© Borgis - Postępy Nauk Medycznych 3/2015, s. 181-185
*Martyna Zbiciak-Nylec1, Dominika Wcisło-Dziadecka2, Ligia Brzezińska-Wcisło3, Michał Smyła4, Bartosz Miziołek1, Anna Michalska-Bańkowska1
Siła stereotypów. Wnioski z pilotażowego badania dotyczącego aspektów psychospołecznych oraz jakości życia wśród pacjentów z łysieniem androgenowym
The power of stereotypes. Findings of a pilot study on the psychosocial aspects and quality of life among patients with androgenetic alopecia
1Andrzej Mielęcki Silesian Independent Public Clinical Hospital in Katowice, Department of Dermatology
Head of Department: prof. Ligia Brzezińska-Wcisło, MD, PhD
2School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Department of Skin Structural Studies
Head of Department: Associate Professor of Biology Krzysztof Jasik, PhD
3School of Medicine in Katowice, Medical University of Silesia in Katowice, Department of Dermatology
Head of Department: prof. Ligia Brzezińska-Wcisło, MD, PhD
4Association by the Department of Dermatology, Silesian Medical University in Katowice
Tutor of Association: Dominika Wcisło-Dziadecka, MD, PhD
Streszczenie
Wstęp. Łysienie jest to zaburzenie równowagi między wzrostem włosów a ich utratą, charakteryzujące się nadmiernym wypadaniem włosów. Patogeneza łysienia typu męskiego jest bardzo złożona. Żyjemy w kulturze, która premiuje atrakcyjność fizyczną, a włosy uważane są za atrybut piękna, sukcesu i siły. W tym kontekście zmiany w wyglądzie mogą mieć negatywne skutki społeczne. Do tej pory przeprowadzono niewiele badań w zakresie aspektów psychospołecznych i jakości życia u mężczyzn cierpiących na łysienie androgenowe.
Cel pracy. Celem pracy było przedstawienie wyników badania: „Oceny jakości życia u pacjentów z łysieniem androgenowym” przeprowadzonego w oparciu o zmodyfikowany kwestionariusz DLQI.
Materiał i metody. Grupę badaną stanowili mężczyźni prezentujący wyraźne objawy łysienia. Grupę kontrolną reprezentowały osoby z prawidłowym owłosieniem. Każdy z mężczyzn został poproszony o wypełnienie ankiety. Dokonano analizy statystycznej uzyskanych wyników.
Wyniki. Wśród badanych mężczyzn pierwsze objawy łysienia wystąpiły średnio w 22. roku życia. Zaobserwowano, że mężczyźni z grupy badanej byli narażeni na większy stres w porównaniu z mężczyznami z grupy kontrolnej. Wśród mężczyzn z łysieniem androgenowym istotnie częściej niż u osób z prawidłowym owłosieniem stwierdzono obniżenie jakości życia w przypadku wszystkich analizowanych aspektów, z wyjątkiem niemożliwości uprawiania sportu oraz wykonywania pracy. Łysienie miało istotny wpływ na wycofywanie się z kontaktów towarzyskich.
Wnioski. Łysienie androgenowe może wywierać niekorzystny wpływ na obraz własnej osoby oraz jakość życia (ang. quality of live – QOL). Według naszych badań łysienie dotyka głównie młodych mężczyzn, co przy braku dojrzałości psychicznej może ostatecznie znacząco wpłynąć na ich samoocenę oraz jakość życia. W związku z przedstawionymi wynikami można wnioskować, iż wraz z wiekiem łysienie ma coraz mniejszy wpływ na obniżenie jakości życia ocenianej w zakresie kwestionariusza DLQI. Mimo iż łysienie nie jest chorobą zagrażającą życiu, może znacznie pogorszyć jego jakość.
Summary
Introduction. Alopecia is an imbalance between hair growth and hair loss, characterised by excessive hair loss. The pathogenesis of male pattern alopecia is very complex. We live in a culture that rewards physical attractiveness, where hair is considered an attribute of beauty, success and strength. In this context, changes in appearance can have negative social consequences. Until now, there has been little research on the psychosocial aspects and the quality of life in men suffering from androgenetic alopecia.
Aim. The aim of the study was to present results of the Evaluation of the quality of life in patients with androgenetic alopecia study, conducted on the basis of a modified DLQI questionnaire.
Material and methods. The study group consisted men presenting clear symptoms of alopecia. The control group consisted people with no evidence of alopecia. Each patient was asked to complete the questionnaire. Statistical analysis was performed.
Results. The first signs of balding among the respondents were on average at 22 years of age. It was observed that the men in the study group were exposed to significantly higher levels of stress compared to the men in the control group. Decreased quality of life was significantly more frequent among men with androgenetic alopecia compared to men with normal hair in all aspects except for difficulty doing sports and working.
Conclusions. Androgenetic alopecia can have a negative impact on self-image and quality of life (QoL). According to our research, alopecia affects mostly young men, which, in conjunction with psychological immaturity, may ultimately have a significant impact on their self-esteem and quality of life. On the basis of the presented results, it can be concluded that the negative impact of alopecia on the quality of life of patients, assessed by the DLQI questionnaire, decreases with age. Although alopecia is not a life threatening disease, it may significantly impair its quality.
INTRODUCTION
There comes a day in most men’s lives when they look at their fathers’ shiny heads and start to become anxious. These concerns are fully justified, as the problem of alopecia affects a growing number of people in different age groups. Literature reports indicate that male pattern alopecia can have a significant impact on the quality of life of patients and can be strongly associated with very serious psychological problems (1, 2). Balding men are perceived as less attractive in the physical, social and personality sense. Given this stereotype, it is not surprising that some patients with androgenetic alopecia seem to have lower self esteem, be depressed and more introverted. We live in a culture that rewards physical attractiveness, where hair is considered an attribute of beauty, success and strength. In this context, changes in appearance can have negative social consequences. Until now, there has been little research on the psychosocial aspects and the quality of life in men suffering from androgenetic alopecia. It is not clear whether alopecia is the cause of low self-esteem, depression, introversion and feeling unattractive among patients, or if there are other causative factors prior to hair loss (2).
Alopecia is an imbalance between hair growth and hair loss, characterised by excessive hair loss. The pathogenesis of male pattern alopecia is very complex. Dihydrotestosterone (DHT) plays a very important role in the mechanism of androgenetic alopecia. Based on several scientific publications, it appears that genetic sensitivity of hair follicles to DHT is the most important factor in the pathogenesis of this disease. It is DHT that is the main culprit for receding hairline and thinning of hair on the top of the head (3-6). Among men with androgenetic alopecia, DHT causes miniaturisation of hair follicles and production of gradually weaker hairs (called vellus hair) instead of long, well-colored hairs. This is not only due to a decrease in hair density, but also due to a reduction in thickness of the hair shaft (7, 8). This mechanism is the result of complex biochemical processes occurring in the follicles, in particular the effect of DHT on the production of new hairs in their growth cycle.
Among many other factors affecting hair loss (such as endocrine disorders, fever, stress, cancer), drug use should also be considered. Knowledge among doctors on the pathogenesis of the disease is often limited to clinical observations and is not supported by trichological research which could help understand the cause of alopecia.
AIM
The aim of the study was to present selected results of the „Evaluation of the quality of life in patients with androgenetic alopecia” study, conducted on the basis of a proprietary questionnaire as well as a modified DLQI questionnaire.
MATERIAL AND METHODS
The study group consisted of 200 men presenting clear symptoms of alopecia based on the Norwood-Hamilton scale. The control group consisted of 150 people with no evidence of alopecia. Each patient was asked to complete the questionnaire consisting of two parts: Part 1 – proprietary questionnaire and Part 2 – modified DLQI questionnaire. Part 1 of the questionnaire regarded issues related to the patient’s age, comorbidities (including scalp diseases, systemic diseases, endocrine disorders as well as connective tissue disorders) and stress levels. Statistical analysis was performed using Stata 12. The significance level was set as p < 0.05.
RESULTS
The analysis of Part 1 of the questionnaire shows that the first signs of balding among the respondents were on average at 22 years of age. It was also observed that the men in the study group were exposed to significantly higher levels of stress compared to the men in the control group (student’s t-test). On a scale of 1 to 5, they assessed their stress levels at an average of 3.3, compared to 2.9 in the control group.
The study revealed that balding men think about their baldness significantly more than the men in the control group (student’s t-test). 36% of men in the study group reported they constantly think about their problem (control group: 0%), while 46% reported they think about their problem very often (control group: 0%) (Mann-Whitney U test, p < 0.05). According to men in the study group, their baldness is an impeding factor in starting relationships, while in the assessment of the control group, it is not a problem. As many as 60% of men in the study group believe that people without alopecia are much more attractive.
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Piśmiennictwo
1. Grimalt R: Psychological aspects of hair disease. J Cosmet Dermatol 2005; 4(2): 142-147.
2. Brzezińska-Wcisło L, Wcisło-Dziadecka D, Bergler-Czop B et al.: Najczęstsze problemy trichologiczne u kobiet. Dermatologia Kliniczna 2014; 16(1): 19-24.
3. Brzezińska-Wcisło L, Wcisło-Dziadecka D, Meszyńska E et al.: New perspectives on the pathogenesis and treatment of hair disorders. Post Nauk Med 2012; 10: 800-805.
4. Urysiak-Czubatka I, Kmieć M, Broniarczyk-Dyła G: Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia. Postepy Dermatol Alergol 2014; 31(4): 207-215.
5. Ellis J, Scurrah K, Cobb J et al.: Baldness and the androgen receptor: the AR polyglycine repeat polymorphism does not confer susceptibility to androgenetic alopecia. Hum Genet 2007; 121(3-4): 451-457.
6. Prodi D, Pirastu N, Maninchedda G et al.: EDA2R is associated with androgenetic alopecia. J Invest Dermatol 2008; 128(9): 2268-2270.
7. Brzezińska-Wcisło L, Lis A, Kamińska G, Wcisło-Dziadecka D: Physiology and pathology of hair growth and loss on the human scalp. Postep Derm Alergol 2003; 20: 260-266.
8. Brzezińska-Wcisło L: Badania wpływu wybranych leków na dynamikę wzrostu włosów przeprowadzone na podstawie wariantu doświadczalnego na modelu szczurów rasy Wistar oraz ocena skuteczności tych leków w aspekcie klinicznym i trichologicznym w łysieniu rozlanym kobiet. Rozprawa habilitacyjna. Ann Acad Med Siles. ŚAM, Katowice 1996.
9. Stankiewicz-Habrat P, Brzeźińska-Wcisło L: Original paper Changes in the dynamics of hair growth in rats after application of methotrexate, metoprolol and naproxen. Post Dermatol Alergol 2010; 1: 11-17.
10. Han S, Byun J, Lee W et al.: Quality of life assessment in male patients with androgenetic alopecia: result of a prospective, multicenterstudy. Ann Dermatol 2012; 24: 311-318.
11. Sawant N, Chikhalkar S, Mehta V et al.: Androgenetic Alopecia: Quality-of-life and Associated Lifestyle Patterns. Int J Trichology 2010; 2(2): 81-85.
12. Reid E, Haley A, Borovicka J et al.: Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia. J Am Acad Dermatol 2012; 66(3): 97-102.
13. Cartwright T, Endean N, Porter A: Illness perceptions, coping and quality of life in patients with alopecia. Br J Dermatol 2009; 160: 1034-1039.
14. Williamson D, Gonzalez M, Finlay A: The effect of hair loss on quality of life. J Eur Acad Dermatol Venereol 2001; 15(2): 137-139.
15. Z Chiang Y, Bundy C, Griffiths C et al.: The role of beliefs: Lessons from a pilot study on illness perception, psychological distress, and quality of life in patients with primary cicatricial alopecia. Br J Dermatol 2014; 12.
16. Fabbrocini G, Panariello L, De Vita V et al.: Quality of life in alopecia areata: a disease-specific questionnaire. J Eur Acad Dermatol Venereol 2013; 27(3): 276-281.
17. Ghajarzadeh M, Ghiasi M, Kheirkhah S: Associations between skin diseases and quality of life: a comparison of psoriasis, vitiligo, and alopecia areata. Acta Med Iran 2012; 50(7): 511-515.
18. Brzezińska-Wcisło L, Bergler-Czop B, Wcisło-Dziadecka D et al.: New aspects of the treatment of alopecia areata. Postepy Dermatol Alergol 2014; 31(4): 262-265.
19. Inui S, Inoue T, Itami S: Effect of wigs on perceived quality of life level in androgenetic alopecia patients. J Dermatol 2013; 40(3): 223-225.
20. Rousso D, Kim S: A review of medical and surgical treatment options for androgenetic alopecia. JAMA Facial Plast Surg 2014; 16(6): 444-450.
21. Varothai S, Bergfeld W: Androgenetic alopecia: an evidence-based treatment update. Am J Clin Dermatol 2014; 15(3): 217-230.
22. Mirmirani P, Consolo M, Oyetakin-White P et al.: Similar Response Patterns to 5% Topical Minoxidil Foam in Frontal and Vertex Scalp of Men with Androgenetic Alopecia: A Microarray Analysis. Br J Dermatol 2014; 10. doi: 10.1111/bjd.13399. (Epub ahead of print).
23. Goren A, Shapiro J, Roberts J et al.: Clinical utility and validity of minoxidil response testing in androgenetic alopecia. Dermatol Ther 2014; 12. doi: 10.1111/dth.12164. (Epub ahead of print).
24. Famenini S, Goh C: Evidence for supplemental treatments in androgenetic alopecia. J Drugs Dermatol 2014; 13(7): 809-812.
25. Brzezińska-Wcisło L: Effect of minoxidil on hair growth in androgenic alopecia in women. Pol Merkur Lekarski 2002; 13(75): 208-211.
26. Yamazaki M, Miyakura T, Uchiyama M et al.: Oral finasteride improved the quality of life of androgenetic alopecia patients. J Dermatol 2011; 38: 773-777.
27. Traish A, Hassani J, Guay A et al.: Adverse side effects of 5α-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med 2011; 8(3): 872-884.
28. Yim E, Nole K, Tosti A: 5α-Reductase inhibitors in androgenetic alopecia. Curr Opin Endocrinol Diabetes Obes 2014; 21(6): 493-498.
