ORIGINAL ARTICLE Distinct temperament and character profiles in first onset vitiligo but not in alopecia areata Gamze ERFAN, 1 Yakup ALBAYRAK, 2 M. Emin YANIK, 1 Ozden OKSUZ, 2 Kaan TASOLAR, 1 Birol TOPCU, 3 Cuneyt UNSAL 2 Departments of 1 Dermatology, 2 Psychiatry, and 3 Biostatistics, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey ABSTRACT Alopecia areata (AA) and vitiligo (V) are diseases that are correlated with psychiatric disorders before, during and after diagnosis. The Temperament and Character Inventory (TCI) is a well-established approach for investi- gating personality traits in various psychosomatic diseases. The aim of this study is to compare and investigate the differences in the TCI between patients with first onset AA, patients with V and healthy controls (HC). Partici- pants in the study included 42 patients with first onset AA, 50 adult patients with V and 60 HC who had no history or diagnoses of psychiatric or dermatological disorders. All participants were assessed with the TCI and the Dermatology Life Quality Index (DLQI). Among the temperament traits, the extravagance, disorderliness and total novelty-seeking scores were lower, and the worry and pessimism scores were higher in patients with V com- pared with patients with AA and the HC. The mean score of the enlightened second nature and the total self- directedness score of the character traits were higher in patients with V compared with patients with AA and the HC group. In the AA group, there was a negative correlation only between the reward dependence total score and the DLQI score. This study suggests that patients with first onset V have a distinct temperament, such as being unenthusiastic and unemotional, and character profiles, such as worry and pessimism, independent of their psychiatric comorbidities, and patients with AA do not have a different personality from the non-affected population. Key words: alopecia areata, character, Temperament and Character Inventory, vitiligo. INTRODUCTION Skin diseases are usually associated with psychiatric symp- tomatology. Because skin diseases can be seen by others and this state can create stressful events for the individual, it is dif- ficult to establish whether psychiatric disorders are the causes of the skin disease. 1 Alopecia areata (AA) is a clinical condition that presents with a non-scarring hair loss that can be seen on the scalp and hair-covered areas without skin changes. 2 The lifetime preva- lence of AA is approximately 1.7%. Environmental and genetic factors are suspected in the etiology of AA. 3 Emotional stress is an important part of the environmental factors in the etiology of AA. 3,4 Evidence has shown that various psychiatric disorders such as anxiety disorders, paranoid disorders and depression are seen in patients who suffer from AA. 5–7 The lifetime preva- lence of any psychiatric disorder has been estimated at approximately 74%, and major depressive disorder and gener- alized anxiety were reported as the most common psychiatric disorders among patients with AA. 8 In addition to this high percentage of psychiatric comorbidities in patients with AA, studies have concluded that there is no association between the onset of AA and mood and anxiety disorders. 9,10 Further- more, no association was reported between hair regrowth and psychological well-being in patients with AA in a study conducted by Kose et al. 11 The prevalence of vitiligo (V) is estimated at approximately 1–4%. 12 It does not cause pain or physical limitations; how- ever, patients with V experience a high degree of social func- tional impairment. 13 Numerous studies have investigated the association between psychiatric disorders or symptoms and V. Patients with V have been reported to have high anxiety scores, depressive disorder, generalized anxiety disorder, social phobia, obsessive symptoms and hypochondria, high rates of alexithymia and avoidant behavior, and high rates of sleep disturbances. 14–18 Furthermore, stigmatization may have a strong negative psychosocial impact on patients who suffer from V. 19 In addition, a limited number of studies have aimed to identify the temperament and character profiles of patients with V. To our knowledge, only two studies (one in adults and one in a pediatric group) have examined temperament and character traits in patients with V. 20,21 Correspondence: Gamze Erfan, M.D., Department of Dermatology, Namık Kemal Universitesi Uygulama ve Arastırma Hastanesi Dermatoloji, Pol- iklinigi Tunca Cad. 100. Yıl mah, Tekirdag, Turkey. Email: gamzeerfan@gmail.com Received 25 March 2014; accepted 4 June 2014. © 2014 Japanese Dermatological Association 709 doi: 10.1111/1346-8138.12553 Journal of Dermatology 2014; 41: 709–715