Hypnosis in refractory alopecia areata significantly improves depression, anxiety, and life quality but not hair regrowth

Ria Willemsen, MD, Patrick Haentjens, MD, PhD, Diane Roseeuw, MD, PhD, Johan Vanderlinden, PhD
MARCH 01, 2010

To the Editor: Our preliminary results on the use of hypnosis in alopecia areata (AA), previously published in the JAAD, have suggested the possible efficacy of hypnosis in refractory AA forms.1 However, from the research finding of our latest study, another message emerges. In this prospective cohort study, a hypnotherapeutic approach was used without any other treatment, to compare the evolution of anxiety, depression, and health-related quality of life (HRQOL) of patients with AA that was refractory to conventional treatment, with control patients receiving only treatment for AA as usual. Only patients and controls presenting more than 30% hair loss with a minimal duration of 3 months were included. For ethical reasons, a nonrandomized controlled study protocol was selected.

The hypnotic treatment sample consisted of 20 patients (80.0% female, mean age 41.6 years). The control sample included 21 patients (85.7% female, mean age 47.2 years). Both groups presented no significant differences in education, AA type, percentage of hair loss or duration of outbreak. Baseline scores for depression, anxiety, and HRQOL yielded no statistical differences. The majority of patients and controls presented longstanding AA with more than 75% hair loss, alopecia totalis or universalis, and mentioned a 2-year minimal duration of outbreak. Hypnosis consisted of 10 individual sessions, given bimonthly, following a standardized step-by-step approach including suggestions for hair regrowth and improvement of relaxation and self-confidence.2 Patients were instructed to perform daily self-hypnosis with a CD. Data for psychic evolution were collected with self-report questionnaires for depression, anxiety (90-item Symptom Checklist [SCL-90]), and HRQOL (Skindex 17, 36-item Short Form [SF-36]), at baseline (T1) and after the 6 months of treatment (T2).

Table I shows the mean difference between scores at T1 and T2. Compared to controls, the hypnotically treated patients presented a statistically significant higher decrease in scores for depression (P = .001) and anxiety (P = .009), reflecting a shift from pathological “high” toward “normal” SCL-90 values. Moreover, hypnotherapeutic management was associated with a significant amelioration in the SF-36 mental component summary score, leading to a final score of 50.15 (standard deviation, 10.56), a value that reflects the average HRQOL of the general population. Differences in Skindex 17 subscores, although indicating a better outcome for the hypnosis group, were not significant.