BH29 Psychological distress in alopecia areata: are we doing enough?

Abstract

Alopecia areata (AA) is a chronic autoimmune condition associated with significant psychological morbidity and impaired quality of life. Current BAD guidance recommends routine psychological assessment and appropriate psychosocial support for patients with AA. However, the lack of infrastructure for ancillary psychological services makes implementing these recommendations challenging. A retrospective audit was conducted to evaluate the psychological burden of AA, current documentation of psychosocial assessment and engagement with support services, to identify gaps impacting delivery of guideline-­recommended care. Twenty-five patients with AA attending a secondary care dermatology clinic were included. Data collected included demographics, disease duration and severity (Severity of Alopecia Tool, SALT), comorbidities, mental health history, quality-of-life assessment (Dermatology Life Quality Index, DLQI), mental health screening (Patient Health Questionnaire-9 and General Anxiety Disorder-7) and referrals to psychological or patient support services. The cohort was predominantly female (84%), with 66% demonstrating severe or very severe disease (SALT ≥ 50). Comorbidities were present in 76%, including psychiatric and autoimmune conditions. DLQI was documented in less than half of the patients at baseline. However, they demonstrated predominantly moderate-to-severe quality-of-life impairment, with 33% scoring > 21, indicating persistent psychological distress. Formal mental health screening was recorded in only 16% of patients, and referral to psychological services or support organizations was infrequent. These findings likely underestimate the true psychological burden and perhaps reflect time constraints and structural limitations within routine NHS clinics. This audit confirms the psychological impact of AA and highlights a gap between BAD guideline recommendations and real-world practice. With emerging therapies such as Janus kinase inhibitors showing variable and unpredictable responses, and potential relapse following treatment cessation, robust psychological assessment and support are essential. We propose an integrated care model incorporating routine psychological screening using AA-specific tools, dedicated hair clinic nursing support, psychological referral pathways, and tailored patient information resources to ensure holistic, guideline-aligned care for patients with AA.