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. 2025 May 8:1-7.
doi: 10.1159/000546216. Online ahead of print.

The Relationship between Stigma and Healthcare Interaction in Alopecia Areata

Ursula Biba  1   2 , Samantha Gregoire  1   3 , Katherine Sanchez  1   4 , Natasha Atanaskova Mesinkovska  5   6 , Monique Margaret Waldman  5   7 , Lisa Anderson  5 , Arash Mostaghimi  1
Affiliations

The Relationship between Stigma and Healthcare Interaction in Alopecia Areata

Ursula Biba et al. Skin Appendage Disord. .

Abstract

Introduction: People with alopecia areata (AA) experience stigma, but little is known about how this affects healthcare interaction (HCI). We aim to explore the relationship between stigma and HCI in AA.

Methods: A cross-sectional survey of 500 members of the National Alopecia Areata Foundation was performed. Survey items related to stigma and HCI were summed and sorted into low, medium, and high tertiles. Multinomial logistic regressions were performed to control for demographic and clinical factors.

Results: Respondents (n = 500) were white (80.0%), female (86.2%), and insured (96.0%), with a plurality earning over USD 100,000 annually (34.2%). Participants in the high-stigma subgroup were more likely to be in the low-HCI subgroup (relative risk ratio [RRR]: 2.22; 95% CI: 1.31-3.76; p = 0.003), in comparison to participants in the low- or moderate-stigma subgroups (RRR for both: 0.45; p < 0.05). This relationship was independent of demographics and clinical characteristics. However, data are from a population with limited socioeconomic diversity and high baseline healthcare engagement.

Conclusion: People with AA who experience high stigma are less likely to interact with the healthcare system, which cannot be explained by demographics or clinical factors. Stigma and HCI may be related in a dose-dependent manner, and future investigation is needed to support access to care.

Keywords: Access; Alopecia; Alopecia areata; Clinical dermatology; Dermatology; Disparity; Equity; Female alopecia; Hair; Hair disease; Hair disorder; Hair loss; Health services research; Non-scarring alopecia; Stigma.

Plain language summary

Alopecia areata (AA) is an autoimmune disease that causes unpredictable hair loss in 2% of people worldwide. It can be challenging to live with AA because of its emotional impacts, with negative effects on self-confidence and quality of life being common. People with AA also often experience stigma, which becomes more severe as hair loss becomes more severe. To explore how stigma affects how often people with AA interact with healthcare system, we analyzed responses from a survey completed by 500 participants. Participants who experienced the most stigma were twice less likely to seek medical care. They were also more likely to have severe AA, anxiety, and depression. This relationship was seen across different races and economic backgrounds. These results suggest that stigma plays a large role in the care-seeking behaviors of people with AA, which may prevent them from accessing the medications and support needed to treat and manage the condition. This study highlights the need for interventions that address stigma as a barrier to care and support patients with AA in accessing comprehensive healthcare.

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Conflict of interest statement

A.M. has received consulting fees from AbbVie, ACOM Health, Bioniz, Boehringer Ingelheim, Concert, Digital Diagnostics, Eli Lilly, Equillium, Hims & Hers Health, and Pfizer; equity from ACOM Health, Figure 1, and Hims & Hers Health; licensing/royalties from Concert and Pfizer; and research funding from Aclaris, Concert, Eli Lilly, and Incyte. Other authors have no conflicts of interest to disclose.

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References

    1. Trüeb RM, Dias MFRG. Alopecia areata: a comprehensive review of pathogenesis and management. Clin Rev Allergy Immunol. 2018;54(1):68–87. - PubMed
    1. Mesinkovska N, Craiglow B, Ball SG, Morrow P, Smith SG, Pierce E, et al. . The invisible impact of a visible disease: psychosocial impact of alopecia areata. Dermatol Ther. 2023;13(7):1503–15. - PMC - PubMed
    1. Gandhi K, Shy ME, Ray M, Fridman M, Vaghela S, Mostaghimi A. The association of alopecia areata-related emotional symptoms with work productivity and daily activity among patients with alopecia areata. Dermatol Ther. 2023;13(1):285–98. - PMC - PubMed
    1. Mostaghimi A, Napatalung L, Sikirica V, Winnette R, Xenakis J, Zwillich SH, et al. . Patient perspectives of the social, emotional and functional impact of alopecia areata: a systematic literature review. Dermatol Ther. 2021;11(3):867–83. - PMC - PubMed
    1. 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(1):S62–8. - PubMed