Components of Severity in Alopecia Areata.

Introduction: Severity of alopecia areata (AA) has been commonly defined by clinician assessment of scalp hair loss. Our aim was to characterize patient-reported factors beyond scalp hair loss that contribute to AA severity while modifying for socioeconomic factors.

Methods: Patients with AA were recruited to take a survey. Multivariable linear regression was performed to evaluate lifetime AA severity while adjusting for socioeconomic variables, current AA severity at the time of survey, and patient-reported disease burden.

Results: Patient-reported AA severity was associated with scalp hair loss (OR: 4.19, 95% CI: [1.35-13], p = 0.013), facial hair loss (OR: 3.55, 95% CI: [1.75-7.21], p < 0.001), increased financial burden (OR: 2.41, 95% CI: [1.21-4.8], p = 0.013), and greater emotional burden (OR: 2.96, 95% CI: [1.48-5.93], p = 0.002), while presence of comorbidities were linked to less severe AA (OR: 0.38, 95% CI: [0.17-0.84], p = 0.017).

Conclusion: Survey population was homogeneous and may not reflect the general community with AA. Self-reported data may introduce recency or recall bias. Scalp and facial hair loss, along with emotional and financial burdens, correlate with increased patient-reported AA severity. This suggests factors beyond scalp hair loss should be considered when assessing AA severity.