Gieler U, Niemeier V, Kupfer J
Centre of Psychosomatic Medicine, University of Giessen, Germany

Although some authors negotiate the influence of emotional stress in the pathogenesis of alopecia, mostly there are life-events or other psychosocial stress-factors which are significant increased, and the comorbidity with depression, anxiety and social phobia is evident. The dysmorphic reaction means to the patients especially in severe cases a great psychic impairment and behaviour of social avoidance, disgust and shame. The secondary coping behaviour depends from the predominant personality structure and might have many problems in the psychosocial area of the patients. It is useful to have a longer communication with the patient in sense of psychosomatic aspects. It is necessary to have in the first consultation some aspects about possible psychosocial influences. The careful inspection of the dermatologist-patient communication are important to recognize emotional affects which is a diagnostic aid for recognition of emotional influences to the disease (e.g. feeling of shame and disgust as well as social phobia and depression. Psychometric questionnaires to realize depressive mood or anxiety as well as impairment of the life quality are helpful. Sometimes there are difficulties to recognize trichotillomania, which is necessary to differentiate for the different therapeutical approaches. Dermatologist-patient contacts and focussing the attentiveness to the psychosocial impairment as well as take care about the self-insecurity. There are no studies to show the improvement only with relaxation techniques. There is one study about the combination of autogenic training, imagination and low dose immunosuppressive agents (psychoimmunotherapy). In some cases the psychodynamic or psychoanalytic psychotherapy seems efficient. There are no studies to show the efficacy of cognitive behaviour therapy, but it might be helpful to give a training for social competence or decrease the social anxieties. As well as the coping strategies, in children a family therapy might also be useful. Some case reports about hypnotherapy exist without clear effects for the hair regrowing. In a double-blind-placebo controlled study it was shown that 5 of 7 patients have better results with Imipramin. There was a clinically significant hair-regrowing in comparison with the placebo control group in which no effects developed.