Quality of life in alopecia areata: a study of 60 cases.

TO THE EDITOR Alopecia areata (AA) is a chronically relapsing skin disorder characterized by a sudden loss of hair. Because the perception of patients may differ significantly from those of their health-care providers, quality of life (Qol) appears to be a more relevant criterion to assess the severity of this disease than clinical evaluation such as AA extension. To our knowledge, only one Turkish study investigated the impact of AA on Qol using short form 36 (SF36), indicating lower Qol levels compared with sex-matched individuals (Gulec et al., 2004). In this study, Qol was assessed using a generic instrument. Because only three dimensions were affected and results may be linked to the specific culture, a confirmation was needed. We used an approach combining generic and specific measures to assess the impact of AA on French patients’ Qol, to compare Qol levels with those observed in the general population and in other dermatological conditions, and finally to determine the impact of clinical characteristics and sociodemographic factors on Qol. Subjects were aged over 16 years, presenting with a minimum of 8 weeks AA history, having given informed consent to participate, and having the French language as their native language. Sociodemographic data and characteristics of the disease (duration and course, treatments in the recent period, affected surfaces on the scalp and other areas involved) were recorded. The severity of each AA was reported using visual analogical scales (0–10) by reference to (i) all the AA cases seen in daily practice; (ii) all cases of all skin disorders. Three selfadministered questionnaires were used to assess Qol: the generic and worldwide-used SF36 (Leplege et al., 1998, 2001; Coste, 2001), and two ‘‘chronic skin disorders’’-specific Qol instruments with French validated available versions, the VQ-Dermato (Grob et al., 1999, 2009) and the Skindex (Chren et al., 1996, 1997; Leplege et al., 2003). To better figure out the level of QoL in AA, we compared AA scores with those available in literature related to the French population: (1) rare dermatological diseases including hidradenitis suppurativa (Wolkenstein et al., 2007) and neurofibromatosis type 1 (Wolkenstein et al., 2001); (2) chronic/frequent dermatological diseases including psoriasis, chronic idiopathic urticaria, and atopic dermatitis (Grob et al., 2005); (3) general population: French ageand sex-matched controls (Leplege et al., 2001). This study was conducted in adherence to the Helsinki guidelines. Institutional approval was not required for experiments. After having given their inform consent, 60 patients were included (39 women and 21 men); their mean age was 40.1 years (SD 15.2) and median AA duration was 6 years (2 months to 60 years). Course of the disease was stable in 25 subjects and unstable in 35. The median of the scalp surface involved was 77%. The median of severity score was 6.5 (range 4.0–9.0) by reference to the AA patients and 3.5 (range 2.0–6.0) by reference to the patients presenting any skin disorder. Mental health and vitality were the most altered SF36 dimensions, whereas physical functioning, role physical and body pain were the least ones. Regarding VQ-Dermato, daily life, leisure activity, and physical discomfort were the least altered dimensions. For Skindex, emotions dimension was the most affected and symptoms the least one. Compared with the general population and with patients suffering from other dermatological conditions (Table 1), AA patients presented significantly altered Qol for almost all the SF36 dimensions. For VQ-Dermato, AA patients reported (i) significantly better (mood state, leisure activity, daily life, and physical discomfort) or worse scores (self-perception) than psoriasis, chronic idiopathic urticaria, and atopic dermatitis patients; (ii) being less bothered to treatment-induced restrictions than psoriasis, but more than chronic idioAbbreviations: AA, alopecia areata; Qol, quality of life; SF36, short form 36