Physician- and Patient-Reported Severity and Quality of Life Impact of Alopecia Areata: Results from a Real-World Survey in Five European Countries

IntroductionAlopecia areata (AA) can negatively affect quality of life (QoL) and is associated with increased prevalence of anxiety and depression (vs people without AA). This study compared physician-assessed and patient self-rated severity of AA in a European sample and described the patient-reported burden of AA stratified by physician-assessed severity.MethodsReal-world data were collected from the Adelphi Real World AA Disease Specific Programme (TM), a retrospective point-in-time cross-sectional survey of dermatologists and their adult patients with AA in five European countries (France, Germany, Italy, Spain, UK). Physicians provided clinical data and an AA severity assessment, according to their own definition of 'mild', 'moderate' and 'severe'. Patients were invited to provide their perception of AA severity and completed patient-reported outcome (PRO) questionnaires, including Skindex-16 for AA (Skindex-16 AA), EuroQol-5-dimension questionnaire 5-level (EQ-5D-5L), Hospital Anxiety and Depression Scale and the Work Productivity and Activity Impairment Questionnaire.ResultsData for 2083 patients were collected by 239 physicians; 561 of these patients completed PRO questionnaires. In 78.5% of cases with available data (N = 549), there was alignment between patient and physician-rated AA severity (severity was rated higher by physicians in 15.7% of cases, by patients in 5.8% of cases). Data from all PRO instruments showed an increase in patient-reported burden and work and activity impairment with increasing physician-rated AA severity. For the Skindex-16 AA, the Emotions scale had the worst scores; anxiety/depression was the EQ-5D-5L dimension with the highest percentages of patients reporting any perceived problem.ConclusionsThese data highlight the significant impact that AA can have beyond hair loss, especially for patients with severe AA. There was substantial physician-patient alignment on severity assessment. Higher physician-rated AA severity was associated with higher levels of patient-reported disease burden, including anxiety and depression, and work and activity impairment. These data may help inform appropriate treatment strategies. Alopecia areata (AA) can negatively affect quality of life and is associated with increased prevalence of anxiety and depression (vs people without AA). This study used surveys of adult patients with AA in Europe and their dermatologists to compare how doctors and patients assess AA severity. We also looked at how patients rate the overall burden and broader effects of AA (not just hair loss) according to whether their doctor classed their AA as 'mild', 'moderate' or 'severe'. Data for 2083 patients were collected by 239 doctors; 561 patients completed questionnaires about their AA and its potential effects on their quality of life, mental health and ability to work or perform other activities. In 78.5% of cases (from 549 patients with both patient and doctor-rated severity), patients and their doctors agreed on the same AA severity category (mild, moderate or severe). However, in 15.7% of cases, doctors rated AA severity as being higher than reported by the patient, and in 5.8% of cases the patient classed their AA as being more severe than reported by the doctor. Data from patient questionnaires showed that the burden associated with AA was higher in patients with more severe AA (as per their doctor's own definition of severity); anxiety/depression was the most commonly reported problem related to quality of life. This study highlights the significant impact that AA can have beyond hair loss, especially for patients with severe AA. Information from this study may help to inform appropriate treatment strategies for people with AA.