Translation into Portuguese language (Brazil), transcultural adaptation and validation of the quality of life questionnaire in female pattern hair loss (WAA-QoL-BP)

Abstract: Background: Female pattern hair loss (FPHL) is a common complaint in adult women and inflicts major impact in quality of life, however, there is no specific questionnaire available in Portuguese for such evaluation. Objectives: Translation into Brazilian Portuguese, cultural adaptation and validation of the WAA-QoL (Women's Androgenetic Alopecia Quality of Life Questionnaire). Methods: Methodological study. After authorization by the author, cultural (linguistic) translation and adaptation to Portuguese of the WAA-QoL questionnaire were carried out. The translated version (WAA-QoL-BP) and DLQI (Dermatology Life Quality index) were submitted to patients with FPHL for concurrent validation. Twenty patients were reevaluated to assess temporal stability. Results: A total of 116 patients with APF were evaluated, the mean age (SD) was 47 (14) years, and 89 (76%) patients were classified as grades II and III (Sinclair). There was high internal consistency: Cronbach´s alpha was 0.97 for the WAA-QoL-BP and 0.87 for the DLQI. The correlation between WAA-QoL and DLQI resulted in (rho) 0.81 (p <0.01). The intraclass correlation coefficient for complete agreement of WAA-QoL-BP was 0.95 (p <0.01) in the test-retest comparison. Study Limitations: Sampling of patients only from the State of São Paulo. Conclusions: A Brazilian version for WAA-QoL was translated and adapted, which proved to be valid and consistent.

Comparison of quality of life in patients with androgenetic alopecia and alopecia areata

Abstract: Background: Androgenetic alopecia is one of the most common forms of hair loss. Alopecia areata is a common autoimmune disorder which causes hair loss. It has been previously reported that both alopecia disorders can have negative effects on quality of life. However, only a few studies have compared the effects of the two disorders. Objective: The aim is to show the impact of alopecia on patients' quality of life and compare patients with androgenetic alopecia and alopecia areata. Methods: 82 androgenetic alopecia and 56 alopecia areata patients were recruited. All patients were evaluated with the Hairdex scale and dermatology quality of life instrument in Turkish (TQL), and the scores were statistically compared according to age, sex, employment and education status, and severity of illness in the two groups. Also, female patients were statistically evaluated according to whether they wore headscarves. Results: Androgenetic alopecia patients had significantly higher total Hairdex scores in terms of emotions, functioning, and symptoms, while self-confidence was significantly higher in the alopecia areata patients. No significant differences were found in stigmatization or TQL scores between groups. The Hairdex scale and TQL scores did not show differences between the groups in terms of wearing headscarves. Study limitations: The validity and reliability of the Hairdex index have not been established in Turkey. Conclusions: Based on the Hairdex scale, our findings revealed that androgenetic alopecia patients are more affected by their disorder than alopecia areata patients. Although androgenetic alopecia is common and neither life-threatening nor painful, it is a stressful disorder with increased need for improvement in the patient's quality of life.

The tendency towards the development of psychosexual disorders in androgenetic alopecia according to the different stages of hair loss: a cross-sectional study

Abstract: Background: Androgenetic alopecia is a common dermatological condition affecting both genders. Objective: To evaluate the tendency towards development of psychosexual disorders according to the clinical stages of androgenetic alopecia. Methods: A cross-sectional study was conducted including 353 patients of both sexes on different clinical stages of hair loss, and the patients were enquired about self-perception, self-esteem, sexual experiences, anxiety and depression states. Hair loss was classified by standardized hair loss scales, and psychological effects were assessed with questionnaires. Results were compared to p<0.05. Results: Negative effects on each psychological parameter of androgenetic alopecia in females were higher than in males. While overall comparisons according to hair loss stages for each parameter were significant in males, only sexual experiences, anxiety and depression values were significant in females. Sexual experiences and depression values were higher in Ludwig 3 than in 1&2, while anxiety was higher in Ludwig 3 than 1. Self-perception values in Norwood 2&2A were higher than 3A, 3V, 4 and 4A, while self-esteem values in 2A were higher than 3&4. Sexual experiences values in 2&2A were lower than 3, 3A, 3V, 4 and 4A, while 3&3A were lower than 4&4A. Depression was lower in 2A than 3, 3A, and 3V, and lower in 2A than 4A. Anxiety was lower in 2A than in 4&4A. Study limitations: Relatively small number of patients, who were from a single center. Conclusions: In the management of androgenetic alopecia, it should be considered that patients may need psychological support according to the clinical stages, because of increased tendency to develop psychosexual disorders.

Impactos de adoecimento de longa duração: experiência de adultos jovens com Leucemia Mieloide Aguda / Impacts of long-term illness: experience of young adults with Acute Myeloid Leukemia

Resumo O presente artigo analisa os impactos materiais e imateriais imersos na experiência de adultos jovens com um adoecimento de longa duração - Leucemia Mieloide Aguda. Decorre de pesquisa mais ampla, inspirada na Fenomenologia de Alfred Schutz. Os dados foram obtidos por entrevistas em profundidade com quatro jovens, de 20 a 28 anos, em fase de manutenção no tratamento oncológico, entre novembro de 2013 a janeiro de 2014, em Mato Grosso. Os resultados enfocam aspectos marcantes dos impactos na experiência como o processo de descoberta da enfermidade em que o diagnóstico provocou sentimentos mobilizados por ideias sobre uma doença grave. Seguem-se os impactos na aparência devidos ao tratamento, sobressaindo a queda de cabelo e as estratégias cotidianas de enfrentamento, bem como o aumento ou a perda de peso. Por fim, é marcante o impacto da iminência da morte diante da letalidade da doença e o testemunho da ocorrência em pessoas conhecidas, colocando-a como possibilidade concreta para si, mas também como sobreviventes. Os impactos são os efeitos e as transformações na vida das pessoas e seu entorno e evocam (re) ações, contudo, diluem-se na experiência compondo-a, e não sendo homogênea, sua abordagem privilegia a singularidade inscrita em biografias contextualizadas.

Abstract This article analyzes the tangible and intangible impacts involved in the experience of young adults diagnosed with a long-term illness, namely Acute Myeloid Leukemia. It follows on from broader research, inspired by the Phenomenology of Alfred Schutz. The data were obtained through in-depth interviews with four young adults, aged between 20 and 28, who were in the maintenance phase of cancer treatment between November 2013 and January 2014 in the State of Mato Grosso. The results focus on striking aspects of the impacts of the experience during the process of becoming aware of the illness in which the diagnosis provoked feelings mobilized by ideas regarding a serious illness. This is followed by the impacts on appearance due to the treatment, especially hair loss and day-to-day coping strategies, as well as weight gain or loss. Finally, there is the marked impact of the imminence of death due to the lethality of the disease and the testimony of the occurrence in friends and family, but also for the survivors. The impacts are the effects and transformations in the lives of people and their relations and evoke (re)actions, however, they are diluted in the experience composing it, and not being homogeneous, its approach addresses the singularity encountered in contextualized biographies.

Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic / Percepção de queda de cabelos e sintomas depressivos em pacientes do sexo feminino em ambulatório de dermatologia geral

BACKGROUND: Hair loss is a common complaint among women and may be associated with psychological disturbances. OBJECTIVES: This study investigated dermatology patients with respect to the prevalence of complaints of hair loss and the association between these complaints and symptoms of depression. METHODS: A cross-sectional study was conducted with female outpatients over 20 years of age with no hair-related disorders. Patients were asked about hair loss and were evaluated with respect to symptoms of depression. The following variables were also analyzed: age, dermatological diagnosis, comorbidities, medications, family history of alopecia, hair length, the number of hairs extracted in the hair pull test and the presence of hair thinning or seborrheic dermatitis. Data were compared by bivariate analysis and multiple logistic regressions between groups of women with and without hair loss. RESULTS: Of the 157 women interviewed, 54% reported hair loss and 29% reported at least two key symptoms of depression. The median (IQD) age of the women was 51 (20) years. Complaints of hair loss were associated with the presence of symptoms of depression even following adjustment for the other covariates (p=0.02; OR=2.79; 95%CI: 1.18-6.61). Statistically significant differences were also found between the patients with and without hair loss with respect to: age (p=0.03), family history of alopecia (p<0.01), hair length (p=0.01), number of hairs extracted in the hair pull test (p=0.02), hair thinning (p<0.01), seborrheic dermatitis (p<0.01) and problems with personal relationships (p=0.04). DISCUSSION: Hair-related disorders are a common topic of interest in this population. The significant association found between this complaint and symptoms of depression indicates a relationship between the perception of hair loss and the psychological well being of the women evaluated. CONCLUSION: Complaints of hair loss were common and were associated with a greater prevalence of symptoms of depression among adult female outpatients at a public dermatology clinic.

FUNDAMENTOS: Queda de cabelos é queixa frequente entre mulheres, podendo estar relacionada a comprometimento psicológico. OBJETIVOS: Investigar a prevalência da queixa de queda capilar em pacientes dermatológicas e sua associação com sintomas depressivos. MÉTODOS: Estudo transversal com pacientes femininas, ambulatoriais, maiores de 20 anos de idade, sem doenças capilares. Foram questionadas quanto à presença de queda de cabelos e avaliadas quanto à presença de sintomas depressivos. Também analisaram-se: idade, diagnóstico dermatológico, comorbidades, medicações, história familiar de alopecia, comprimento capilar, número de fios obtidos à tração e presença de rarefação capilar ou dermatite seborreica. Os dados foram comparados bivariadamente e por regressão logística múltipla entre os grupos com e sem queixa de queda capilar. RESULTADOS: Das 157 mulheres entrevistadas, 54% referiam queda capilar e 29%, ao menos dois sintomas depressivos fundamentais. A idade mediana foi 51+20 anos. A queixa de queda capilar esteve associada à presença de sintomas depressivos, mesmo quando ajustada pelas demais covariáveis (p = 0,02; OR = 2,79 [IC 95%: 1,18-6,61]). Pacientes com e sem queixa também diferiram, significativamente, quanto à idade (p = 0,03), à história familiar de alopecia (p < 0,01), ao comprimento capilar (p = 0,01), ao número de fios obtidos à tração (p = 0,02), à rarefação capilar (p < 0,01), à dermatite seborreica (p < 0,01) e a problemas de relacionamento pessoal (p = 0,04). DISCUSSÃO: Alterações capilares configuram tema de frequente interesse nessa população. A significativa associação dessa queixa com sintomas depressivos indica relação entre a percepção da saúde capilar e o bem-estar psicológico das mulheres avaliadas. CONCLUSÃO: A queixa de queda capilar foi frequente e esteve associada a maior prevalência de sintomas depressivos entre as pacientes adultas de ambulatório dermatológico público.

Alopecia androgenética femenina: etiología y diagnóstico / Female androgenetic alopecia: etiology and diagnosis

La alopecia de patrón femenino es un problema clínico cada día más frecuente en las mujeres. El cuadro clínico de la alopecia androgenética femenina (FAGA) típica comienza con una específica “pérdida difusa de cabellos de las regiones parietal y frontovertical respetando la línea de implantación frontal”. Ludwig llamó a este proceso “rarefacción”. En la clasificación de Ludwig se describieron tres grados o tipos progresivos de FAGA. Grado I o mínimo, grado II o moderado y grado III o intenso. Ludwig también describió la alopecia androgenética femenina de patrón masculino que debe ser subclasificada de acuerdo con la graduación de Ebling; es decir, FAGA.M desde grado I a V. Generalmente se observa en mujeres con nivelesde testosterona elevados o con hipersensibilidad del órgano diana a esta hormona. La FAGA.M puede observarse en cuatro situaciones: síndrome de persistencia de la adrenarquía, alopecia por tumor suprarrenal u ovárico, alopecia posmenopáusica y alopecia involutiva. Hay otras propuestas de clasificación como la Olsen que considera la alopecia de patrón femenino de dos tipos: de comienzo precoz o tardío y cada unode ellos con o sin exceso de andrógenos. El diagnóstico debe efectuarse con la historia clínica, exploración con el “signo del arrancamiento”, signo de la tracción”, trichoscan®, tricoscopía, test del lavado y tricograma, y con test bioquímicos, especialmente determinaciones androgénicas. Como en el varón, la alopecia femenina causa importantes problemas psicológicosa la mujer, siendo la depresión el síntoma más constante. Con frecuencia se asocia a efluvio telogénico crónico y alopecia frontal fibrosante.

Female pattern hair loss is a clinical problem which every day is more common in women. The clinical picture of typical female androgenetic alopecia (FAGA) begins with a specific “diffuse loss of hair from the parietal or frontovertical areas with an intact frontal hair implantation line”. Ludwig called this process “rarefaction”. In the Ludwig’s classification three degrees or progressive type of FAGA were described: grade I or minimal, grade II or moderate and grade III or severe. Ludwig also described female androgenetic alopecia of male pattern that should be sub- classified according to Ebling’s degrees; that is to say, FAGA.M from grade I to V. It is usually seen in women with increased testosterone levels, or with a hypersensitivity of the target organ to this hormone. FAGA.M may be present in four situations: persistence adrenarche syndrome, alopecia due to an adrenal or an ovarian tumor, post-hysterectomy and as an involutive alopecia. There were other proposal of classification as the most recent Olsen’s classification of female pattern hair loss (FPHL) with two types: of early and late onset and in each one with or without androgens excess. Diagnosis must be made by clinical history, clinical examination with the “pull-out sign”, “tug sign”, trichoscan®, trichoscopy, wash test and trichograms and laboratory test, especially androgenic determinations. FPHL causes important psychological problems in women, being depression the most constant symptom. Frequently, FPHL is associated with chronic telogen effluvium and frontal fibrosing alopecia.

Psicoterapia de criança com alopecia areata universal: desenvolvendo a resiliência / Psychotherapy of child with universal alopecia areata: developing resilience / Psicoterapia del niño con alopecia areata universal: desarrollando la resiliencia

Este artigo apresenta um estudo de caso de uma criança portadora de alopecia areata universal, vitiligo e transtorno de ansiedade generalizada, atendida em clínica-escola de psicologia de 2002 a 2007. A abordagem terapêutica adotada foi a psicoterapia de orientação psicanalítica infantil e a orientação sistemática aos pais, objetivando a diminuição dos sintomas e o desenvolvimento de habilidades para o enfrentamento da doença crônica. No decorrer do processo, ao longo dos cinco anos de atendimento, a paciente adaptou-se positivamente à doença, ocorrendo a remissão dos sintomas de ansiedade e o desenvolvimento de comportamentos resilientes que indicaram a alta terapêutica.

This paper presents a study of case of a child with universal alopecia areata disease vitiligo, generalized anxiety disorder, taken care of in school-clinic of psychology in the period of 2002 to 2007. The therapeutical boarding was the psychotherapy of infantile psychoanalytical orientation and the systematic parents orientation to reach the reduction of the symptoms and development of abilities for the confrontation of the chronic illness. During of the process, to the long of the five years of attendance, the patient presented positively adaptation to the illness, the remission of the anxiety symptoms and the development of resilient behaviors.

Este artículo presenta un estudio del caso de un niño con alopecia areata, vitíligo y trastorno de la ansiedad generalizada atendida en una clínica-escuela de psicología en el período del 2002 al 2007. El tratamiento terapéutico adoptado fue la psicoterapia de orientación psicoanalítica infantil y la orientación a los padres, buscando la reducción de los síntomas y el desarrollo de las capacidades para confrontación de la enfermedad crónica, ocurriendo la remisión de los síntomas de la ansiedad y el desarrollo de los comportamientos resilientes que habían indicado el fin terapéutico.

Tricotilomania: revisão da literatura / Trichotillomania

Um número substancial de pacientes sofrre de tricotilomania, uma doença psiquiátrica com manifestações dermatológicas. Pessoas que sofrem de tricotilomania normalmente sabem de sua doença, mas não procuram ajuda devido à vergonha que sentem. Neste artigo, os autores discutem as características clinicas e propedêuticas da tricotilomania, com ênfase nos aspectos psiquiátricos dos pacientes.

A substancial number of patients are suffering about trichotilomania, a psychiatric disease that has dermatological manifestations. People who suffer about trichotillomania, generally know about their disease, but they don't look after help due to the shame that feel. In this article, the authors discuss the clinical characteristics and propedeutic of trichotillomania, with emphasis on the psychiatric aspects of the patients.

Cabelos: da etologia ao imaginário / Hairs: from the ethology to the imaginary / Cabellos: de la etología al imaginario

O atendimento de uma criança que tinha grande atração por "cabelos" levou a autora a investigar o tema. Foi realizado um apanhado da função dos cabelos do ponto de vista anatômico, biológico e etológico, concluindo-se que, tendo uma função protetora onto e filogenética, os cabelos constituem a pré-concepção de um objeto que nos contém e mantém seguros. O fato de os cabelos se prestarem a ser utilizados como defesa contra diferentes tipos de angústia encontra expressão nos hábitos e costumes dos povos, em diferentes épocas, em seus mitos e contos. Os cabelos surgem também com freqüência nas situações clínicas, e a autora aponta seu uso para fazer frente às angústias de separação, sua manipulação como defesa contra angústias persecutórias, a alopecia como expressão do medo da perda do objeto de amor e como expressão de defesa contra o risco de se tornar "não-ser".

The attendance of a child who had great attraction for hair led the author to do an investigation about such theme. It was gathered an amount of information about the hair's function regarding the anatomical, biological and ethological aspects. It concluded that, having a phylogenic and ontological protecting role, the hair establishes a pre-conception of an object which contain us and keep us safe. The fact of the hair being a defense agent against several types of grief finds expression among several peoples' costumes, in their remained myths and tales, in which the hair is pointed out. It also suggests breaking up grieves; manipulation as defense against persecutory sorrows; alopecy as expression of fear of losing an object of love and even as expression of defense against a risk of turning into "not-being".

El interés de un niño que sentía gran atracción por cabellos le ha llevado a la autora hacer una investigación sobre el tema. Se ha realizado un recogido de la función de los cabellos desde el punto de vista anatómico, biológico y etológico, concluyendo que, habiendo una función protectora onto y filogenética, cabellos constituyen la preconcepción de un objeto que nos contiene y mantiene seguros. El hecho de "cabellos" prestarse a ser utilizado como defensa contra diferentes tipos de angustia encuentra expresión en los hábitos y costumbres de varios pueblos, en sus mitos y cuentos, que son aquí mencionados. "Cabellos" surgen también con frecuencia en las situaciones clínicas, y aquí la autora señala su uso para hacer frente a las angustias de separación, su manipulación como defensa contra angustias persecutorias, alopecia como expresión del miedo a la pérdida del objeto de amor y además como expresión de defensa contra el riesgo de volverse "no-ser".

Psicossomática na infância: enfoque psicodinâmico / Psychosomatics in childhood: a psychoanalytical approach

As autoras apresentam inicialmente alguns conceitos e as principais abordagens psicodinâmicas da psicossomática. Dentre os diferentes pontos de vista, identificam-se com as idéias da Escola Psicossomática de Paris, dos trabalhos atuais da psicanalista Joyce Mc Dougall e com a concepçäo da "Medicina da Pessoa" desenvolvida por Danilo Perestello, Abram Eksterman e outros. A partir dessas idéias, passam a entender as desordens psicossomáticas como criaçöes do indivíduo para reduzir a intensidade da dor psíquica, no momento em que há uma incapacidade para elaborar e integrar psiquicamente os conflitos ou traumatismos. Desta forma, o corpo age no lugar da mente. Quanto à psicossomática na infância, essa incapacidade de integraçäo e elaboraçäo psíquicas deve-se à imaturidade (especialmente nos bebês) ou a uma crise natural do desenvolvimento. Na medida em que essa capacidade de eleboraçäo se desenvolve, progressivamente as crianças deixam de utilizar o corpo como meio previlegiado de expressäo da tensäo e da angústia. A cristalizaçäo desta forma de expressäo é que caracterizaria o distúrbio psicossomático. Após desenvolvimento dessas colocaçöes teóricas, as autoras tecem algumas consideraçöes sobre a psicoterapia de crianças que apresentam desordens psicossomáticas. Apresentam um caso clínico de uma criança gêmea, näo univitelina, do sexo feminino, com alopecia. A apresentaçäo desse caso pretende ilustrar as consideraçöes teóricas apresentadas assim como contribuir para conhecimento empírico no

O complexo de Sansäo: aspectos psicológicos da alopécia androgênica masculina / The complex of Sanson: psychological aspects of male androgenic alopecia

Säo focalizados aspectos psicológicos relacionados a alopécia androgênica no homem, com ênfase nos conflitos existentes na esfera da sexualidade