Resilience in Alopecia Areata Patients — Donovan Hair Clinic

What is resilience? How might it impact alopecia areata?

Resilience is defined as the ability of an individual, when confronted with a stressful environment or stressful situation to maintain a good quality of life. It’s the ability of an individual to withstand adversity and bounce back from stressful life events.

Hair loss is one such stressful event. Some patients with minimal hair loss note that their quality of life is profoundly affected and some patients with profound hair loss note that their quality of life is minimally affected. It has been proposed that the resilience of a given patient could be one such reason for these observations.


A new study aimed to characterize resilience in patients with AA and to investigate the correlation between resilience and perceived stress.

The authors used validated questionnaires to assess resilience, stress, and patient-reported AA symptoms in patients with alopecia areata. These questions included  the brief resilient coping scale (BRCS), perceived stress scale (PSS), and alopecia areata symptom impact scale

The Brief Resilient Coping Scale (BRCS)

The BRCS is a validated tool that evaluates an individual’s resilience and tendencies to cope with stress

On a scale of 1-5 patients rate the following ( from 1 = Does not describe me at all 2=Does not describe me 3=Neutral 4=Describes me 5=Describes me very well)

I look for creative ways to alter difficult situations.

Regardless of what happens to me, I believe I can control my reaction to it.

I believe that I can grow in positive ways by dealing with difficult situations.

I actively look for ways to replace the losses I encounter in life.



There were 141 participants in the study. 73.8 % were women and 70.9 % were Caucasians. About 1/3 had 0-25 % of scalp involved, 1/3 had 76-100 % and 1/3 were in between.

The participants were found to have moderate stress and resilience, and AA symptoms impacted various domains of psychosocial functioning


Overall, symptom impact was directly correlated with the perceived stress whereas the resilience was inversely correlated with perceived stress.  In other words, greater resilience was strongly associated with lower perceived stress.

The conclusions of this study was that greater resilience in AA patients is associated with improvement in perceived stress, regardless of the severity of hair loss or the patients’ perceived impact of AA on their lives

The authors point out that the study of resilience is important because resilience skills can be taught, and so it represents a strategy to help patient cope and improve quality of life


Resilience training focuses on four areas, including emotional, cognitive and mental, physical, and spiritual resilience. Training in these areas can improve patient resiliency, enhance patient quality of life, and decrease stress and anxiety by teaching the patient  to actually learn view life’s inevitable challenges as opportunities.

Resilience training helps patients identify ways of responding positively to various pressures. Patients gain tips and strategies to develop his or her own natural strengths.  They learn ways to identify opportunities that are present in challenges. They develop creativity and problem solving skills and learn relaxation techniques.

Resilience training helps patients learn to have a more positive outlook in the face of pretty tough situation. It teaches ways of coping

Overall understanding the factors that affect a higher level of resilience can have important clinical implications and can represent a guiding principle for designing psychological interventions that would accelerate recovery and improve the quality of life of dermatological patients.


Han JJ et al. Association of resilience and perceived stress in patients with alopecia areata: A cross-sectional study. J Am Acad Dermatol. 2022 Jul;87(1):151-153.

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