533 Physician assessment of alopecia areata disease severity: Results from a real-world study

Abstract

Information on how severity of Alopecia areata (AA) is assessed is limited. The objective was to understand how physicians determine severity in AA patients in the real world. Data were drawn from the 2019 AA Disease Specific Programme, a cross-sectional survey of US dermatologists. Physicians completed an attitudinal survey covering perceptions of severity, then completed record forms for the next 5 patients consulting with AA capturing diagnosis, physician-subjective AA severity, % scalp hair loss, and other areas affected. The results revealed 72% of physicians (n=93) surveyed indicated that amount of scalp involvement was the most important factor in determining severity; 9.5% for mild patients, 23.1% moderate, 40.7% severe. 17% indicated it was patient distress over hair loss. For actual patients (n=452), excluding AA totalis or universalis patients, mean scalp hair loss for patients assessed as mild was 8.2%, as moderate 24.2%, as severe 55.6%. Including AA totalis/universalis (n=32), the mean percentage hair loss for moderate patients increased to 24.6% and for severe to 66.4%. In conclusion, scalp hair loss is the most important factor in AA severity, though facial and body hair loss are also particularly associated with increased severity. Patient distress is also important, suggesting the burden of AA may be more than visual.