Alopecia and Mental Health: Psychosocial Burden, Neuroendocrine Mechanisms, and Therapeutic Implications

Alopecia is a dermatologic condition characterized by hair loss, including subtypes such as alopecia areata 
(AA), androgenetic alopecia (AGA), telogen effluvium (TE), and cicatricial alopecias. This disorder is 
increasingly recognized for its significant psychosocial impact and association with psychiatric 
comorbidities. The experience of hair loss can profoundly affect self-identity, body image, and social 
interactions, with growing evidence showing heightened rates of depression, anxiety disorders, social 
anxiety, and a lower quality of life among individuals with different types of alopecia. 
This review summarizes current evidence regarding the psychosocial effects of alopecia, the role of 
neuroendocrine mechanisms—particularly the dysregulation of the hypothalamic–pituitary–adrenal (HPA) 
axis—and the intricate relationships between stress, immune system activation, and hair follicle pathology. 
A thorough literature search was performed using PubMed, Scopus, and Web of Science databases, focusing 
on studies published from 2006 to 2026, prioritizing randomized controlled trials, cohort studies, case
control studies, systematic reviews, and meta-analyses. 
Recent studies indicate that patients with alopecia areata exhibit higher rates of depressive and anxiety 
disorders compared to the general population. This relationship seems to be partially influenced by immune 
activation, cytokine signaling, and stress-related dysregulation of the hypothalamic-pituitary-adrenal axis. 
Emerging therapeutic approaches, including Janus kinase inhibitors and structured psychodermatologic 
interventions, not only facilitate hair regrowth but are also linked to measurable improvements in quality
of-life metrics. These findings suggest that alopecia—especially alopecia areata—should be viewed as a 
stress-responsive inflammatory condition with significant psychiatric implications rather than merely a 
cosmetic issue.