What employers need to know about alopecia areata

“It was a really difficult transition going from someone who was a redhead . . . to having no hair, no eyebrows, no eyelashes and staring [in the mirror] at someone I just didn’t know,” recalled Krahn, now the owner of Image Evolution by Freedom Wigs, during Benefits Canada’s 2023 Chronic Disease at Work conference in early February. “It was devastating and it really took me out and made me a shell of my current self.”

Read: Webinar coverage: How can alopecia areata affect benefits plan members?

Alopecia areata is an autoimmune disease caused by the body’s immune system attacking the hair follicles. Affecting roughly two per cent of people globally, the disease is typically chronic in nature and can start at any age, said Jeff Donovan, dermatologist at Donovan Hair Clinic, also speaking during the session, which was supported by Pfizer Canada Inc.

There are three types of alopecia: areata, which involves small or medium patches of hair loss that eventually grow back on their own or with treatment; totalis, which means complete hair loss on the head; and universalis, which is when someone experiences complete hair loss all over their body. Roughly five to 10 per cent of patients progress to total hair loss.

People who have one autoimmune condition are more likely to also experience others, something that’s true for those living with alopecia, said Donovan, noting many alopecia patients also have autoimmune thyroid disease. Eczema or atopic dermatitis, rheumatoid arthritis and pernicious anemia also occur in smaller numbers of patients.

Alopecia can be treated with cortisone creams or injections to reduce inflammation around the hair follicles, minoxidil to stimulate hair growth and, in cases of significant hair loss, immunosuppressive medications that are also used for other autoimmune conditions like rheumatoid arthritis or inflammatory bowel disease. 

Read: A primer for plan sponsors on autoimmune conditions

But Donovan noted that, while small patches of hair loss may respond well to treatment, it’s often much harder to treat significant hair loss. “We have a long way to go to improve the outcomes that we are able to achieve, but certainly new medications are on the horizon.” 

Indeed, he noted no Health Canada-approved treatments for alopecia currently exist, but treatment is key for many patients because it helps to reduce some of the psychological impacts associated with the disease. Given the profound emotional impact of hair loss, people living with alopecia face an increased risk of developing anxiety and depression.

A 2020 study in the Journal of Investigative Dermatology found 62 per cent of alopecia areata patients made “major life decisions” about their relationships, education and/or career due to their disease. Some studies have suggested more than 75 per cent have experienced a change in their quality of life after developing alopecia. And the impact is more severe for younger patients, women and patients who lose their eyebrows and eyelashes.

Alopecia may also prompt employees to take more time off work, according to multiple studies of alopecia in the workplace. One study of 5,000 adults with the disease found they also experienced an up to 12 per cent reduction in productivity while at work.

“The more feelings of self-consciousness, embarrassment, sadness or frustration [a person with alopecia reported], the more they had impairment in their productivity at work,” said Donovan, noting some studies have found alopecia patients make career decisions specifically to take on roles with less public visibility.

Read: Panel: Should drug coverage for certain conditions still be optional?

Krahn encouraged plan sponsors to support employees with alopecia through their benefits plans by covering the cost of wigs or hair pieces — which can range from $1,000 to $10,000 — and existing and future treatments for the condition. Some workplace benefits plans may consider hairpieces cosmetic rather than medical, she said, but argued that was the wrong approach.

“Hair is part of our identity . . . and it’s very much attached to our mental health, though you don’t realize that until it’s going and you’re experiencing all the feelings associated with that loss. Just to treat it as aesthetic would be incorrect. If we realized that, I think we’d be making [strides] and there’d be so many more people who would be [comfortable] working in the workplace.”

For Krahn, finally finding a good hair piece allowed her to feel confident again and to feel comfortable returning to her teaching career. “It’s been a difficult process to go through, but it’s been rewarding at the same time to get to the other side of that loss.”

Read more coverage of the 2023 Chronic Disease at Work conference.