The prevalence and magnitude of stigmatizing attitudes toward individuals with alopecia were described through results from a study published in JAMA Dermatology. In a survey administered to the general US population, it was found that stigma toward individuals with alopecia was common and increased with the degree of hair loss.

Although self-perceived stigma among patients with alopecia is well documented, the attitudes of unaffected individuals are largely unexplored. To inform this gap, investigators administered an online survey to a convenience sample of US adults who did not have alopecia. The survey was made available on an online crowdsourcing platform from January 9 to 10, 2020.

The survey randomly displayed 1 of 18 computer-generated portraits of individuals of different races, sexes, and degrees of hair loss. Images were generated by manipulating portrait stock photographs of 2 White men, 2 White women, 1 Black man, and 1 Black woman to depict people with either no hair loss, scalp hair loss only, or total hair loss.


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Respondents’ opinions and attitudes toward each portrait were captured using a battery of tests grouped into 3 domains: stereotypes, social distance, and disease-related myths. To assess stereotyping attitudes, respondents were asked to select 1 adjective from 6 pairs of opposing adjectives to describe the individual pictured. Individuals were then asked to rate on a 5-point scale their comfort regarding being in various social situations with the pictured individual. Higher scores indicated less stigma.

Respondents were asked whether they believed the pictured individual had a medical condition. If respondents answered yes, they were given additional questions assessing their agreement with common myths about alopecia. Descriptive statistics were used to summarize stigma towards individuals with hair loss.

Data from 2015 completed surveys were included in analyses. Respondents had a mean age of 37±12 years; 50.3% were men; and most were White (79.2%) and/or non-Hispanic (85.8%). The majority were currently employed (81.1%) and had a college or higher level of education (69.3%).

A significant percentage of respondents had either never heard of alopecia areata (45.8%) or had heard of it but were unfamiliar with the specifics of the disorder (34.9%).

The percentage of respondents endorsing each individual stereotype or social distance item increased as alopecia severity increased. Between the unaltered and total hair loss versions of each portrait, the percentage of participants endorsing the adjectives “sick” and “unattractive” increased by 27.6% and 16.5%, respectively. Similarly, the percentage of those disagreeing with the statements “I would find the person in this photo attractive” and “I wouldn’t mind having physical contact with the person in this photo” increased by 18.3% and 6.9%, respectively.

The adjusted absolute change on the social distance scale was +0.2 between the unaltered and total hair loss photo versions for all race and sex categories, excluding the Black man pictured. For the Black man, the absolute change was +0.5, suggesting that stigmatizing attitudes towards hair loss may be more pronounced for Black men who are affected.

Increased alopecia severity was associated with increased likelihood of the belief that the individual pictured had a medical condition. However, the adjusted percent change varied depending on which individual was shown (P <.001). If the portrait was of a Black woman, the percentage of respondents endorsing a medical disorder increased just 33.6% between the unaltered and total hair loss versions (95% CI, 23.7% to 43.6%). For the White man sets, however, the percentage believing the pictured individual had a medical condition increased by 75.7% (95% CI, 69.8% to 81.8%).

For respondents who answered “yes” to the medical condition question, agreement with disease-related myths decreased with disease severity. From this result, investigators hypothesized that recognition of alopecia as a medical disorder may reduce stigma in some respects.

Per these data, stigmatizing attitudes toward people with alopecia are highly prevalent among laypeople and increase with greater degree of hair loss.

Study limitations include the use of a convenience sample; a larger and more diverse sample may have responded differently to portraits overall. Further study is needed to better examine stigma against people with alopecia in the general population.

“This cross-sectional survey study found that stigmatizing attitudes of laypersons toward patients with alopecia exist across a multitude of social and professional scenarios,” investigators wrote. “Stigma prevalence and magnitude vary by alopecia severity and possibly by whether alopecia is believed to be a medical condition.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Creadore A, Manjaly P, Li SJ, et al. Evaluation of stigma toward individuals with alopecia. JAMA Dermatol. 2021;157(4):392-398. doi:10.1001/jamadermatol.2020.5732