Psychological burden of alopecia areata in patients with cancer: A narrative review
Abstract
Alopecia areata is an immune-mediated, non-scarring alopecia that is not specific to cancer but may occur during the cancer trajectory, including diagnosis, active treatment, and survivorship. In oncology settings, hair loss is commonly framed as a temporary and expected consequence of chemotherapy, whereas alopecia areata follows a distinct and often unpredictable course. This narrative review synthesizes current evidence on the psychological burden of alopecia areata in patients with cancer, integrating findings from dermatology, psycho-dermatology, and psycho-oncology. We highlight how alopecia areata contributes to distress, anxiety, depression, body image disturbance, stigma, and impaired health-related quality of life, frequently in ways disproportionate to the visible extent of hair loss. Particular attention is given to the psychosocial significance of diagnostic uncertainty, illness identity disruption, and the reactivation of cancer-related vigilance when alopecia areata emerges during or after oncologic treatment. We discuss potential bidirectional interactions between psychological stress, immune dysregulation, and cancer treatment context, including immune checkpoint inhibitor–associated alopecia. Practical implications for psycho-oncology practice are outlined, emphasizing the importance of timely dermatologic differentiation, systematic psychosocial assessment, empathic communication, and integrated supportive care pathways. Finally, we identify key research gaps, including the need for cancer-specific epidemiological data, standardized psychological outcome measures, and intervention studies evaluating integrated dermatology–psycho-oncology models. Recognizing alopecia areata as a psycho-oncological concern rather than a purely cosmetic issue is essential for person-centred cancer care and improved quality of life.
Copyright (c) 2026 Chu Qiu
This work is licensed under a Creative Commons Attribution 4.0 International License.
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