Quality of Life Measures in Alopecia Areata: Patients perceived severity matters!.

What factors are associated with altered quality of life in alopecia areata?

Alopecia areata can affect the way patient’s feel about themselves. In a 2016 study meta-analysis by Liu et al, the impact of AA on health-related quality of life (QoL) was similar as atopic dermatitis or psoriasis (Liu et al., 2016). It is well accepted that alopecia areata can impact anxiety, depression, low self-esteem and sleeping.

It’s increasingly clear that simply estimating the amount of scalp hair loss does not always accurately predict how patients feel about their hair loss and the impact on quality of life. Other factors are relevant and need to be considered as we come to determine how severe a person’s alopecia areata is for them. A patient with 30 % scalp hair loss but loss of eyebrows and eyelashes may have more severe disease than someone with 70 % hair loss but unaffected eyebrows and eyelashes.

Senna et al, 2022

A new study by Senna and colleagues set out to evaluate the factors that predict altered quality of life in patients with alopecia areata.

259 patients were surveyed for demographics, AA illness characteristics, as well as various quality of life indices including QoL (Skindex-16 AA), and daily impairment (Work Productivity Activity Impairment [WPAI]).

The mean age of patients was 39 years and about half were male and half female. Nearly all patients (96%) presented with scalp hair loss, followed by eyebrow loss (20%), eyelash loss (14%), facial hair (14%), body hair (9%) and nail (9%) involvement. 21 % of patients rated their AA as mild, 54 % as moderate (54%), and 25 % as severe.

Interestingly, the degree of physician rated scalp hair loss (SALT score) was not predictive of QoL. However the patients’ self-report of moderate or severe disease, gender (females more impacted), and eyebrow and eyelash involvement were predictors of diminished QoL.

Conclusion

These results add to a growing body of literature that highlight the importance of patient’s perceptions as well as the importance of eyebrow and eyelash loss. It’s clear that evaluation tools to evaluate severity of alopecia areata are going to require us all to ask patients how they are doing rather than only resorting to counting hairs on the scalp.

The presence of eyebrow and eyelash loss is correlated with more severe impact on quality of life and may trigger the clinician to consider more aggressive treatments regardless of the degree of perceived scalp hair loss.

REFERENCE

Senna M et al. Predictors of Quality of Life in Patients with Alopecia Areata. J Invest Dermatol 2022 Mar 21;S0022-202X(22)00208

Liu LY, King BA, Craiglow BG. Health-related quality of life (HRQoL) among patients with alopecia areata (AA): A systematic review. J Am Acad Dermatol 2016;75(4):806- 12.e3.