Living with alopecia areata: An online qualitative survey study

Abstract

Background

Living with alopecia areata, totalis and universalis (collectively referred to here as AA) involves unpredictable, sometimes rapid hair loss. There is currently no effective treatment and patients describe feelings of shock, loss, trauma and disrupted identity. Cultural meanings attached to hair and hair loss, including associations between hair and femininity, and hair loss and cancer may exacerbate distress. Consequently, wigs and make‐up are frequently used as camouflage, but this can produce feelings of inauthenticity, shame and anxiety.

Objectives

To explore how meanings associated with hair and hair loss influence experiences of living with AA. To identify how this understanding might inform practice by healthcare professionals to best support patients to cope with the condition.

Methods

Ninety‐five participants with AA completed an online qualitative survey about their experiences of living with the condition. Data were subjected to thematic analysis within a critical realist theoretical framework.

Results

Four themes were identified: It's (not) just hair; A restricted life; Abandon hope all ye who lose their hair; and Seeking support in "a highly personal journey".

Conclusions

Findings suggest that negative cultural meanings of hair and hair loss are pervasive and may drive social avoidance and camouflage behaviours in people with AA. Normalising social interactions with healthcare practitioners, significant others and peers were cited as pivotal to positive adjustment. Support groups and online forums were highly valued particularly as few had been offered specialist psychological support. Future research should develop and evaluate psychological support to address the specific challenges of living with AA.

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