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Table.  Clinical of Characteristics of 82 Patients With Frontal Fibrosing Alopecia
Clinical of Characteristics of 82 Patients With Frontal Fibrosing Alopecia
1.
Chiang  YZ, Bundy  C, Griffiths  CEM, Paus  R, Harries  MJ.  The role of beliefs: lessons from a pilot study on illness perception, psychological distress and quality of life in patients with primary cicatricial alopecia.  Br J Dermatol. 2015;172(1):130-137.PubMedGoogle ScholarCrossref
2.
Rencz  F, Gulácsi  L, Péntek  M, Wikonkál  N, Baji  P, Brodszky  V.  Alopecia areata and health-related quality of life: a systematic review and meta-analysis.  Br J Dermatol. 2016;175(3):561-571.PubMedGoogle ScholarCrossref
3.
Vañó-Galván  S, Molina-Ruiz  AM, Serrano-Falcón  C,  et al.  Frontal fibrosing alopecia: a multicenter review of 355 patients.  J Am Acad Dermatol. 2014;70(4):670-678.PubMedGoogle ScholarCrossref
4.
Fabbrocini  G, Panariello  L, De Vita  V,  et al.  Quality of life in alopecia areata: a disease-specific questionnaire.  J Eur Acad Dermatol Venereol. 2013;27(3):e276-e281.PubMedGoogle ScholarCrossref
5.
Eder  J, Kammerstätter  M, Erhart  F, Mairhofer-Muri  D, Trautinger  F.  Illness perception in primary cutaneous t-cell lymphomas: what patients believe about their disease.  Acta Derm Venereol. 2016;96(3):381-385.PubMedGoogle ScholarCrossref
6.
Banka  N, Mubki  T, Bunagan  MJK, McElwee  K, Shapiro  J.  Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up.  Int J Dermatol. 2014;53(11):1324-1330.PubMedGoogle ScholarCrossref
Research Letter
April 2018

Health-Related Quality of Life in Patients With Frontal Fibrosing Alopecia

Author Affiliations
  • 1Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain
  • 2Department of Medicina and Medical Specialties, University of Alcalá, Alcalá de Henares, Madrid, Spain
JAMA Dermatol. 2018;154(4):479-480. doi:10.1001/jamadermatol.2017.6330

Alopecia has a negative association with health-related quality of life (HRQOL).1,2 To our knowledge, there are no large studies focusing on HRQOL in patients with frontal fibrosing alopecia (FFA). The aim of our study was to describe the association between HRQOL, psychological distress, and perception of disease in a large series of patients with FFA.

Methods

We designed a descriptive cross-sectional study including patients diagnosed with FFA in our center from January 1, 2016, to February 28, 2017. The institutional review board at Ramon y Cajal University Hospital approved the study, and participants provided oral informed consent. Calculations determined a total sample size of 80 patients to provide 80% power with a type I error of .05. Demographic and clinical characteristics were collected.3 We used the following questionnaires: the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), and the Revised Illness Perception Questionnaire (IPQ-R). All 3 tools are validated methods for evaluating dermatology-specific HRQOL, self-reported measure of anxiety and depression, and perception of disease, respectively.4,5 Scoring for the measures is described in the Table. For comparison between groups, we used the Pearson correlation coefficient or χ2 test, as appropriate. All given P values are 2-tailed and P <.05 indicates statistical significance. Statistical analysis was conducted with SPSS, version 19.0 (SPSS Inc).

Results

Eighty-two patients completed at least 1 questionnaire (DLQI, n = 82; HADS, n = 80; IPQ-R, n = 75). All patients were women; their demographic and clinical features are represented in the Table. The DLQI showed a slight association between alopecia and HRQOL (median total DLQI score, 2; range, 0-22), although 48 (58.5%) of patients had some degree of association with their HRQOL that was severe in 4 (4.9%) of them. Regarding HADS, the mean (SD) levels of psychological distress were low (HADS total score, 5.8 [3.6]), but 18.8% and 6.3% of the patients had moderate to severe anxiety and depression symptoms, respectively.

Scores on the IPQ-R questionnaire indicated that patients perceived FFA as a chronic disease (IPQ-R timeline, 22.3 [4.7]) with an unpredictable course (IPQ-R timeline cyclical, 9.9 [3.6]). The women considered that their alopecia had significant consequences on their lives (IPQ-R consequences, 16.8, [4.5]). Participants believed that they could control the alopecia progression by their own treatment (IPQ-R personal control, 17.8 [4.9]) and with medical treatment (IPQ-R treatment control, 16.2 [3.7]). The patients considered stress (33 [44.6%]), altered immunity (33 [44.4%]), aging (27 [36.5%]), and bad luck (25 [31.9%]) as the most common causes of the disease.

Rates of DLQI, HADS, and IPQ-R were correlated with demographic and clinical variables. There was a negative correlation between age of onset of FFA and HADS (r = −0.393, P = .03). A negative correlation between the grade of severity and personal control of the disease was also detected (r = −0.34, P = .008). Patients presenting with trichodynia had a higher impairment of HRQOL (χ2 = 0.508, P = .04); the rest of the clinical variables demonstrated no significant association with the total DLQI score. Patients with low levels of HRQOL had higher levels of anxiety (r = 0.336, P = .01), and those with more anxiety had more depression symptoms (r = 0.624, P = .007).

Discussion

Although a negative association between HRQOL and FFA exists, our study did not find any association with severity of the alopecia, as previous studies described.1 Older patients with FFA may be more likely to have anxiety or depression and patients with severe alopecia might feel powerless to control their illness. Trichodynia was the only clinical feature related to impaired HRQOL; despite its infrequency in FFA, approximately 20% of the patients may have trichodynia.3,6 Control of this symptom might help to improve FFA patients’ HRQOL and prevent psychological distress. A limitation of the study is that data about the duration of the disease and treatments received were not collected. In conclusion, our study shows that FFA may be negatively associated with HRQOL and induce psychological distress.

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Article Information

Accepted for Publication: December 16, 2017.

Corresponding Author: David Saceda-Corralo, MD, PhD, Dermatology Department, Ramon y Cajal Hospital, Carretera Colmenar Viejo km 9.100, 28034, Madrid, Spain (d.saceda@gmail.com).

Published Online: March 7, 2018. doi:10.1001/jamadermatol.2017.6330

Author Contributions: Drs Saceda-Corralo and Vañó-Galván had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Saceda-Corralo, Moreno-Arrones, Jaen-Olasolo, Vano-Galvan.

Acquisition, analysis, or interpretation of data: Pindado-Ortega, Moreno-Arrones, Fernandez-Gonzalez, Rodrigues-Barata, Jaen-Olasolo, Vano-Galvan.

Drafting of the manuscript: Saceda-Corralo, Pindado-Ortega, Fernandez-Gonzalez, Vano-Galvan.

Critical revision of the manuscript for important intellectual content: Saceda-Corralo, Moreno-Arrones, Fernandez-Gonzalez, Rodrigues-Barata, Jaen-Olasolo.

Statistical analysis: Saceda-Corralo, Pindado-Ortega, Fernandez-Gonzalez, Vano-Galvan.

Administrative, technical, or material support: Saceda-Corralo, Pindado-Ortega, Fernandez-Gonzalez, Rodrigues-Barata.

Study supervision: Saceda-Corralo, Moreno-Arrones, Jaen-Olasolo.

Conflict of Interest Disclosures: None reported.

References
1.
Chiang  YZ, Bundy  C, Griffiths  CEM, Paus  R, Harries  MJ.  The role of beliefs: lessons from a pilot study on illness perception, psychological distress and quality of life in patients with primary cicatricial alopecia.  Br J Dermatol. 2015;172(1):130-137.PubMedGoogle ScholarCrossref
2.
Rencz  F, Gulácsi  L, Péntek  M, Wikonkál  N, Baji  P, Brodszky  V.  Alopecia areata and health-related quality of life: a systematic review and meta-analysis.  Br J Dermatol. 2016;175(3):561-571.PubMedGoogle ScholarCrossref
3.
Vañó-Galván  S, Molina-Ruiz  AM, Serrano-Falcón  C,  et al.  Frontal fibrosing alopecia: a multicenter review of 355 patients.  J Am Acad Dermatol. 2014;70(4):670-678.PubMedGoogle ScholarCrossref
4.
Fabbrocini  G, Panariello  L, De Vita  V,  et al.  Quality of life in alopecia areata: a disease-specific questionnaire.  J Eur Acad Dermatol Venereol. 2013;27(3):e276-e281.PubMedGoogle ScholarCrossref
5.
Eder  J, Kammerstätter  M, Erhart  F, Mairhofer-Muri  D, Trautinger  F.  Illness perception in primary cutaneous t-cell lymphomas: what patients believe about their disease.  Acta Derm Venereol. 2016;96(3):381-385.PubMedGoogle ScholarCrossref
6.
Banka  N, Mubki  T, Bunagan  MJK, McElwee  K, Shapiro  J.  Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up.  Int J Dermatol. 2014;53(11):1324-1330.PubMedGoogle ScholarCrossref
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