A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic

To the Editor,

Alopecia areata (AA) in children is frequently associated with anxiety and depression, which can worsen treatment response and reduce satisfaction with care.^1,2 While therapy dogs have been shown to reduce stress, anxiety, and improve well-being in pediatric clinical settings, their role in dermatology has not been studied. Children with AA and comorbid anxiety or depression may particularly benefit, as animal-assisted interventions can reduce acute distress and improve procedural engagement.^3,4 The aim of this pilot study was to assess whether implementing a therapy dog in a pediatric dermatology AA clinic could help alleviate patients’ anxiety surrounding their visit.

This study was approved by the SickKids Research Ethics Board and conducted at the SickKids Dermatology AA Clinic (Toronto, Canada) between February and November 2025, in partnership with the St. John Ambulance Canada. Patients were eligible if 3 to 17 years old with an appointment in the AA clinic; exclusion criteria included fear of dogs, or inability to complete the questionnaires. Participants were offered a one-time voluntary visit after their appointment, with a single handler-dog team and no set duration. The handler introduced the dog, facilitated interaction, and provided a photo (“business card”) as a keepsake. Questionnaires (Supplemental Figures 1 and 2) were administered before and after the therapy dog interaction. The pre-intervention questionnaire included Patient-Reported Outcomes Measurement Information System (PROMIS) ⁵ anxiety items and self-reported anxiety levels on a visual scale (0 = most anxious, 10 = happy/relaxed). The postintervention questionnaire reassessed anxiety and asked how the therapy dog made the patient feel, using the same 0 to 10 visual scale. Severity of Alopecia Tool (SALT) scores were obtained from the electronic medical record on the day of the visit. Descriptive statistics and t-tests were used to analyze changes in anxiety levels.

In total, 10 pediatric patients with AA were included in the pilot study, (average age 8.2 years, 50.0% males, 50.0% females) (Supplemental Table 1). Four patients (40.0%) had AA total is and 6 patients (60.0%) had patchy AA. Four patients (40.0%) owned pets, and 2 others (28.6%) reported frequent contact with a relative’s pet. Before the therapy dog encounter, the PROMIS anxiety T-score was 45.1 ± 7.3, indicating mild anxiety, and the mean visual anxiety rating was 6.7 ± 2.9 (0 = most anxious, 10 = happy/relaxed). Following the interaction, visual anxiety ratings significantly improved to 9.3 ± 1.4 (t = 2.5, P = .02) (Supplemental Table 2). When asked how the therapy dog made them feel, patients reported a similar mean score of 9.7 ± 0.7 on the same visual scale. Qualitative feedback supported these findings, with 1 patient noting that “having the dog was nice,” and another stating that the dog “makes me feel happy.”

Study limitations include the small sample size, subjectivity of patient-reported responses, and communication challenges related to the young age of participants.

This pilot study suggests that therapy dogs may reduce anxiety among children with dermatologic conditions with known associated mental health comorbidities, such as AA. Future research should examine larger cohorts to evaluate the impact of therapy dogs not only on anxiety in children but also on pain perception during dermatologic procedures.

Therapy dogs represent a low-cost, low-resource intervention that may enhance the pediatric dermatology experience and be feasibly implemented across diverse clinical settings.

Supplemental Material

sj-docx-1-cms-10.1177_12034754251410191 – Supplemental material for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic

Supplemental material, sj-docx-1-cms-10.1177_12034754251410191 for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic by Megan Park, Samiha Mohsen and Cathryn Sibbald in Journal of Cutaneous Medicine and Surgery

Supplemental Material

sj-docx-2-cms-10.1177_12034754251410191 – Supplemental material for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic

Supplemental material, sj-docx-2-cms-10.1177_12034754251410191 for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic by Megan Park, Samiha Mohsen and Cathryn Sibbald in Journal of Cutaneous Medicine and Surgery

Supplemental Material

sj-docx-3-cms-10.1177_12034754251410191 – Supplemental material for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic

Supplemental material, sj-docx-3-cms-10.1177_12034754251410191 for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic by Megan Park, Samiha Mohsen and Cathryn Sibbald in Journal of Cutaneous Medicine and Surgery

Supplemental Material

sj-docx-4-cms-10.1177_12034754251410191 – Supplemental material for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic

Supplemental material, sj-docx-4-cms-10.1177_12034754251410191 for A Pilot Study on the Use of Therapy Dogs to Reduce Anxiety in a Pediatric Alopecia Areata Clinic by Megan Park, Samiha Mohsen and Cathryn Sibbald in Journal of Cutaneous Medicine and Surgery