Relationship between serum dheas and cortisol levels and psychogenic stress scales with disease severity in patients diagnosed with alopeia areata

Aim: Alopecia Areata (AA) is a condition whose exact cause is not fully understood; however, it is believed to arise from various factors such as genetic traits, autoimmunity, emotional stress, and atopy. In our study, we aimed to investigate the effect of psychological stress on the severity of AA by measuring the Beck Depression Inventory and serum cortisol and Dehydroepiandrosterone Sulfate (DHEAS) levels, which are indicators of psychological stress that play a significant role in the etiology of AA. Method: Our study included 50 patients diagnosed with AA aged 18-65 who presented to the Dermatology Department of Van Yüzüncü Yıl University Hospital between November 2023 and March 2024, along with a control group of 50 individuals aged 18-65 who had never been diagnosed with AA at any point in their lives. Serum DHEAS and cortisol levels were measured for all participants, and the Beck Depression Inventory was administered to assess psychological stress, with the results recorded. Additionally, the Severity of Alopecia Tool (SALT) scores of individuals in the patient group were determined through clinical evaluation and recorded. The obtained data were statistically compared both within the groups and between the patient and control groups. Results: Among the 100 volunteers participating in our study, 42 (42%) were female and 58 (58%) were male. The vast majority of participants (72%) were aged between 18-34 years. The majority of participants (%96) were residing in Van. Only 1 participant (1%) had a serum cortisol level above normal, and this individual was in the patient group. The serum DHEAS level was above normal in 7 participants (7%), with 42.8% of these in the patient group. A total of 37 participants (37%) exhibited minimal depression, with 54.1% being from the patient group. Mild depression was observed in the same number of individuals in both the patient and control groups, totaling 30 (30) individuals. Moderate depression was seen in 28 participants (28%), with 42.9% from the patient group. Severe depression was identified in 5 participants (5%), 60% of whom were in the patient group. When analyzing the SALT scores of the patient group, it was found that the majority of patients (68%) were in the group with <25% hair loss. Conclusion: According to our findings, there was no statistically significant relationship between both DHEAS and psychological stress, as well as between the SALT score and disease severity. However, it was observed that individuals with elevated DHEAS levels tended to have a higher prevalence of mild and severe depression compared to those with normal DHEAS levels. Similarly, no significant relationship was found between the severity of depression from the Beck Depression Inventory and disease severity. Although our data were not statistically significant, the prevalence of minimal and severe depression was found to be higher in the patient group compared to the control group. While the role of stress in the etiology of AA cannot be denied, larger sample sizes are needed to achieve more significant results. Keywords: alopecia areata, stress, cortisol, DHEAS