Treatment of Multiplex Alopecia Areata Utilizing Transactional Analysis: A Case Study
The patient was a 13-year-old woman. 6 years previously, she developed an alopecia location when her moms and dad divorced. One year after that, the bald location drastically broadened when her mother remarried. She was treated at her local healthcare facility; however, no enhancement was observed. She then visited our medical facility for examination. A bald patch was covering > 80% of her head.
Self Grow-Up Egogram suggested the basic interpersonal relationship stance of ‘I am not OK, You are OK’. We, therefore, executed a transactional analysis technique to increase the client’s score on the Free Child subscale. New hair development was observed after 6 months and the bald spot disappeared after 2 years. Our outcomes suggest that this method could likewise be quickly used in a scientific setting by skin doctors.
© 2014 S. Karger AG, asel
Alopecia areata (AA) is a persistent inflammatory disease that establishes in hair roots and seldom in the nail plate  Studies recommending a relationship in between AA and mental stress have been often reported; these research studies consisted of both animal experiments and clinical research study [2,3,4] The autoimmune theory that AA is caused by T cells determining hair roots as autoantigens is thought about highly plausible [5,6] However, to date, no study has actually scientifically shown this relationship.
We dealt with the present pediatric case of AA that established as a result of the divorce of the client’s moms and dads and the remarriage of her mom. We describe the transactional analysis approach to AA, which is a type of psychotherapy and appears to have entirely cured AA in this patient.
The client was a 13-year-old woman with a history of nocturnal enuresis. Her moms and dad divorced 6 years previously. Ever since circular bald spots appeared on her head; these patches displayed repeated brand-new development and hair loss. She received treatment for this condition at her local health center.
Her mom remarried 1 year later on. Ever since her loss of hair ended up being acutely worsened; for that reason, she was examined at her local healthcare facility once again. She underwent treatment with externally and internally administered corticosteroids in addition to liquid nitrogen treatment.
This treatment did not completely treat her condition, and she was hence examined at our health center. Bald spots of various sizes had merged to form one big reticular bald patch. The area of hair loss surpassed 80% of the patient’s head (fig. 1). Her eyebrows and eyelashes were undamaged. Peripheral blood and biochemical tests revealed no aberrations, and autoantibodies and thyroid hormones were within the recommendation ranges.
The results of psychological screening were as follows: Self-Rating Anxiety Scale 47 points, State-Trait Anxiety Inventory, state stress and anxiety 48 points (high), and State-Trait Stress and anxiety Stock, characteristic stress and anxiety 63 points (extremely high).
Among the outcomes of the Self Grow-Up Egogram (SGE), the score on the Nurturing Moms And Dad (NP) subscale were the highest which on the Free Kid (FC) subscale was the most affordable (fig. 2). This information recommends the standard social relationship stance of ‘I am not OK, You are OK’.
Genuine positive affirmations, such as ‘you are important to us even if you lose your hair’, were consistently provided. In addition, we tried to increase the FC ego state on SGE. In particular, when the patient went through outpatient assessments, she was encouraged to speak about a minimum of one intriguing episode that had taken place in her everyday life. Six months later on, brand-new hair development appeared when she acquired the capability to proactively talk about herself. 2 years later on, the bald spot had entirely disappeared.
There has been no recurrence of any bald spots for 5 years because her initial assessment (fig. 3). While speaking about her sensations during her illness, she stated, ‘When I was experiencing duplicated loss of hair, I could not forgive myself for losing my hair. Thinking of it now, I feel that I was blaming myself exceedingly.’
Fig. 1 Alopecia Areata Figures
Scientific function on preliminary assessment. Bald patches of differing sizes had combined to turn into one large reticular bald patch. The area of loss of hair went beyond 80% of the patient’s head.
Outcomes of SGE. The patient had the frame of mind ‘I am not OKAY, You are OK’ relating to interpersonal relationships. In this case, the NP subscale had the highest score and the FC subscale the lowest. CP = Vital Parent; NP = Nurturing Moms And Dad; A = Adult; FC = Free Child; A/C = Adjusted Kid.
Scientific function 5 years after our preliminary assessment. No recurrence of bald spots was observed.
Discussion Alopecia Areata A-A
The seriousness of AA on preliminary assessment is considered a strong long-term prognostic aspect. The recovery rate of patients with a location of hair loss covering ≥ 50% of their head is 8%  Cases of intractable AA, such as ours, are treated with systemic administration of steroids and regional immunotherapy.
But treatment is frequently unsuccessful  One report shows that in a mouse model of AA caused by tension an antidepressant drug, tianeptine, is effective  Our patient experienced negative life events (divorce of her parents and her mom’s remarriage) when AA onset and exacerbation happened; therefore, it is most likely that psychosocial aspects were involved.
Our company believes that there would be severe threats involved in prescribing antidepressants to a teen and for that reason chose to attempt the transactional analysis technique.
Transactional analysis is a mental theory proposed by Eric Berne  According to this theory, each person is made up of 3 ego states; Moms and dad, Grownup, and Kid. In the program, the moms and dad alter ego is divided into the nurturing and important components, and the child alter ego is divided into the adjusted and free aspects, hence forming the five functional ego states: Crucial Moms and dad (CP), NP, Adult (A), FC and Adapted Kid (Air Conditioning)  SGE was developed by the Japanese scientist (T. Katsura) as a standardized approach for assessing personality  SGE includes 50 statements that can be classified into the 5 practical ego states.
Respondents indicate the degree of their agreements with each statement using a three-point scale: concur, disagree and neither concur nor disagree, ball games for which are 2, 0 and 1, respectively  SGE allows for mental counseling utilizing feedback from program patterns  We had the ability to help the client to alter her way of thinking from ‘I am not OK, You are OKAY’ to ‘I am OK, You are OK’ by raising the FC state. This change helped her to accept herself with her loss of hair, and this approval appears to have minimized the stress.
Transactional analysis is an easy-to-understand useful psychosomatic treatment. We believe that this approach could likewise be quickly utilized by dermatologists and may reveal a common language between the caretaker and the patient.