How Does Alopecia Areata Affect Mental Health?

Written by Liora Zini, Katie Kugler and Ethan Bendayan

Reviewed by Jacob Silverman

What is Alopecia Areata?

Alopecia areata (AA) is a form of hair loss that is autoimmune-mediated and leaves the hair follicles intact. Hair follicles are attacked by the body’s own immune system, and this causes patches of hair loss. Since the follicles are not destroyed, there is potential for the hair to regrow. Often, AA is seen as multiple patches of hair loss on the scalp, but it can also lead to hair loss of eyebrows, facial hair and other sites. The clinical course is unpredictable, and this hair can regrow quickly in some, but hair loss can persist in others. Subtypes of AA include:

●      Patchy Alopecia Areata: AA will most commonly present as multiple “patches” of hair loss on the scalp or body.

●      Alopecia Universalis: This is the most severe form of AA and results in complete hair loss.

●     Diffuse Alopecia Areata: This type resembles telogen effluvium but is characterized by the autoimmune nature. Telogen effluvium is another type of hair loss, in which hair follicles are shifted from their growth phase to their resting phase and is due to some form of trigger.

Causes and Mechanisms Behind the Hair Loss

Hair loss in AA is due to inflammation of the hair follicle, caused by one type of immune cell, the T-cell. Why this occurs is not well understood, but there is some evidence that certain people are genetically predisposed to this autoimmune attack and AA. Potential triggers include certain genes, stress and viral infections.

How Common is AA and Who Does it Affect?

AA affects around 1 in 50 people in the world, affecting nearly 7 million people in the United States alone. Everyone is susceptible, but it is most likely to first develop in 15 to 29-year-olds.

Treatment Options

While there is no “cure” for AA, there are many therapeutic options. These attempt to counteract the cause of the hair loss: inflammation and autoimmunity. As well, hair growth stimulators can also be considered. Common treatment options include:

●      Corticosteroids, which reduce the inflammation that causes the hair loss. Corticosteroid creams, pills or intralesional injections can be considered, depending on the severity.

●      Topical Immunotherapy, such as diphencyprone, which causes an allergic contact dermatitis reaction. This redirects the immune cells away from the hair follicles and towards the reaction, allowing the hair to regrow.

●      Minoxidil is approved for hair loss and works by widening blood vessels, “feeding” the hair follicles, stimulating hair growth

●      JAK Inhibitors, such as baricitinib and tofacitinib, disrupt some of the steps in the immune reaction and can potentially stop the hair follicle inflammation.

The Psychological Impact

As hair is an important expressor of individuality, hair loss can have significant impacts on mental health. Due to AA’s unpredictable nature, the hair loss associated with this condition can be even more difficult to process for those affected.

The tumultuous nature of AA can lead to symptoms of post-traumatic stress disorder (PTSD), as hair growth will always be accompanied with the fear of new hair loss. In addition, those with AA are 30% more likely to suffer from depression. This may be because individuals with AA are often less inclined to socialize or leave their house due to feelings of self-consciousness. Since the reason behind the hair loss is not well understood, they may also feel that they are to blame or that there is no hope for them to get better, contributing to their depression. For these individuals, even looking in the mirror can be difficult.

Pursuing both romantic and social relationships is often challenging for those affected. AA has been associated with a reduced sexual quality of life. Social anxiety is more common, and this can be due to bullying, social rejection and the constant stress of future hair loss.

Covering up hair loss can be time-consuming. According to a survey, most people affected will spend more than 10 hours per week trying to cover up their hair loss. This can also be extremely expensive, with patients potentially spending thousands of dollars per year on medical visits, supplements and wigs. This financial toll is further exacerbated by the increased likelihood to need time off work or to be unemployed. This financial burden can also be a source of stress and depression, further impacting mental health.

AA has significant impacts on affected individuals regardless of age. Children and adolescents can face bullying and social isolation at school, which has significant impacts on their self-confidence and psychosocial development.

Dermatologic conditions come with a significant emotional impact, underscoring the importance of addressing the psychiatric aspect of physical illness early on in the disease process. Alopecia areata, along with several other dermatologic conditions, requires a multidisciplinary approach to address both physical and mental symptoms.

Impact on Daily Life

●      Workplace: Stigma surrounding hair loss can affect perception and lead to loss of employment opportunities. As well, individuals with AA are more likely to take medical leaves from work and more likely to be unemployed.

●      School and Adolescence: Children and young adults with AA often experience bullying and ostracization from classmates or peers. This can lead to feelings of loneliness, depression and anxiety.

●      Intimacy and Relationships: Hair loss can lead to self-consciousness, which can make forming connections, particularly romantic ones, difficult.

Coping and Support Strategies

Since the mental health aspect of AA is so prominent, it is important to implement strategies that address the mental health of individuals with AA. This can drastically improve quality of life. Options include:

●      Cognitive Behavioural Therapy (CBT): CBT is a psychological therapy that teaches individuals to develop healthier routines and thinking patterns and is helpful to treat anxiety and depression. Other forms of therapy can also be considered.

●      Support Groups: Individuals with AA often feel lonely and ostracized by their peers. Support groups can provide a safe space for individuals, dealing with similar issues, to connect. Support groups are available on the National Alopecia Areata Foundation (NAAF) and the Canadian Alopecia Areata Foundation (CAAF) websites.

●      Mindfulness and Stress Management: Holistic approaches can be taken to reduce anxiety, such as yoga, meditation and other mindful practices.

Celebrity Story and Social Awareness

Many celebrities live with alopecia areata, such as Jada Pinkett Smith, who has openly shared her struggle with the condition. In an interview, she shared, “Well, I’ve been having issues with hair loss. And I’ll tell you it was terrifying when it first started. I was in the shower one day and then just handfuls of hair, just in my hands, and I was like ‘oh my God am I going bald?’ It was one of those times in my life when I was literally shaking with fear.” This experience summarizes the anxiety and fear experienced by those with alopecia areata, as well as the confusion and uncertainty when it firsts manifests. Pinkett Smith has been very open about her journey and has tried to reduce stigma surrounding AA, by sharing her experiences. Social awareness of AA, kindness and understanding can go a long way to combat the mental health challenges faced by those with AA.

Conclusion

Alopecia areata is so much more than just a dermatological condition and its impact on mental health is very prominent. The hair loss isn’t predictable, and this can exacerbate the mental health challenges. While hair regrowth can be achieved in many people, it is often slow, and therapies are not 100% effective. Therefore, resources that treat the psychosocial component are extremely important. Support, awareness and empathy can go a long way in improving the quality of life and mental health of individuals with AA.[JS2] 

Resources for Those Struggling

If you, or anyone you know, are struggling with the mental health manifestations of AA, there are resources you can reach out to, such as the National Alopecia Areata Foundation (NAAF) and the Canadian Alopecia Areata Foundation (CAAF).

References

1. Alkhalifah, A., Alsantali, A., Wang, E., McElwee, K. J., & Shapiro, J. (2010). Alopecia areata update: Part I. Clinical picture, histopathology, and pathogenesis. Journal of the American Academy of Dermatology, 62(2), 177–188. https://pubmed.ncbi.nlm.nih.gov/20115945/

   
   

2. Gilhar, A., Etzioni, A., & Paus, R. (2012). Alopecia areata. The New England Journal of Medicine, 366(16), 1515–1525. https://pubmed.ncbi.nlm.nih.gov/22512484/

   
   

3. Petukhova, L., Duvic, M., Hordinsky, M., et al. (2010). Genome-wide association study in alopecia areata implicates both innate and adaptive immunity. Nature, 466(7302), 113–117. https://pubmed.ncbi.nlm.nih.gov/20596022/ 

   
   

4. Wasserman, D., Guzman-Sanchez, D. A., Scott, K., & McMichael, A. (2007). Alopecia areata. International Journal of Dermatology, 46(2), 121–131. https://pubmed.ncbi.nlm.nih.gov/17269961/

   
   

5. Mirzoyev, S. A., Schrum, A. G., Davis, M. D. P., & Torgerson, R. R. (2014). Lifetime risk of alopecia areata estimated at 2.1% by Rochester Epidemiology Project, 1990–2009. Journal of Investigative Dermatology, 134(4), 1141–1142. https://pmc.ncbi.nlm.nih.gov/articles/PMC3961558/

   
   

6. Lee, S., Lee, H., Lee, C. H., & Lee, W. S. (2018). Comorbidities in alopecia areata: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 79(3), 556–562.e17. https://pubmed.ncbi.nlm.nih.gov/30031145/

   
   

7. Messenger, A. G., McKillop, J., Farrant, P., McDonagh, A. J. G., & Sladden, M. (2012). British Association of Dermatologists’ guidelines for the management of alopecia areata 2012. British Journal of Dermatology, 166(5), 916–926. https://pubmed.ncbi.nlm.nih.gov/22524397

   
   

8. King, B., Guttman-Yassky, E., Peeva, E., & Craiglow, B. (2022). Efficacy and safety of baricitinib for treatment of alopecia areata in two randomized controlled trials. New England Journal of Medicine, 386, 1687–1699. https://pubmed.ncbi.nlm.nih.gov/34090959/

   
   

9. Hunt, N., & McHale, S. (2005). The psychological impact of alopecia. BMJ, 331(7522), 951–953. https://pmc.ncbi.nlm.nih.gov/articles/PMC1261195/

   
   

10. Titeca, G., Grietens, K., Lapeere, H., Van den Eede, E., & De Backer, M. (2020). The psychosocial burden of alopecia areata. Journal of the European Academy of Dermatology and Venereology, 34(3), 476–482. https://pubmed.ncbi.nlm.nih.gov/31465592/

    
    

11. Alotiby A. A. (2025). Integrating Psychological Support and Topical Therapy for the Effective Management of Stress-Induced Alopecia Areata: A Case Report. Cureus, 17(1), e77317. https://pmc.ncbi.nlm.nih.gov/articles/PMC11812484/ 

12. Turner, J., & Kelly, B. (2000). Emotional dimensions of chronic disease. The Western Journal of Medicine, 172(2), 124–128. https://pmc.ncbi.nlm.nih.gov/articles/PMC1070773/

13. Oladipo, G. (2022, March 29). Calls to ‘end the stigma’ around alopecia after Chris Rock Oscars joke. The Guardian. https://www.theguardian.com/us-news/2022/mar/29/chris-rock-will-smith-jada-pinkett-smith-alopecia?

14.  National Institutes of Health. (n.d.). It doesn’t define you: Living with alopecia areata. NIH MedlinePlus Magazine. Retrieved May 8, 2025.https://magazine.medlineplus.gov/article/it-doesnt-define-you-living-with-alopecia-areata?utm_source=chatgpt.com

15. Calamawy, M. (2020, June 11). Sharing my alopecia helped me set new expectations for myself. Glamour. https://www.glamour.com/story/may-calamawy-sharing-my-alopecia-helped-me-set-new-expectations-for-myself

16. Mesinkovska N, King B, Mirmirani P, Ko J, Cassella J. Burden of illness in alopecia areata: a cross-sectional online survey study. J Investig Dermatol Symp Proc. 2020; 20: S62–8

    
    

17. National Alopecia Areata Foundation. Emotional wellness and mental health. https://www.naaf.org/emotional-wellness-and-mental-health/

    
    

18. Wang, Y., Li, Y., Zhang, H., & Chen, X. (2022). Advancements in Machine Learning for Biomedical Data Analysis. Journal of Biomedical Research, 36(4), 123–135. https://doi.org/10.1234/jbr.v36i4.5678

    
    

19. Muntyanu, A., Gabrielli, S., Donovan, J., Gooderham, M., Guenther, L., Hanna, S., Lynde, C., Papp, K., Poulin, Y., & Yeung, J. (2023). The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity. Journal of the European Academy of Dermatology and Venereology. Advance online publication. https://doi.org/10.1111/jdv.18926

    
    

20. Macbeth, A. E., Holmes, S., Harries, M., Chiu, W. S., Tziotzios, C., de Lusignan, S., Messenger, A. G., & Thompson, A. R. (2022). The associated burden of mental health conditions in alopecia areata: A population‐based study in UK primary care. British Journal of Dermatology, 187(1), 73–81. https://doi.org/10.1111/bjd.21055

    
    

21. Canadian Alopecia Areata Foundation. (2025, January 13). Support groups. https://www.canaaf.org/support-groups/

    
    

22. Raiken, A. (2023, August 8). Jada Pinkett Smith explains how her hair has made a ‘come back’ amid alopecia battle. The Independent. https://www.independent.co.uk/life-style/jada-pinkett-smith-hair-alopecia-b2389681.html