In Patients With Alopecia Areata, Shared Decision Making Increases Satisfaction

Alopecia Areata

Hair changes are another common finding in patients with thyroid disorders. In patients with hypothyroidism, hair can become thin, dry, coarse, and brittle, often resulting in accelerated hair loss.10 Patients also have a longer duration and higher percentage of hairs in the telogen phase, the resting phase after the hair has fallen out and during which the follicle remains inactive before a new hair growth cycle begins, further contributing to diffuse or partial (pictured) alopecia of the scalp. There may also be loss of hair on the outer third of the eyebrow and diminished body hair. As with nail changes in these patients, there is a higher risk of fungal infection, with Candida folliculitis sometimes reported.3

Patients with hyperthyroidism often have fine or soft hair.3 Loss of pigment or premature development of gray hair have also been reported as early symptoms.4 As with hypothyroidism, patients may have partial or diffuse alopecia. Image credit: Dr P. Marazzi / Science Source

Patient preferences for shared decision making and its link to decisional regret are investigated.

Patients with alopecia areata (AA) prefer to make treatment decisions with their dermatologist with use of shared decision making (SDM), researchers reported in a study published in JAMA Dermatology.

The findings are based on a cross-sectional study that used an online survey to assess patient preferences in SDM during AA treatment decision making and to determine which aspects of their involvement and treatment decisions are associated with lower decisional regret and improved satisfaction.

The survey was distributed to a sample of patients from the National Alopecia Areata Foundation (NAAF) from July 12, 2021, to August 2, 2021, and data analysis was conducted from October 2021 to March 2022. Of 1387 individuals who initiated the survey, 1074 completed it (77.4%). Most respondents (85.4%) were women 85.4% and White (77.8%), with a mean (SD) age of 49.3 (15.4) years. Participants had a diagnosis of AA for a mean (SD) of 17.7 (15.4) years, and 28.8% indicated steroid injections as their last treatment used.

A total of 503 participants (46.8%) preferred to make the final treatment decision themselves after considering the opinion of their physician. Also, 708 participants (65.9%) stated that they made their last treatment decision together with their physician, with 283 (26.4%) patients making the decision themselves and 83 (7.7%) leaving the decision up to their physician. A majority of patients who preferred to make treatment decisions with use of SDM made the last AA treatment decision with their physician (596 [55%]; 95% CI, 53%-58%; P <.001).

SDM components that were most identified as part of the patients’ last AA treatment decision were that their physician “explained the advantages and disadvantages of treatment options” (472 [44%] completely or strongly agreed) and “asked me which treatment option I prefer” (494 completely or strongly agreed [45.9%]). All SDM components were significantly associated with decreased decisional regret (all odds ratios [ORs] with 95% CIs >1.1; P <.001) except for “doctor made clear that a decision needs to be made” (OR, 1.45; 95% CI, 0.88-2.37; P =.14).

Regarding decisional regret for their last AA treatment decision, about half of the patients (559 [52%]) believed that they made the right decision and stated that they would make the same choice again (546 [50.8%]). A total of 62 participants (5.8%) believed that the decision did them harm.

For specific treatment choices and whether they would make the same choice again, 74.5% who used Janus kinase inhibitors, 60% who used biologic agents, 49.8% of those who used steroid injections, and 55.9% who made the decision to not treat, respectively, would do so again. In contrast, only 44.4% of those who used anthralin and 37.3% who used minoxidil would “make the same choice again.”

Among several study limitations, the participants were recruited from the NAAF and most were White women with long-term AA. Also, the survey did not collect data regarding the role of culture and religion in decision making, and it did not consider previous treatment modalities.

“The findings of this cross-sectional survey study elucidate patient preferences for treatment decision-making in the context of AA, a complex disease with a myriad of existing and emerging treatment options,” stated the researchers. “Patients preferred to make AA treatment decisions using SDM, which was associated with less decisional regret. Regardless of the treatment choice, implementing components of SDM may help improve the quality of treatment decisions patients make by allowing them to choose treatment options that align with their values and preferences.”

Disclosure: Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Reyes-Hadsall S, Drake L, Han JJ, et al. Shared decision-making, therapeutic choice, and decisional regret in patients with alopecia areata. JAMA Dermatol. Published online August 17, 2022. doi:10.1001/jamadermatol.2022.3025