Alopecia in survivors of critical illness

Dear Editor,

Although alopecia is reported to occur after severe psychological stress, multisystem illness and drug administration, it has received limited attention in critical care research.^1–3 During the acute critical illness phase, alopecia is of minimal concern to the intensive care team, when patient survival is the primary objective of care given. In the recovery phase of illness, however, alopecia can prove distressing for the patient. In the publication by Scott et al. ⁴ in JICS, the incidence of alopecia was described in a cohort of UK military casualties. Alopecia was reported in 35% of survivors. ⁴ In response to the work by Scott et al., ⁴ we undertook a small pilot study to investigate the incidence and nature of patient-reported alopecia in civilian survivors of critical illness.

A total of 75 patients who had been discharged home for at least 12 weeks from our general ICU, attending the follow-up clinic in 2014, completed a pre-designed alopecia survey. Median age was 65 years, with 35% males and a median ICU length of stay of eight days. A total of 17% of patients reported suffering alopecia. The severity of hair loss ranged between less than 10% and over 50%, with the location of hair loss varying between the patients. Duration of alopecia lasted between three weeks to seven months. The type of hair loss varied between patients, with only one patient reporting the additional loss of non-scalp hair. Five patients reported that complete regrowth had not occurred by the time they attended the clinic. There were no significant differences in demographic variables between the patients with and without alopecia.

The percentage of patients reporting alopecia was lower (17% versus 35%) than that reported by Scott et al. ⁴ This could be due to the higher injury severity and longer median length of stay reported in the military cohort. The military cohort was also younger and all patients male, so further research into age and sex as risk factors for alopecia may be warranted. On analysis, no significant differences were found between the patients with and without alopecia in terms of age, sex, primary admission diagnosis and APACHE II score. There are a number of potential causes for the alopecia in this patient cohort, including the severity of the critical illness, presence of fever, medications received, pre-morbid conditions and blood loss during surgery. A multicentred, prospective study is planned to investigate predictors in more detail.