Introduction

Alopecia is a chronic dermatological disorder in which people lose some or all of the hair on their head and sometimes on their body as well. It is a chronic inflammatory disease that affects the hair follicles. It is neither life threatening nor painful, though there can be irritation of the skin, as well as physical problems resulting from the loss of eyelashes and eyebrows. The aetiology and subsequent development of alopecia is not fully understood, but it is an autoimmune disorder that arises from a combination of genetic and environmental influences.1 We have included alopecia secondary to chemotherapy in the current review as, although there are fundamental aetiological differences, they may share similarities—for example, anxiety arising from the alopecia and the psychological impact relating to identity.

Alopecia has few physically harmful effects, but may lead to psychological consequences, including high levels of anxiety and depression. Medical treatment for the disorder has limited effectiveness, and the failure to find a cure can leave patients very distressed. This article reviews the research into the psychological impact of alopecia.

Sources and selection criteria

We conducted the searches for this clinical review in September 2005 through Ovid, focusing particularly on Medline, PsycINFO, ScienceDirect, the Cochrane Library, and the Web of Science. Searches went as far back as 1980. The main terms used were: alopecia, stress, psychology, treatment, anxiety, depression, and trauma. We also examined the reference lists of articles found. We included all studies that focused on the psychological consequences of alopecia, irrespective of method used. Studies were excluded if they focused on androgenetic alopecia. We included studies relating to hair loss from chemotherapy, as some of the evidence shows that such hair loss can be psychologically damaging beyond the impact of the chemotherapy. We included a total of 34 studies in the analysis (table). …