title: Environmental stress but not subjective distress in children or adolescents with alopecia areata.
abstract: OBJECTIVE
  Alopecia areata (AA) has been considered a psychosomatic disease. This case-control study tries to determine whether environmental adverse conditions are associated with AA and to describe the subjective and physiological state of the patients.
  
  
  METHODS
  A series of 31 children or adolescents with AA (16 boys and 15 girls; aged 12.2±3.8 years [range, 7-19]) were compared with both 23 patients of similar demographic characteristics undergoing a chronic illness (epilepsy) and 25 healthy siblings (HS) of the AA patients. The research protocol included assessment, by interview with the mother, of stressful life events in the 12 months previous to the AA onset and of developmental and family conditions, as well as self-rating instruments for anxiety, depression and family functioning. Some neuroendocrine and immunological parameters were also measured. Logistic regression analyses were used to confirm independent associations with AA.
  
  
  RESULTS
  In contrast with their HS, AA patients experienced more stressful life events and showed higher 24-h urinary excretion of catecholamines. In contrast with epilepsy patients, AA patients were more likely the member of a single-parent family and perceived less expressiveness within their family. On the other hand, the three groups showed no significant differences in anxiety and depression scores.
  
  
  CONCLUSIONS
  Alopecia areata is a complex skin disorder in juvenile patients whose conscious experience of distress is often absent and that might be precipitated by stressful life events in individuals under the influence of defective family functioning or biological vulnerability.
authors.affiliation: Department of Psychiatry and Medical Psychology, University of Granada, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Díaz-Atienza
authors.forename: Manuel
authors.initials: M
authors.lastname: Gurpegui
mesh_terms: D000293:Adolescent; D000506:Alopecia Areata / Q000523:psychology*; D001007:Anxiety / Q000523:psychology; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D004827:Epilepsy / Q000523:psychology; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D011569:Psychiatric Status Rating Scales; D012931:Social Environment; D013315:Stress, Psychological / Q000523:psychology*; D055815:Young Adult