Comparative analysis of Health-Related Quality of Life, anxiety and depression in patients with alopecia areata, atopic dermatitis and with association of these diseases

Introduction. Alopecia areata (AA) and atopic dermatitis (AtD) are associated with significant psychosocial burden, emphasizing the importance of quality of life (QoL) assessment due to potential psychological distress and treatment hindrance.

Aim. To conduct a comparative analysis of QoL, anxiety and depression in patients with AA, AtD and their combination, according to diseases severity.

Materials and methods. The study included 91 patients of both sexes (18–52 years old). All patients were divided into 3 groups: group 1 – 25% patients with AA, group 2 – 28% with AtD, group 3 – 47% patients with both diseases; the groups were subdivided by dermatoses severity. The DLQI, Skindex-29 and HADS questionnaires were used. Mann-Whitney U-test was conducted to compare the mean values of quantitative data (М ± n) (p < 0.05).

Results. Group 1 had moderately decreased QoL according to DLQI (6.5 ± 0.67); total Skindex-29 score was 23.55 ± 2.46 (low impact) with the highest value in the emotion domain. In group 2 DLQI score was 12.5 ± 1.51, total Skindex-29 score was

48.41 ± 3.76; in group 3 DLQI was 11.5 ± 0.58, Skindex-29 – 50.46 ± 2.14. These values corresponded to very negative impact on QoL, increasing with diseases severity. There was a reliable difference in DLQI and Skindex-29 values between groups 1 and 2 and groups 1 and 3. Mean HADS scores in all groups were generally comparable and correlated with AtD and AA severity.

Conclusion. Compared to AA, AtD has a greater impact on QoL, involving all areas of social health; AA predominantly affects emotional sphere. The presence of both diseases worsens QoL as well as AtD alone, especially in aspects “emotions” and “functions”.

1. Адаскевич ВП. Диагностические методы в дерматологии. М.: Издательство Панфилова; 2014. 352 с.

2. Chren MM. The Skindex instruments to measure the effects of skin disease on quality of life. Dermatol Clin. 2012;30(2):231–236. https://doi.org/10.1016/j.det.2011.11.003.

3. Muntyanu A, Gabrielli S, Donovan J, Gooderham M, Guenther L, Hanna S et al. The burden of alopecia areata: A scoping review focusing on quality of life, mental health and work productivity. J Eur Acad Dermatol Venereol. 2023;37(8):1490–1520. https://doi.org/10.1111/jdv.18926.

4. Vélez-Muñiz RDC, Peralta-Pedrero ML, Jurado-Santa Cruz F, Morales-Sánchez MA. Psychological Profile and Quality of Life of Patients with Alopecia Areata. Skin Appendage Disord. 2019;5(5):293–298. https://doi.org/10.1159/000497166.

5. van Dalen M, Muller KS, Kasperkovitz-Oosterloo JM, Okkerse JME, Pasmans SGMA. Anxiety, depression, and quality of life in children and adults with alopecia areata: A systematic review and meta-analysis. Front Med (Lausanne). 2022;9:1054898. https://doi.org/10.3389/fmed.2022.1054898.

6. Atış G, Tekin A, Ferhatoğlu ZA, Göktay F, Yaşar S, Aytekin S. Type D personality and quality of life in alopecia areata and vitiligo patients: A crosssectional study in a Turkish population. Turkderm-Turk Arch Dermatol Venereol. 2021;55(2):87–91. Available at: https://doi.org/10.4274/turkderm.galenos.2020.36776.

7. Altınöz AE, Taşkıntuna N, Altınöz ST, Ceran S. A cohort study of the relationship between anger and chronic spontaneous urticaria. Adv Ther. 2014;31(9):1000–1007. https://doi.org/10.1007/s12325-014-0152-6.

8. Karia SB, De Sousa A, Shah N, Sonavane S, Bharati A. Psychiatric morbidity and quality of life in skin diseases: A comparison of alopecia areata and psoriasis. Ind Psychiatry J. 2015;24(2):125–128. https://doi.org/10.4103/0972-6748.181724.

9. Aldhouse NVJ, Kitchen H, Knight S, Macey J, Nunes FP, Dutronc Y et al. “You lose your hair, what’s the big deal?” I was so embarrassed, I was so self-conscious, I was so depressed”: a qualitative interview study to understand the psychosocial burden of alopecia areata. J Patient Rep Outcomes. 2020;4(1):76. https://doi.org/10.1186/s41687-020-00240-7.

10. Macbeth AE, Holmes S, Harries M, Chiu WS, Tziotzios C, de Lusignan S et al. The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care. Br J Dermatol. 2022;187(1):73–81. https://doi.org/10.1111/bjd.21055.

11. Tzur Bitan D, Berzin D, Kridin K, Sela Y, Cohen A. Alopecia Areata as a Proximal Risk Factor for the Development of Comorbid Depression: A Populationbased Study. Acta Derm Venereol. 2022;102:adv00669. https://doi.org/10.2340/actadv.v102.1622.

12. Villasante Fricke AC, Miteva M. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol. 2015;8:397–403. https://doi.org/10.2147/CCID.S53985.

13. Vañó-Galván S, Blume-Peytavi U, Farrant P, Reygagne P, Johansson E, Reed C et al. Physician- and Patient-Reported Severity and Quality of Life Impact of Alopecia Areata: Results from a Real-World Survey in Five European Countries. Dermatol Ther (Heidelb). 2023;13(12):3121–3135. https://doi.org/10.1007/s13555-023-01057-0.

14. Gelhorn HL, Cutts K, Edson-Heredia E, Wright P, Delozier A, Shapiro J et al. The Relationship Between Patient-Reported Severity of Hair Loss and Health-Related Quality of Life and Treatment Patterns Among Patients with Alopecia Areata. Dermatol Ther (Heidelb). 2022;12(4):989–997. https://doi.org/10.1007/s13555-022-00702-4.

15. Shi Q, Duvic M, Osei JS, Hordinsky MK, Norris DA, Price VH et al. HealthRelated Quality of Life (HRQoL) in alopecia areata patients-a secondary analysis of the National Alopecia Areata Registry Data. J Investig Dermatol Symp Proc. 2013;16(1):S49–S50. https://doi.org/10.1038/jidsymp.2013.18.

16. Ito T, Kamei K, Yuasa A, Matsumoto F, Hoshi Y, Okada M, Noto S. Healthrelated quality of life in patients with alopecia areata: Results of a Japanese survey with norm-based comparisons. J Dermatol. 2022;49(6):584–593. https://doi.org/10.1111/1346-8138.16364.

17. Senna M, Ko J, Glashofer M, Walker C, Ball S, Edson-Heredia E et al. Predictors of quality of life in patients with alopecia areata. J Invest Dermatol. 2022;142;2646–2650.e2643. https://doi.org/10.1016/j.jid.2022.02.019.

18. Abedini R, Hallaji Z, Lajevardi V, Nasimi M, Karimi Khaledi M, Tohidinik HR. Quality of life in mild and severe alopecia areata patients. Int J Womens Dermatol. 2017;4(2):91–94. https://doi.org/10.1016/j.ijwd.2017.07.001.

19. Liu LY, King BA, Craiglow BG. Alopecia areata is associated with impaired health-related quality of life: A survey of affected adults and children and their families. J Am Acad Dermatol. 2018;79(3):556–558.e1. https://doi.org/10.1016/j.jaad.2018.01.048.

20. Qi S, Xu F, Sheng Y, Yang Q. Assessing quality of life in Alopecia areata patients in China. Psychol Health Med. 2015;20(1):97–102. https://doi.org/10.1080/13548506.2014.894641.

21. Capozza K, Gadd H, Kelley K, Russell S, Shi V, Schwartz A. Insights From Caregivers on the Impact of Pediatric Atopic Dermatitis on Families: “I’m Tired, Overwhelmed, and Feel Like I’m Failing as a Mother”. Dermatitis. 2020;31(3):223–227. https://doi.org/10.1097/DER.0000000000000582.

22. Gandhi K, Shy ME, Ray M, Fridman M, Vaghela S, Mostaghimi A. The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata. Dermatol Ther (Heidelb). 2023;13(1):285–298. https://doi.org/10.1007/s13555-022-00864-1.

23. Christensen T, Yang JS, Castelo-Soccio L. Bullying and Quality of Life in Pediatric Alopecia Areata. Skin Appendage Disord. 2017;3(3):115–118. https://doi.org/10.1159/000466704.

24. Mesinkovska N, King B, Mirmirani P, Ko J, Cassella J. Burden of Illness in Alopecia Areata: A Cross-Sectional Online Survey Study. J Investig Dermatol Symp Proc. 2020;20(1):S62–S68. https://doi.org/10.1016/j.jisp.2020.05.007.

25. Mostaghimi A, Gandhi K, Done N, Ray M, Gao W, Carley C et al. All-cause health care resource utilization and costs among adults with alopecia areata: A retrospective claims database study in the United States. J Manag Care Spec Pharm. 2022;28(4):426–434. https://doi.org/10.18553/jmcp.2022.28.4.426.

26. Li SJ, Mostaghimi A, Tkachenko E, Huang KP. Association of Out-of-Pocket Health Care Costs and Financial Burden for Patients With Alopecia Areata. JAMA Dermatol. 2019;155(4):493–494. https://doi.org/10.1001/jamadermatol.2018.5218.

27. Rudnicka L, Trzeciak M, Alpsoy E, Arenberger P, Alper S, Benáková N et al. Disease burden, clinical management and unmet treatment need of patients with moderate to severe alopecia areata; consensus statements, insights, and practices from CERTAAE (Central/Eastern EU, Russia, Türkiye AA experts) Delphi panel. Front Med (Lausanne). 2024;11:1353354. https://doi.org/10.3389/fmed.2024.1353354.

28. Kridin K, Renert-Yuval Y, Guttman-Yassky E, Cohen AD. Alopecia Areata Is Associated with Atopic Diathesis: Results from a Population-Based Study of 51,561 Patients. J Allergy Clin Immunol Pract. 2020;8(4):1323–1328.e1. https://doi.org/10.1016/j.jaip.2020.01.052.

29. Mohan GC, Silverberg JI. Association of Vitiligo and Alopecia Areata With Atopic Dermatitis: A Systematic Review and Meta-analysis. JAMA Dermatol. 2015;151(5):522–528. https://doi.org/10.1001/jamadermatol.2014.3324.

30. Sun R, Kong D. Bilateral Association Between Atopic Dermatitis and Alopecia Areata: A Systematic Review and Meta-Analysis. Dermatitis. 2024;35(3):208–218. https://doi.org/10.1089/derm.2023.0114.

31. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH et al. Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Ann Allergy Asthma Immunol. 2018;121(3):340–347. https://doi.org/10.1016/j.anai.2018.07.006.

32. Thyssen JP, Halling A-S, Schmid-Grendelmeier P, Guttman-Yassky E, Silverberg JI. Comorbidities of atopic dermatitis – what does the evidence say? J Allergy Clin Immunol. 2023;151(5):1155–1162. https://doi.org/10.1016/j.jaci.2022.12.002.

33. Elliott BE, Luker K. The experiences of mothers caring for a child with severe atopic eczema. J Clin Nurs. 1997;6(3):241–247. https://doi.org/10.1111/j.1365-2702.1997.tb00310.x.

34. Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev. 2010;14(6):359–369. https://doi.org/10.1016/j.smrv.2010.01.004.

35. Silverberg JI. Association between childhood eczema and headaches: An analysis of 19 US population-based studies. J Allergy Clin Immunol. 2016;137(2):492–499.e5. https://doi.org/10.1016/j.jaci.2015.07.020.

36. Silverberg JI, Paller AS. Association between eczema and stature in 9 US population-based studies. JAMA Dermatol. 2015;151(4):401–409. https://doi.org/10.1001/jamadermatol.2014.3432.

37. Silverberg JI, Greenland P. Eczema and cardiovascular risk factors in 2 US adult population studies. J Allergy Clin Immunol. 2015;135(3):721–728.e6. https://doi.org/10.1016/j.jaci.2014.11.023.

38. Romanos M, Gerlach M, Warnke A, Schmitt J. Association of attentiondeficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. J Epidemiol Community Health. 2010;64(3):269–273. https://doi.org/10.1136/jech.2009.093534.

39. Silverberg JI. Comorbidities and the impact of atopic dermatitis. Ann Allergy Asthma Immunol. 2019;123(2):144–151. https://doi.org/10.1016/j.anai.2019.04.020.

40. Patel KR, Immaneni S, Singam V, Rastogi S, Silverberg JI. Association between atopic dermatitis, depression, and suicidal ideation: A systematic review and meta-analysis. J Am Acad Dermatol. 2019;80(2):402–410. https://doi.org/10.1016/j.jaad.2018.08.063.

41. Yu SH, Silverberg JI. Association between Atopic Dermatitis and Depression in US Adults. J Invest Dermatol. 2015;135(12):3183–3186. https://doi.org/10.1038/jid.2015.337.

42. Beattie P, Lewis-Jones M. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155(1):145–151. https://doi.org/10.1111/j.1365-2133.2006.07185.x.

43. Kochergin NG, Smirnova LM. Dermatology quality of life as a psychosomatic symptom dermatosis. Russian Journal of Skin and Venereal Diseases. 2006;(4):11–15. (In Russ.)

44. Prinsen CA, Lindeboom R, de Korte J. Interpretation of Skindex-29 scores: cutoffs for mild, moderate, and severe impairment of health-related quality of life. J Invest Dermatol. 2011;131(9):1945–1947. https://doi.org/10.1038/jid.2011.138.

45. Prinsen CA, Lindeboom R, Sprangers MA, Legierse CM, de Korte J. Healthrelated quality of life assessment in dermatology: interpretation of Skindex-29 scores using patient-based anchors. J Invest Dermatol. 2010;130(5):1318–1322. https://doi.org/10.1038/jid.2009.404.

46. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77. https://doi.org/10.1016/s0022-3999(01)00296-3.

47. Chernyshov PV, Tomas-Aragones L, Finlay AY, Manolache L, Marron SE, Sampogna F et al. Quality of life measurement in alopecia areata. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes. J Eur Acad Dermatol Venereol. 2021;35(8):1614–1621. https://doi.org/10.1111/jdv.17370.

48. Thadanipon K, Suchonwanit P. Measuring Patient Quality of Life Following Treatment for Alopecia. Patient Prefer Adherence. 2021;15:1601–1610. https://doi.org/10.2147/PPA.S282399.

49. Liu LY, King BA, Craiglow BG. Health-related quality of life (HRQoL) among patients with alopecia areata (AA): A systematic review. J Am Acad Dermatol. 2016;75(4):806–812.e3. https://doi.org/10.1016/j.jaad.2016.04.035.

50. Ara G, Tunio W, Khan NI, Tariq A, Jamshed T. “Anxiety, Depression and Low Self-Esteem Among People with Alopecia”. KMUJ. 2023;15(3):161–166. https://doi.org/10.35845/kmuj.2023.22653.

51. Romanova YuYu, Romanov DV, Brazhnikov АYu, Voronova EI, Lvov AN, Potekaev NN. Perspective targets for secondary prevention of quality of life decrease and psychosomatic disorders in alopecia: results of an observational study. Profilakticheskaya Meditsina. 2019;22(5):104–111. (In Russ.) https://doi.org/10.17116/profmed201922051104.

52. Vilsbøll AW, Kragh N, Hahn-Pedersen J, Jensen CE. Mapping Dermatology Life Quality Index (DLQI) scores to EQ-5D utility scores using data of patients with atopic dermatitis from the National Health and Wellness Study. Qual Life Res. 2020;29(9):2529–2539. https://doi.org/10.1007/s11136-020-02499-1.

53. Beikert FC, Langenbruch AK, Radtke MA, Kornek T, Purwins S, Augustin M. Willingness to pay and quality of life in patients with atopic dermatitis. Arch Dermatol Res. 2014;306(3):279–286. https://doi.org/10.1007/s00403-013-1402-1.

54. Hsieh BJ, Shen D, Hsu CJ, Chan TC, Cho YT, Tang CH, Chu CY. The impact of atopic dermatitis on health-related quality of life in Taiwan. J Formos Med Assoc. 2022;121(1):269–277. https://doi.org/10.1016/j.jfma.2021.03.024.

55. Lim VZ, Ho RC, Tee SI, Ho MS, Pan JY, Lim YL et al. Anxiety and Depression in Patients with Atopic Dermatitis in a Southeast Asian Tertiary Dermatological Centre. Ann Acad Med Singap. 2016;45(10):451–455. Available at: https://pubmed.ncbi.nlm.nih.gov/27832219.

56. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol. 2019;181(3):554–565. https://doi.org/10.1111/bjd.17683.

57. Sarsenbayeva GI, Tursynbekova AE. Modern approaches to the assessment of comorbidity in patients. Cardiosomatics. 2019;10(1):19–23. https://doi.org/10.26442/22217185.2019.1.180073.

58. Sampogna F, Abeni D. Interpretation of Skindex-29 scores. J Invest Dermatol. 2011;131(9):1790–1792. https://doi.org/10.1038/jid.2011.191.