Abstract
Background: Both psychiatric disorders and diverse medications used to treat them have been associated with alopecia. The objective of our study was to investigate the existence of an association between attention-deficit/hyperactivity disorder (ADHD) stimulant medication (ASM) and various types of alopecia.Methods: We conducted a retrospective case-control medical record review of patients between the ages of 6 and 18 years seen in dermatology clinics during a 10-year period. Cases included patients diagnosed with alopecia areata (AA), alopecia totalis (AT), or alopecia universalis (AU). We matched 3 controls on age and sex to each case. We reviewed patients’ medical records for the following medications: lisdexamfetamine, amphetamine/dextroamphetamine, dexmethylphenidate, and methylphenidate. We examined the association between medications used to treat ADHD and diagnoses of AA, AT, and/or AU by calculating a series of odds ratios and 95% CIs.Results: We identified 124 cases (110 with AA, 11 with AT, and 3 with AU) and 372 controls. We found a strong association between AU and ASM use (P<0.0071). No relationship between ASM use and other types of hair loss was found.Conclusion: Although the sample size of cases with AU was small, we found a significant association between AU and ASM. While further study is needed, practitioners may consider close monitoring of patients with AA who use ASM for the development of worsening disease and discontinue the medication if the patient experiences an increase in hair loss that appears to be progressing to AU.
Highlights
Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss that typically presents as welldemarcated patches and can progress to include all scalp hair or all body hair
In the comparison of cases with any type of alopecia (AA, alopecia totalis (AT), alopecia universalis (AU)) to controls (Table 2), we found no association between hair loss and ADHD stimulant medications (ASM) use (OR=0.72, 95% CI 0.41-1.26; P=0.2811)
In the comparison of AA cases to controls, we found no significant association between ASM and AA (OR=0.66, 95% CI 0.35-1.24; P=0.0861)
Summary
Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss that typically presents as welldemarcated patches and can progress to include all scalp hair (alopecia totalis [AT]) or all body hair (alopecia universalis [AU]). A 2019 retrospective review of more than 5,500 patients in the United States found that AA was associated with several mental health disorders, and the strongest association was found with attentiondeficit/hyperactivity disorder (ADHD).[2] A Taiwanese study demonstrated an association between AA and several psychiatric conditions; that study found no association between AA and ADHD.[3] While the existence of an association between psychiatric conditions and AA is not clear, a high stress level and the associated increase in cortisol have been hypothesized to stimulate proinflammatory cytokines, causing an alteration in the immune system and leading to immune attack on hair follicles.[3] Both psychiatric disorders and diverse medications used to treat them have been associated with alopecia. While further study is needed, practitioners may consider close monitoring of patients with AA who use ASM for the development of worsening disease and discontinue the medication if the patient experiences an increase in hair loss that appears to be progressing to AU
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