Mortality Associated With Self-Harm, Psychiatric Diseases Higher in Patients With Alopecia Areata

Alopecia Areata

Hair changes are another common finding in patients with thyroid disorders. In patients with hypothyroidism, hair can become thin, dry, coarse, and brittle, often resulting in accelerated hair loss.10 Patients also have a longer duration and higher percentage of hairs in the telogen phase, the resting phase after the hair has fallen out and during which the follicle remains inactive before a new hair growth cycle begins, further contributing to diffuse or partial (pictured) alopecia of the scalp. There may also be loss of hair on the outer third of the eyebrow and diminished body hair. As with nail changes in these patients, there is a higher risk of fungal infection, with Candida folliculitis sometimes reported.3

Patients with hyperthyroidism often have fine or soft hair.3 Loss of pigment or premature development of gray hair have also been reported as early symptoms.4 As with hypothyroidism, patients may have partial or diffuse alopecia. Image credit: Dr P. Marazzi / Science Source

A number of risk factors contribute to the higher mortality rate found in patients with alopecia areata.

A study found that patients with alopecia areata (AA) have a higher risk for mortality attributable to self-harm, psychiatric disease, and smoking compared with individuals without the disorder. Risk factors associated with higher mortality attributed to these factors included being ≤35 years of age and having alopecia totalis/universalis. Findings from the study were published in JAMA Dermatology.

The retrospective study relied on data from the National Health Insurance Service database and the National Death Registry of Korea. Data were collected from 2006 through 2016, with a focus on mortality outcomes in people with AA (n=73,107) and without AA (n=731,070). People with AA were identified by ≥3 documented visits to a dermatologist and an International Statistical Classification of Diseases (tenth revision) code of L63. The researchers compared mortality outcomes as well as risk factors for mortality in 1:10 age- and sex-matched controls without a documented dermatologic visit and without an L63 code.

Overall, there was no difference in the all-cause mortality risk between the 2 cohorts (hazard ratio [HR], 0.97; 95% CI, 0.87-1.09). Despite this finding, the researchers discovered a higher rate of mortality associated with intentional self-harm/psychiatric diseases in the AA group compared with the control group (HR, 1.21; 95% CI, 1.04-1.41). Risk factors associated with higher mortality attributable to self-harm and psychiatric diseases included being ≤35 years of age (HR, 1.68; 95% CI, 1.32-2.12) and having an alopecia totalis/universalis diagnosis (HR, 1.85; 95% CI, 1.25-2.75). Patients with alopecia totalis/universalis also had higher mortality associated with lung cancer (HR, 2.16; 95% CI, 1.41-3.33). Conversely, diabetes-associated mortality was lower in patients with AA (HR, 0.53; 95% CI, 0.36-0.79).

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Limitations of the study include its retrospective nature and the reliance on a database, which may have resulted in misclassification bias.

To reduce self-harm and other risk factors for mortality in people with AA, the researchers encourage clinicians “to provide more appropriate treatment for unmet needs, including psychological interventions, in addition to providing therapeutic regimens for hair regrowth.”

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Lee S, Lee YB, Kim BJ, Bae S, Lee WS. All-cause and cause-specific mortality risks associated with alopecia areata: a Korean nationwide population-based study [published online May 29, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.0629