Perceived Stress, Illness and Stigma in Patients with Alopecia Areata

Alopecia areata is a nonscarring autoimmune hair loss disorder. Little is known about patients' perceptions of their condition. This French cross-sectional online study primarily aimed to assess patients' perception of stress as a causal factor, with secondary objectives examining illness perception and stigma. Adults aged ≥18 years with a confirmed alopecia areata diagnosis were included. The primary outcome was patients" attribution of stress as a cause of alopecia areata, while secondary outcomes included IPQ-R and PUSHD scores. Among 96 participants, there was a strong female predominance (15.6 : 1) and a high proportion of alopecia totalis (65%). Stress was identified as a cause by 52 patients (54%), and this belief was shared by their dermatologist in 18 cases (35%). Patients reported significant emotional consequences, major life impact and a chronic course. Those attributing alopecia areata to stress showed higher perceived personal control (15.3±4.9 vs. 12.7±4.3; p=0.006). The mean PUSHD score was 18. Poorer perceived consequences and stronger emotional representations correlated with greater stigma (ρ=0.56; ρ=0.59; p<0.05), while lower disease understanding correlated with higher stigma (ρ=-0.34; p<0.05). Integrating educational programmes into routine care may enhance patients with alopecia areata understanding and coping.