Interactions between Posttraumatic Stress Disorder and Alopecia Areata in Child with Trauma Exposure: Two Case Reports

Quality of life in children and adolescents with alopecia areata-A systematic review

Alopecia areata (AA) is an autoimmune-mediated non-scarring hair loss whose stigmatizing effect may have a severe psychosocial impact. AA has been reported to be correlated with bullying, reduced quality of life (QoL) and psychiatric comorbidities. The effect of AA on QoL in adult patients has been systematically reviewed and found to be detrimental. No systematic evaluation of QoL in children with AA has been performed. The aim of this review is to systematically describe QoL in the child and adolescent population affected by AA. A systematic review of multiple databases and grey literature sources was conducted. Search terms included, but were not limited to, alopecia areata and quality of life. Only studies reporting results on health-related QoL in children and adolescents were included. We evaluated the studies regarding the risk of bias, and conceptual rigour concerning the quality of life and performed a descriptive synthesis of findings. Eight studies met the inclusion criteria, encompassing 358 participants with AA and 64 healthy peers. Seven studies were quantitative using four different standardized questionnaires and scores to measure QoL. One study used a qualitative design. All studies described impairment of children and adolescents' QoL by AA. The most consistently affected QoL domain was embarrassment and self-consciousness. Further psychosocial implications of AA included bullying and limiting participation in school or spare time activities. Existing evidence indicates a substantial impact of AA on QoL in children. In daily clinical practice as well as for developing new treatments QoL in paediatric AA plays a critical role. It should be considered a key outcome in clinical research and decision-making.

The impact of perceived stress on the hair follicle: Towards solving a psychoneuroendocrine and neuroimmunological puzzle

While popular belief harbors little doubt that perceived stress can cause hair loss and premature graying, the scientific evidence for this is arguably much thinner. Here, we investigate whether these phenomena are real, and show that the cyclic growth and pigmentation of the hair follicle (HF) provides a tractable model system for dissecting how perceived stress modulates aspects of human physiology. Local production of stress-associated neurohormones and neurotrophins coalesces with neurotransmitters and neuropeptides released from HF-associated sensory and autonomic nerve endings, forming a complex local stress-response system that regulates perifollicular neurogenic inflammation, interacts with the HF microbiome and controls mitochondrial function. This local system integrates into the central stress response systems, allowing the study of systemic stress responses affecting organ function by quantifying stress mediator content of hair. Focusing on selected mediators in this "brain-HF axis" under stress conditions, we distill general principles of HF dysfunction induced by perceived stress.

[Psychodermatology: Foundations for new developments in integrated care]

The burden of a skin disease is easily understood by any observer due to its visibility: psychosocial issues are therefore ubiquitous in dermatology. Current evidence now shows that this relationship is two-way, as psychosocial stress can cause skin disease and its worsening. This interrelationship poses a major challenge.

Psychiatric basics of alopecia areata in pediatric patients: Evaluation of emotion dysregulation, somatization, depression, and anxiety levels

BACKGROUND/OBJECTIVE

Alopecia areata (AA) is a skin disease characterized by sudden-onset hair loss. The relationship between psychiatric status and AA has not been fully elucidated. The aim of this study was to evaluate emotion dysregulation, somatization, depression, and anxiety levels in children and adolescents with AA.

METHODS

The study included 27 patients aged 8-18 years diagnosed with AA, and an age and gender-matched control group consisting of 30 cases without a known chronic medical disease. All individuals were screened for existing psychiatric illnesses by a pediatric psychiatrist through the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (K-SADS-PL). The patients were then evaluated using the Children's Depression Inventory (CDI), Screen for Child Anxiety-Related Emotional Disorders (SCARED), State-Trait Anxiety Inventory for Children (STAI-C), and Children Somatization Inventory (CSI-24). In addition, the patients' parents were asked to complete the Emotion Regulation Checklist-Family Form (ERC).

RESULTS

When comparing the scale scores of the AA and control group, there was a statistically significant difference between the groups in terms of the Emotional Lability/Negativity subscale scores on ERC. K-SADSPL ratios denoted features of at least one psychiatric condition in 62.9% and 16.6% of the AA group and control group, respectively.

CONCLUSIONS

Our results emphasize the importance of psychiatric evaluation in patients with AA. Our study also reveals the need for further studies with a larger sample of AA patients being evaluated in terms of emotion regulation.