PS67 Perceived stress, illness and stigma in patients with alopecia areata

Abstract

Alopecia areata (AA) is a nonscarring autoimmune hair loss disorder. Despite progress in understanding its pathomechanisms, little is known about how patients perceive their condition. The primary aim of this study was to assess the perceived role of stress among patients with AA. Secondary objectives were assessment of illness perception and stigma. This French cross-sectional study was conducted online through social media. Adults aged ≥ 18 years with a confirmed diagnosis of AA using the Auto-Diagnostic Questionnaire for Alopecia Areata, were eligible. The main outcome was patients’ perceptions of stress as a cause in AA. Secondary outcomes included the Revised Illness Perception Questionnaire and Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) scores. Among 96 participants, there was a female predominance and a high rate of alopecia totalis (65%). Stress was identified as a cause by 52 patients (54%). This idea was shared by their dermatologist for 18 (35%) of them. Patients reported a significant perceived impact of AA on their lives, strong emotional consequences and a chronic course. Subgroup analyses revealed that patients attributing AA to stress had higher personal control (mean 15.3, SD 4.9 vs. mean 12.7, SD 4.3; P = 0.006). The mean PUSH-D score was 18 (range 0–59), with recent AA scoring 18.2 and chronic forms (> 10 years) scoring 17.6. Regression analyses revealed a strong correlation between worse perceptions of consequences and emotional representations with stigma (P < 0.001). Additionally, less understanding of the disease showed a significant correlation with increased level of stigma (P < 0.001). Over one-half of patients on social media identified stress as a possible cause of AA. A lesser understanding of AA was associated with a higher level of stigma. Integrating educational programmes focused on pathophysiology and emotional regulation into standard care may benefit patient understanding and management.