Quality of life, psychosocial difficulties and bullying in paediatric patients with alopecia areata: A European cross-sectional study

Abstract

Background Alopecia areata (AA) is a chronic immune-mediated condition leading to nonscarring hair loss. Its visible nature often leads to stigmatization and bullying, which can negatively affect the mental health and quality of life (QoL) of adolescents. Objectives To investigate the experiences of bullying, psychosocial challenges and QoL in adolescents with AA. Methods This cross-sectional study included 417 participants aged between 10 and 17 years, with 156 adolescents diagnosed with AA from 6 European countries and 261 healthy German controls. Data collection involved validated questionnaires. These included the Revised Olweus Bully/Victim Questionnaire for bullying, the Strengths and Difficulties Questionnaire for psychosocial difficulties, and the Pediatric Quality of Life Inventory for QoL. Clinical data, including AA severity score, were also recorded. Statistical analyses employed parametric and nonparametric methods, including multivariate analysis of variance, Mann-Whitney U-tests, t-tests and correlation analyses. Results Adolescents with AA reported significantly higher rates of general and verbal bullying, with hair loss and nail damage commonly identified as reasons for bullying. Girls experienced more emotional distress and bullying, while boys reported better emotional and social QoL. Physical functioning (i.e. limitations in physical activity, pain or low energy) was significantly lower in the AA group, although overall QoL differences were low. Longer disease duration was associated with greater emotional difficulties and reduced school functioning. No association was found with the age of the participant or the severity of the disease. Conclusions Adolescents with AA often face significant challenges, including higher rates of bullying and emotional struggles compared with healthy controls. Developing targeted interventions to combat stigma and support mental and emotional wellbeing of paediatric patients with AA, in addition to a collaborative effort involving dermatologists, psychologists and educators could possibly make a meaningful difference in improving the QoL for these young individuals.