205 Nursing Assessment, Management and Treatment of Autoimmune Diseases
typically implemented on a weekly basis. ● Methotrexate : This medication may be prescribed when other treatments fail to be effective. | NURSING CONSIDERATION Methotrexate is also used to treat leukemia and various malignancies including cancers of the breast, skin, head, neck, lung, or uterus. It is also used to treat severe psoriasis and rheumatoid arthritis in adults. Metho - trexate can cause serious, even fatal, side effects (Entringer, 2020). Such side effects include bone marrow, liv- er, lung, and kidney toxicities, soft-tis- sue necrosis, osteonecrosis, severe bone marrow suppression, aplastic anemia, gastrointestinal toxicity, hem- orrhagic enteritis, and intestinal perfo- ration (Comerford & Durkin, 2021). ● Corticosteroids : Taking corticosteroids for about 6 weeks may help hair growth in the presence of widespread alopecia areata. ● Janus kinase (JAK) inhibitors : These types of medications may treat extensive hair loss. Examples include tofacitinib, ruxolitinib, and baricitinib. ● Wigs, hairpieces, or scalp prosthesis : Use of these items may cover up hair loss. Nursing interventions Nurses are typically involved in patient/ family education. They take a lead role in education regarding accurate medication administration, adherence to treatment regimen, and psychosocial support. In the case of patients who are dealing with alopecia areata, body image changes may have psychological consequences,
therefore, mental health is an aspect of care that nurses must assess. Although the symptoms of alopecia areata typically do not cause physical pain, psychological pain may become a serious problem (National Alopecia Areata Foundation, n.d.). EVIDENCE-BASED PRACTICE An analysis of U.S. hospitalizations found that alopecia areata patients are at risk for anxiety disorders, at- tention-deficit hyperactivity disorder, dementia, mood disorders, personal- ity disorders, and suicide or intention- ally self-inflicted injury. It was unclear if psychological stress might cause or exacerbate alopecia areata, or wheth- er alopecia areata can lead to or wors- en mental health disorders (Singam et al., 2018). A diagnosis of alopecia areata in chil- dren can be just as, or even more, upset- ting for parents. Parents of these children have reported that they feel a sense of “guilt” as though they had somehow con- tributed to the development of the dis- ease or cannot stop its progression (Na- tional Alopecia Areata Foundation, n.d.). Parents (and other caregivers) are urged to avoid being overly protective or per- missive with their children. They should identify a support network to help them manage stress. Parents are also encour- aged to speak directly to their children about their alopecia areata and urge the children to talk about their feelings about living with alopecia areata (National Alo- pecia Areata Foundation, n.d.). Children with alopecia areata are at risk for emotional distress, anxiety, depres- sion, and sadness. Children may not be
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