DENVER — A pair of new studies highlight the mental health toll of alopecia areata (AA): Black women with the condition are at a greater risk for depression and anxiety than are women who are not Black, and women overall with scarring forms are more likely than those with nonscarring forms to develop psychiatric disorders.

The findings were presented here at the 2026 Skin of Color Society Scientific Symposium. 

AA Is More Common in Black Women

A 2023 study found that Black women are 1.35 times more likely than White women to develop AA. Black women also experience traction alopecia, in which the pulling of hair (eg, in hairstyles such as cornrows and updos) can cause hair loss. 

“We know that hair has a deep-rooted meaning that goes far beyond aesthetics, and this is especially true for Black patients. Hair is a sense of cultural identity,” said Charity Russell, a medical student at the University of Chicago, in an interview. “It’s community, it’s history. When Black women are losing their hair, there’s something very important that’s at stake.”

Anxiety and Depression Rates in Women With Alopecia

For her study, Russell and a colleague surveyed 128 Black women (43.8% younger than 55 years) and 49 non-Black women (51% younger than 55 years) who sought care for alopecia at a University of Chicago clinic. The women answered questions using surveys that evaluated quality of life, depressive symptoms, and generalized anxiety. 

Black women had higher rates than non-Black women of clinically significant symptoms of anxiety (18% vs 8.2%, respectively) and depression (18.8% vs 10.2%, respectively). Black women also had lower hair-related quality of life (P = .006) and higher levels of anxiety symptoms (P = .17). 

There was no statistically significant difference in overall depression scores between the two groups (P = .120). Still, “there’s a potential that black women are maybe underreporting their symptoms when it comes to depression because there’s also a general mental health stigma that exists in our world today,” Russell said. 

Regardless of race, women older than 55 years reported better quality of life (P = .015).

The Role of Dermatologists

Russell said dermatologists can play an important role in AA by screening for mental illness. “Dermatologists are uniquely placed with the privilege to be able to connect with their patients and let them know that it’s okay to talk about mental health,” she said. “Implementing these screenings as a regular part of intake, although I know they could be time-consuming, because it helps us better treat the patient beyond what’s on the scalp. It’s important to be more wary in terms of understanding what your patients could be dealing with.”

Scarring Alopecia vs Nonscarring Alopecia

In the other study, Nicole J. Baker, a medical student at Thomas Jefferson University, Philadelphia, and colleagues analyzed retrospective data from the TriNetX health system database for two matched cohorts of 42,054 patients with nonscarring alopecia and scarring alopecia. 

Compared with patients who had nonscarring alopecia, those with scarring alopecia had higher rates of several psychiatric disorders such as anxiety (14.75% vs 9.24%), sleep disturbance (14.01% vs 8.29%), depression (8.85% vs 5.14%) and insomnia (7.06% vs 3.79%) (P < .0001 for all).

Baker noted that there was a higher percentage of Black women in the scarring cohort than the nonscarring cohort. She also highlighted study limitations, such as the retrospective nature and reliance on medical coding, and called for prospective research on this topic. 

Creating a Safe Place

Janelle Mallett, MD, MBA, assistant professor of dermatology, University of Connecticut, West Hartford, who is familiar with both studies, praised the research in an interview and said the findings validate what patients experience.

“People come in and say, ‘Oh my God, my scalp. I didn’t do my hair,’” she said. 

She said she responds as follows: “It’s fine. This is a safe space. Come as you are. You don’t have to worry about anything. This is what we’re dealing with all day. We want to help you, and we don’t want you to feel embarrassed.”

The new studies are “ways for us to show them we know this takes a toll on you mentally,” and that “we want to be here to support you,” Mallett added.

No funding information was provided. Russell and Mallett have no disclosures. Disclosure information for Baker was not provided.