Identification and characterization of alopecia areata subgroups regarding quality of life impairment based on demographic, clinical, psychological, and social factors

Abstract

The benign dermatological hair condition Alopecia Areata (AA) is known to impair Quality of Life (QoL), especially mental and social health, due to the accompanying visible appearance changes. Previous studies have identified demographic, clinical, social, and psychological variables related to QoL. Yet, the novelty of this study lies in examining how QoL differences in AA relate to (combinations of) these variables. The aim of the current study is to identify and characterize subgroups of AA persons with less or more QoL impairment by means of (combinations of) demographic, clinical, psychological, and social factors, including both potential risk (perceived stigmatization, avoidant coping, physical identity definition) and protective factors (disclosure, social support, emotion-focused coping and non-physical identity definition). An online questionnaire was filled out by 322 persons with AA, including the Dermatology Life Quality Index (DLQI) as QoL measure, Perceived Stigmatization Questionnaire (FSQ), brief COPE, Social Support Survey, a newly developed identity-definition measure, clinical characteristics, and demographics. Classification and Regression Tree (CART) analysis identified subgroups based on QoL outcome. Lowest QoL impairment was found in persons with low feelings of being flawed combined with low secretiveness. Low QoL impairment was also found in persons feeling flawed combined with low avoidant coping, low sensitivity to others’ opinions and older age. QoL impairment was intermediate in persons perceiving more social support in those with a younger age, and defining identity less on physical appearance in those sensitive to others’ opinions. Highest QoL impairment was characterized by feeling flawed combined with an avoidant coping style. Current findings provide indications for the identification of risk and protective profiles for QoL impairment and which factors to address in interventions to improve QoL in AA.