Few Patients With Alopecia Areata Are Willing to Undergo Treatment

Most patients with alopecia areata (AA) reported that severe health risks are not acceptable when undergoing treatment, and stinging/burning is the only risk that most would tolerate, according to findings from a study published in the Archives of Dermatological Research.

Investigators sought to characterize the willingness of patients with AA to undergo treatment via a secondary data analysis of a Burden of Disease Survey conducted by the National Alopecia Areata Foundation (NAAF) in 2019. The current analysis included only patients with AA who lived in the United States and had been diagnosed with AA by a doctor.

A total of 2329 patients responded to the survey, of whom 1789 were included. Among the responders, 80.28% were women, the median age was 44 (±33) years, and the median time since disease onset was 10 (±22) years. Alopecia universalis was the most common disease severity (38.49%), and 96.48% of patients reported hair loss on the scalp.

The most acceptable treatment side effect for participants was stinging/burning (75.07%), and the least acceptable side effect was risk for skin cancer (11.79%). The most acceptable treatment administration type was topical, with 74.18% of patients willing to accept it, and injection at site of hair loss was the least acceptable type of administration (44.66%).

When asked what percentage of hair regrowth would make treatment worthwhile, the patients’ responses were categorized according to whether the amount of hair regrowth would be considered cosmetically acceptable. Of the group, 47.51% responded that any hair regrowth was worth undergoing treatment for and 52.59% stated that only cosmetically acceptable hair regrowth was worthwhile.

For female patients, the odds of accepting the risk of affecting blood/organs were 0.3003 (0.0887, 0.4629) times less than those odds in male patients (P =.0081). The odds of accepting the risk for skin cancer in female patients were 0.3210 (0.0518, 0.5138) times less than those in male patients (P =.0231). In addition, the odds of accepting injection at site of hair loss in female patients were 0.4828 (0.1664, 0.8852) times greater than those odds for male patients (P =.0013).

The odds of the scalp being the most important location of hair regrowth in female patients were 1.3275 (0.8152, 1.9843) times greater than those in male patients (P <.0001). The odds of the face being the most important location in female patients were 0.6623 (0.5494, 0.7469) times less than those in male patients (P <.0001).

No significant relationship was observed in female patients between age and willingness to accept the risk for affecting blood/organs. For male patients, the odds of accepting the risk of affecting blood/organs were 0.1966 (0.0748, 0.3321) times greater with a 10-year increase in age (P =.0010).

For female patients, the odds of only considering cosmetically acceptable hair regrowth worthwhile were 0.0244 (0.0099, 0.0390) times greater with an increase of 4 years since disease onset.

Among study limitations, cosmetically acceptable hair regrowth was considered to be 80% increase from a baseline of no hair on the head, and the researchers were unable to account for patients who were not completely bald, which may have led to some bias. Also, the measure of disease severity was self-reported, and there may have been a subjective bias in how patients classified their disease severity.

“The results of this study suggest that while patients are willing to tolerate mild side effects when undergoing treatment, severe health risks are not considered acceptable and painful methods of treatment administration may be a deterrent to some patients,” the study authors commented.

Reference

O’Connor LF, Wells KM. Characterizing the willingness to undergo treatment in patients with alopecia areata. Arch Dermatol Res. 2022;314(8):749-757. doi: 10.1007/s00403-021-02286-z