Alopecia Areata: The Role of Stressful Events and an Estimate of Lifetime Risk in First-Degree Relatives

Alopecia areata (AA) is a common disease in the military population; however, a few studies have calculated the lifetime risk of alopecia areata in first-degree relatives of patients as well as the impact of stress. The primary aim of this study was to calculate the lifetime risk of alopecia areata in first-degree relatives of index patients. The secondary aim of this study was to assess the role of stressful events in the onset/recurrence of disease. One hundred and twenty-one patients with alopecia areata and their first-degree relatives, which included 597 subjects in addition to 119 controls, were studied. We considered a gender and age-matched control for each patient. They were investigated for the occurrence of stressful events within the previous six months before the onset/recurrence of the disease. More than twenty-six percent of patients had a positive family history, while 6.4 percent of first-degree relatives were affected by alopecia areata. Lifetime risks were estimated at 7.6% for parents, 9.9% for siblings, and 6.4% for children. Eighty-eight patients (73.9%) experienced stressful events within six months prior to the onset or recurrences of alopecia areata, while 32 subjects (26.9%) of the control group reported such events in the last six months (P value = 0.000). Calculated lifetime risks can be used in genetic counseling. It appears that stressful events can be considered to be contributing factors in the development of alopecia areata. Also, according to our results, the role of stress in the recurrence of alopecia areata is more prominent than the primary development of the disease.