Patient-Reported Psychosocial Burdens and Quality of Life and Work Productivity Impacts Among Patients with Clinically Distinct Alopecia Areata Severity Profiles

Abstract

Introduction

Alopecia areata (AA) may negatively impact patient quality of life (QoL), disease perception, and work productivity. AA severity is not solely based on scalp hair loss; individuals with AA can experience psychosocial burdens, including emotional symptoms and activity limitations (ES/AL). Our objective was to identify discrete AA severity profiles and evaluate the association with patient-reported outcomes (PROs).

Methods

Dermatologist and patient surveys from the Alopecia Areata Disease Specific Programme in France, Germany, Italy, Spain, and the United Kingdom were analyzed. PRO instruments included the Alopecia Areata Patient Priority Outcomes (AAPPO), Work Productivity Activity Index—AA, Skindex-16 AA, Patient Satisfaction with Hair Growth (P-Sat), and Hospital Anxiety and Depression Scale (HADS). Latent class analysis identified distinct classes using the AAPPO hair loss, ES, and AL response options.

Results

A 5-class model was selected. Each class exhibited distinct profiles based on patient-reported hair loss and ES/AL burden: (1) very mild hair loss, very mild ES/AL (n = 175); (2) mild hair loss, mild ES/AL (n = 165); (3) moderate hair loss, very severe ES/AL (n = 111); (4) severe hair loss, moderate ES/AL (n = 52); and (5) very severe hair loss, severe ES/AL (n = 33). Class 3 reported significantly more overall work impairment [β = 16.3 (95% CI, 7.8–24.7)] than class 1. Overall Skindex-16 AA scores were highest for class 3 [β = 38.7 (95% CI, 33.3–44.2)]. Class 3 reported significantly more HADS anxiety [β = 6.0 (95% CI, 4.9–7.0)] and depression [β = 5.7 (95% CI, 4.6–6.9)] than class 1. Across all P-Sat domains, class 5 reported the least satisfaction with therapy.

Conclusion

Generally, patients with more severe patient-reported hair loss and ES/AL had decreased QoL and satisfaction with care and greater work productivity impairment. Although class 3 had moderate patient-reported hair loss, patients experienced the most severe ES/AL burden, suggesting that AA impacts well-being and daily activities in patients with less extensive hair loss.