Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia

Background: Hair loss may significantly impact an individual's self-image, and studies indicate that patients with both clinically apparent and clinically imperceptible hair loss may have significantly decreased quality of life (QoL). Moreover, clinical severity of hair loss does not necessarily predict impact on QoL. Objective: The aim of this study was to assess QoL in patients (n = 104) with alopecia areata, telogen effluvium, and androgenic alopecia, and to compare QoL with hair loss severity (HLS) as independently rated by both patient and dermatologist. Methods: Questionnaires and clinical assessment tools were used to assess HLS, and QoL was measured by completion of Skindex-16. Results: Overall, patients rated their hair loss as more severe than the dermatologist, and the patient's HLS rating more strongly correlated with QoL than the dermatologist's rating. Clinical assessment of HLS did not reliably predict the patient's QoL, nor did it predict the patient's perception of HLS. Limitations: A convenience sample was recruited from a referral clinic and Skindex-16 has not been validated for use in women's alopecia disorders. Conclusion: These findings indicate dermatologists should address these psychosocial and QoL issues when treating patients with alopecia.