32295 Looking beyond scalp hair loss: Factors influencing dermatologists’ assessment of alopecia areata severity

Abstract

Background: Severity criteria for AA currently rely on extent of scalp hair loss (HL) without formally assessing other relevant factors that may influence disease severity. Objective: Identify factors beyond extent (percent) of scalp HL that are associated with dermatologist assessed AA severity. Methods: Real-world data from a 2019 cross-sectional survey of US dermatologists and their adult AA patients were analyzed. Dermatologists provided assessments of patients’ clinical characteristics. Two methodologies were used to evaluate the predictive power of risk factors including percent scalp HL: classification and regression tree (CART) and multinomial logistic regression (MLR) models. Seven domains of dermatologist-reported risk factors were sequentially tested: HL percent, patient impairments, disease/treatment history, demographics, dermatologist treatment satisfaction, comorbidities, and dermatologist characteristics. Results: Patients’ (n = 442) mean (SD) age was 39.3 (13.8) years, time since diagnosis was 4.5 (7.5) years, 51% female. Patient’s AA severity as assessed by the dermatologist was 20% mild, 53% moderate and 27% severe. CART identified percent scalp HL as the primary differentiator between Mild (0-10%), Moderate (11-40%) and Severe (≥41%) AA; treatment success was an additional predictor that differentiated between mild and moderate severity. In MLR, scalp HL was the most important risk factor (generalized R-sq = 60% out of 70% in the final model). Additional differentiating factors included fear of recurrence and day-to-day activity impairment. Conclusions: Although dermatologists’ assessment of AA severity primarily relies on extent of scalp HL, it is also influenced by a combination of physician-related (treatment success) and patient-related (fear of recurrence and activity impairment) factors.