Alopecia Areata Has Significant Effect on Quality of Life in Adult, Pediatric Patients

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Issues with self-image contribute to poor health-related quality of life in patients with alopecia areata.
Issues with self-image contribute to poor health-related quality of life in patients with alopecia areata.

The negative impact of alopecia areata (AA) on health-related quality of life (HRQoL) in both children and adults with the disorder is widespread, affecting the patients, as well as their parents and/or spouses, according to the results of a study conducted via anonymous questionnaire and published in the Journal of the American Academy of Dermatology.

The investigators developed a Qualtrics questionnaire that contains several HRQoL instruments, including the Dermatology Life Quality Index (DLQI) for patients with AA age ≥17, the Children's Dermatology Life Quality Index (CDLQI) for patients with AA between age 4 and 16, the Family Dermatology Life Quality Index (FDLQI) for adult family members, and 2 depression screens — the Patient Health Questionnaire for adolescents (PHQ-9-A) age 12 to 17 and the PHQ-9 questionnaire for adults.

A total of 292 adults, 91 children, and 229 family members were included in the analysis. Overall, adults had tried 2.9±1.4 and children had tried 2.1±1.4 medical therapies, including various procedures and medications. Moreover, 37.9% of participants reported having attempted to use alternative treatments for AA, most often herbal remedies.

Impairment in HRQoL was reported by 77.1% of adults (mean DLQI, 7.7±7.4). Patients were most often affected by feelings of embarrassment and self-consciousness, followed by effects on social and leisure activities. Older age at the time the questionnaire was administered was predictive of significantly worse HRQoL (P =.0148).

In children age 4 to 16, 78.1% with AA reported impairment in HRQoL (CDLQI, 6.3±5.9). In this age group, feelings of self-consciousness and skin symptoms were the most commonly cited reasons. Having a history of consultation with a mental health provider predicted significantly worse HRQoL (P =.00757). In addition, poor DLQI and CDLQI scores were significantly associated with poor scores on the depression screen (r=0.560; P <.001 and r=0.417; P =.0196, respectively).

Family members reported a mean FLDQI of 6.7±6.1, with emotional distress being the most frequently and severely affected measure of HRQoL. In families of children with AA, the burden of care was high, with expenditures >$5000 predictive of worse HRQoL (P =.00128). Significantly worse FDLQI was reported by families of children with AA compared with families of adults with AA (8.5 vs 5.6, respectively; P =.00028). Moreover, poor FLDQI in adults and in children was associated with poor scores on the depression scale (r=0.465; P <.001 and r=0.694; P <.001, respectively).

The investigators concluded that the results of this study underscore the need not only for effective treatments for adults and children with AA, but also for the evaluation of the impact of AA on patients and their families in order to recognize patients who might benefit from early psychological assessment.


Liu LY, King BA, Craiglow BG. Alopecia areata is associated with impaired health-related quality of life: a survey of affected adults and children, and their families [published online February 6, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.01.048

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