Alopecia Areata: it is not just hair

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Alopecia areata (AA) is an autoimmune condition,characterised by hair loss that can affect any hair-bearing area,and can manifest with different patterns. Although until recently, AA was considered to be a disease of pure aesthetic concern, recent data support its systemic nature. Hair loss can be a major source of distress for patients and psychiatric and psychosocial comorbidities of AA are well documented.

Low self-esteem, poor self-image, feelings of isolation, anxiety, depression or even suicidal ideation can be present. Psychological issues can be severe at the onset of symptoms or when the condition persists, and are often unrelated to the extent of hair loss. Onset of disease during childhood can have a detrimental effect on mental well being and quality of life of both patients and parents/family.

Various systemic treatments have been used off-label with variable results in the past. In June 2022, baricitinib, an oral selective inhibitor of Janus kinases 1 and 2, was the the first approved FDA systemic treatment for adult patients with severe AA, transforming our practice and patients’ lives. Other new treatments are also in the process of approval at the moment.

Screening for psychiatric and psychosocial comorbidities in patients with AA should be part of everyday practice. Early intervention and a multidisciplinary approach in AA seems to be beneficial for the patients with better outcomes.