stigmatization in different areas of life, namely in everyday life, at work, in sports and in relationships.

METHODS

Qualitative in-depth semi-structured interviews were conducted among individuals with either psoriasis, AD or mastocytosis. Participants were recruited via self-help networks and were asked to express their experience of stigmatization in different areas of life. All interviews were audio recorded, transcribed verbatim and evaluated based on Mayring's content analysis.

RESULTS

In total, 24 individuals aged 19-79 years and living in Germany were included in the study-eight for each disease. Stigmatization was experienced in all three diseases in all mentioned areas of life as well as in interaction with medical professionals. Self-exclusion, negative self-perception and negative behaviour of others were the most frequent experiences with stigmatization.

CONCLUSION

Stigmatization, both internal and external, is an important factor contributing to the mental burden of people with chronic skin diseases. More research is needed to gain deeper insight into stigmatization and its psychological burden in various contexts to enhance people-centred care in chronic skin diseases.

The Burden of Disease in Alopecia Areata: Canadian Online Survey of Patients and Caregivers

BACKGROUND

Alopecia areata (AA) is associated with negative impacts on the quality of life (QoL). Data on this impact are lacking for Canadian patients and their caregivers.

OBJECTIVE

This study aims to investigate the burden of AA on Canadian patients and their caregivers.

METHODS

We created 4 online surveys for patients 5-11 years old, 12-17 years old, and ≥18 years old and for caregivers of children (<18 years old) with AA. These were disseminated through the Canadian Alopecia Areata Foundation (CANAAF) website and to dermatologists across Canada.

RESULTS

In total, 115 adult patients (n=100, 87%, female), 14 pediatric patients (n=13, 92.9%, female), and 15 caregivers completed the surveys online. The majority (n=123, 95%) of patients felt uncomfortable or self-conscious about their appearance. Camouflaging hair loss with hats, scarves, and hairpieces was a common practice for 11 (78.6%) pediatric and 84 (73%) adult patients. Avoidance of social situations was reported by 8 (57.1%) pediatric and 75 (65.2%) adult patients. Constant worry about losing the achieved hair growth was a concern for 8 (57.1%) pediatric and 75 (65.2%) adult patients. On a scale of 1-5, the mean score of caregivers' own feelings of sadness or depression about their child's AA was 4.0 (SD 0.9) and of their feelings of guilt or helplessness was 4.2 (SD 1.2). The impact on the QoL was moderate for both children and adults. Based on the Adjustment Disorder New Module-20 (ADNM-20), 71 (61.7%) of 115 patients were at high risk of an adjustment disorder. Abnormal anxiety scores were recorded in 40 (34.8%) patients compared to abnormal depression scores in 20 (17.4%) patients.

CONCLUSIONS

This study confirmed a significant burden of AA on Canadian patients' and caregivers' QoL.

Association between Androgenetic Alopecia and Psychosocial Disease Burden: A Cross-Sectional Survey among Polish Men

A decline in quality of life in men with androgenetic alopecia (AGA) is frequently reported, so we aimed to evaluate the psychosocial burden related to AGA in Polish male patients with AGA. We enrolled 75 adult patients with AGA. The study was conducted in an outpatient dermatology clinic in Poland. Each participant answered 23 dedicated questions about demographic data, history of the disease, and a psychosocial condition. Overall, 38.7% of patients did not notice any impact of AGA on their contact with other people or activity in their free time; 50.7% of patients observed little or no effect on their relationship with their partner; 60% of patients often or sometimes felt embarrassed by their baldness (mainly those aged 18–25 years; p=0.002); 66.7% of patients reported a rather large negative impact on their self-esteem; and 81.3% of patients sometimes experienced stress in everyday life. We conclude that AGA impairs the emotional condition and social functioning of men of all ages, but particularly of younger men. Broader interventions should be planned to allow access to a psychological and psychosocial support, starting treatment at an early stage of the disease, and involving family physicians in the treatment of AGA.

Prevalence of alopecia and its contributing factors among primary healthcare attendees in the Jazan region, Saudi Arabia

Background

Alopecia is a common health condition that can be associated with social and psychological consequences.

Aims

This study aims to estimate the prevalence of hair loss and its associated risk factors among primary healthcare center (PHC) attendees in the Jazan region.

Methods

This investigation was a cross-sectional study conducted in the Jazan region of southwest Saudi Arabia. A total of 23 PHCs were randomly selected from five governorates in the region. Data were collected via interviewing PHCs attendees and were asked about their demographic characteristics, presence of hair loss, and among attendees who confirmed having hair loss, they were further asked about associated clinical features, healthcare-seeking behavior, and factors that might contribute to the development of their condition.

Results

A total of 729 participants consented to be involved in this study. The number of respondents who reported having hair loss was 483, representing 66.3% of the whole sample. Gender appears to have the highest level of variability, with the majority of participants reporting hair loss being female (P < 0.001). The most frequently reported type of hair loss was telogen effluvium, followed by androgenic alopecia. A total of 185 respondents reported taking medications to treat their hair loss, of whom 108 (58.3%) did not seek any medical advice to identify the cause of their condition.

Limitations

The main weakness of this investigation is related to relying on a reported presence of hair loss without having it confirmed with a clinical diagnosis.

Conclusion

A minority of participants who reported suffering from hair loss were further evaluated by healthcare professionals to learn the cause of their hair loss. This may indicate the presence of poor hair care and the probability of a higher risk of hair loss requiring the development of suitable preventive strategies.