Acta Dermato-Venereologica 99-2CompleteContent | Page 29

236 SHORT COMMUNICATION Large-scale Retrospective Cohort Study of Psychological Stress in Patients with Alopecia Areata According to the Frequency of Intralesional Steroid Injection Shinwon HWANG 1# , Jaeyong SHIN 2# , Tae-Gyun KIM 1 , Do-Young KIM 1 and Sang Ho OH 1 * 1 Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, 50 Yonsei- ro, Seodaemun-gu, Seoul 03722, and 2 Institute of Health Services Research, Department of Preventive Medicine, Graduate School of Public Health, Yonsei University, Seoul, Korea. E-mail: [email protected] # These authors contributed equally to this study. Accepted Nov 1, 2018; E-published Nov 5, 2018 Alopecia areata (AA) is a non-scarring alopecia resulting from an immune response against hair follicles. It occurs equally in both sexes and can affect every age group. AA is a chronic disease that can negatively affect a patient’s mental health due to its relapsing nature and effect on appearance. Previous cross-sectional, case-control stu- dies have demonstrated a relationship between AA and psychological stress (1–5). Among multiple therapeutic approaches, intralesional injection (ILI) of corticoste- roids is most widely used for treating alopecic patches of AA, but this invasive procedure usually reflects disease severity and chronicity and is accompanied by painful discomfort. There is currently a lack of evidence from a large-scale population-based cohort study to directly examine the presence of psychological stress in patients with AA ac- cording to the invasive therapeutic modalities used. In this study, psychiatric appointments and the burden of AA were analysed in patients with AA using Korea National Health Insurance Cohort Data (NHICD) from 2002 to 2013. In addition, the study evaluated the association between psychiatric appointments and other factors, such as type of AA and treatment modalities. in patients with AA than in the non-AA group. Patients with AA had higher rate of psychiatric visits compared with controls (2,862.5 vs. 853.7 cases/100,000 person- years). The demographic findings of enrolled participants were investigated based on psychiatric visits (Table SII 1 ). The multivariate analyses of all patients were analysed with basic demographic data, including age, sex, income, type of disease and treatment modality. The tendency for visits to psychiatrists was significantly higher in patients with AA compared with the control group (HR 1.64, 95% CI 1.45–1.86) (Table SIII 1 ). Moreover, compared with non-AA controls, the adjusted HRs for psychiatric visits were significantly increased according to the number of ILI treatments (Table I, ILI=1 vs. ILI=2 vs. ILI≥3; HR 1.54, 95% CI 1.09–2.03 vs. HR=2.09, 95% CI 1.31–2.02 vs. HR 1.57, 95% CI 1.22–2.03, respectively). Patients with alopecia totalis or universalis showed an increased adjusted HR for psychiatric clinic visits compared with patients with localized AA; however, this was not sta- tistically significant (HR 1.41, 95% CI 0.90–2.20). The psychiatric visit risk for patients who used oral steroids did not differ from that of control groups (HR 1.08, 95% CI 0.76–1.53). MATERIAL AND METHODS DISCUSSION From a cohort of subjects younger than 20 years, participants who had been newly diagnosed with AA during the study period were included as the AA group, and those who had never been diagno- sed with AA during the same period were included as the control group. Since the study aimed to explore only those patients with new onset of AA, subjects with a history of AA and psychiatric appointments were excluded. The adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for visits to a psychiatrist were estimated by applying a Cox proportional-hazard regression (see Appendix S1 1 for details). Hair is an important part of our appearance, and hair loss can drastically affect self-esteem and social re- lationships. A positive correlation between AA and psychiatric appointments has been confirmed through Minnesota Multiphasic Personality Inventory, surveys and questionnaires (6–8). However, most of these studies RESULTS Alopecia areata Localized Totalis or universalis Oral steroids No Yes Intralesional steroid injection No alopecia areata 0 1 2 3 or more This study included 370,019 subjects, including 4,707 patients with AA (1.3%) and 23,943 patients who had visited the psychiatric clinic at least once during the follow-up period (Table SI 1 ). The ratio of patients visiting a psychiatric clinic was approximately 1.6 times higher https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3079 1 doi: 10.2340/00015555-3079 Acta Derm Venereol 2019; 99: 236–237 Table I. Adjusted hazard ratios (HR) for outpatient visits to psychiatrists by type of disease and treatment modality HR 95% CI p-value 1.00 1.41 0.90–2.20 0.130 1.00 1.08 0.76–1.53 0.686 1.00 1.663 1.540 2.089 1.573 1.372–2.016 1.131–2.098 1.464–2.979 1.221–2.028 < 0.0001 0.0062 < 0.0001 0.0005 CI: confidence interval. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.