Alopecia Severity Linked to Worse Patient Quality of Life Perspective


A new cross-sectional survey assessment shows patients more severe disease report worse survey outcomes on emotional wellbeing and social activity.

Russel Thomas Burge, PhD, MA

Russel Thomas Burge, PhD, MA

Alopecia areata burden, in metrics of both emotional and physical form, are greater among patients with severe disease, according to new findings.

In new research presented at the American Academy of Dermatology (AAD) Virtual Meeting Experience this weekend, a team of investigators reported cross-sectional US survey results showing outcomes including activity and work impairment, as well as quality of life, were notable influenced by severe forms of alopecia areata.

The common form of hair loss is prevalent in nearly 7 million Americans, according to recent estimates, without any curative treatment available.

Led by Russel Thomas Burge, PhD, MA, senior research advisor of Eli Lilly & Company, investigators sought to interpret patient-reported forms of lifestyle burden brought on by alopecia areata, stratified by disease severity. As they noted, patient perspective-driven interpretation of the disease is fairly limited.

Burge and colleagues drew data from the 2019 AA Disease Specific Program, which featured surveyed perspective from US-based dermatologists and patients. The cross-sectional survey recorded physician-subjective submissions of alopecia patients’ alopecia severity. Each patient was invited to complete questionnaires including the Skindex-16, the Work Productivity and Activity Impairment (WPAI) questionnaire, and the 5-level EQ-5D (EQ5D-5L) questionnaire for quality of life status.

Investigators used an analysis of variance (ANOVA) test to compare patient survey outcomes by severity of alopecia areata defined by physicians.

Their assessment included 261 patients who completed a survey.


Subscale scores for the Skindex-16 assessment showed that increasing alopecia areata severity was associated with significantly greater disease burden on emotions (mild, 39.6; moderate, 56.6; severe, 63.1; P <.0001), symptoms (mild, 10.1; moderate, 18.2; severe, 20.8; P = .0265), and functioning (mild, 17.0; moderate, 28.8; severe, 36.4; P = .0018).


Investigators observed worsened WPAI scores relative to disease severity on outcomes for overall work impairment (mild, 4.9; moderate, 12.5; severe, 18.4; P = .0013) as well as activity impairment (mild, 7.1; moderate, 12.3; severe, 19.7; P = .0007).


Again, investigators observed worsened outcomes relative to more severe alopecia areata. Quality of life, per EQ5D-5L, decreased based on disease state (mild, 0.95; moderate, 0.93; severe, 0.87; P = .007).

Burge and colleagues noted that the most impacted domains of health-related quality of life due to disease severity were in outcomes from Skindex-16 and in activities outside of work, per WPAI. As such, they concluded the findings show a correlation between emotional and physical burden and more severe alopecia areata.

“Interventions which can prevent, delay, or reverse the progression to severe disease are likely to have the greatest impact on patients’ HRQoL and emotional burden,” they wrote.

The study, “The Patient-Reported Burden of Alopecia Arearta by Current Severity: A Real-World Study in US,” was presented at AAD VMX.

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