While there’s a 2.5 per cent lifetime chance of having alopecia areata, the progression can be unpredictable and cause a lot of stress for patients, according to Dr. Lyn Guenther, professor of dermatology at Western University, during a webinar hosted by Benefits Canada and supported by Pfizer earlier this month.
Alopecia areata is more than a cosmetic condition — it’s an unpredictable autoimmune medical condition with profound negative impacts on emotional, social and mental health, she said.
Five per cent of patients will progress and suddenly lose all of their scalp or body hair. About 33 per cent of patients will develop chronic alopecia areata and, without systemic therapy, more than half will have patches that come and go, said Guenther. “They tend to be extremely stressed because they never know when a new patch is going to happen and sometimes they have a lot of trouble concealing the patches.”
Of the balance, 30 per cent will develop alopecia totalis — complete loss of scalp hair — and 15 per cent will develop alopecia universalis — loss of all body hair. “There are different degrees of hair loss,” said Guenther. “Some people may just have a small patch and some people may lose all their hair.”
The baldness can present in different forms, such as a band around the head, the frontal hairline, eyelashes or eyebrows, while the beard is a very common location in men. Nail changes are also common and may become painful.
People without hair are very susceptible to cold, heat and sunburn, she said. “The loss of eyebrows and eyelashes is not just [a] cosmetic problem; they help prevent dirt, sweat and water from going into your eyes,” said Guenther, noting hair in the nose can help trap things and, as a result, many who don’t have any hair will have a runny nose or be sneezing.
The psychosocial effects of hair loss can be devastating, she added, referring to a survey that found people compared hair loss to bereavement or loss of a limb. “Many of these patients do not feel adequate, they no longer feel appealing” and lack self-esteem and confidence.
According to research, 85 per cent of respondents called coping with alopecia areata a daily challenge, while 62 per cent said it changed their education, career or relationships and 31 per cent ended a relationship due to the condition. In addition, 51 per cent missed school time and 45 per cent missed time from work.
Currently, alopecia areata has no treatment guidelines or approved treatments, noted Guenther, so dermatologists often prescribe off-label treatments with limited success. There’s an unmet need for safe and efficacious treatment and, fortunately, promising medications are in development, she added.
Guenther encouraged plan sponsors to support employees with alopecia areata by monitoring and discouraging workplace bullying or teasing and recognizing that some may choose to wear a wig or a hat to cover up their condition. She also recommended they ensure their benefits plans cover necessary medications and wigs.
Wigs can be expensive and some patients can’t afford them, she added. “Wigs give patients much more self-confidence in the workplace and I think you’re going to get better work, which means the costs of the wig will pay for itself several times over with what it does for the patient.”