Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia Erika Elise Reid, BA, a Ann Cameron Haley, BA, a Judy H. Borovicka, MD, a Alfred Rademaker, PhD, b Dennis P. West, PhD, a Maria Colavincenzo, MD, a,c and Heather Wickless, MD a,c Chicago, Illinois Background: Hair loss may significantly impact an individual’s self-image, and studies indicate that patients with both clinically apparent and clinically imperceptible hair loss may have significantly decreased quality of life (QoL). Moreover, clinical severity of hair loss does not necessarily predict impact on QoL. Objective: The aim of this study was to assess QoL in patients (n = 104) with alopecia areata, telogen effluvium, and androgenic alopecia, and to compare QoL with hair loss severity (HLS) as independently rated by both patient and dermatologist. Methods: Questionnaires and clinical assessment tools were used to assess HLS, and QoL was measured by completion of Skindex-16. Results: Overall, patients rated their hair loss as more severe than the dermatologist, and the patient’s HLS rating more strongly correlated with QoL than the dermatologist’s rating. Clinical assessment of HLS did not reliably predict the patient’s QoL, nor did it predict the patient’s perception of HLS. Limitations: A convenience sample was recruited from a referral clinic and Skindex-16 has not been validated for use in women’s alopecia disorders. Conclusion: These findings indicate dermatologists should address these psychosocial and QoL issues when treating patients with alopecia. ( J Am Acad Dermatol 2012;66:e97-102.) Key words: alopecia; alopecia areata; androgenic alopecia; quality of life; Skindex-16; telogen effluvium. A lthough nonscarring alopecias are common, origins of these types of hair loss are not well understood and effective medical therapies are limited. Past research focused on psychological problems thought to predispose women to hair loss. 1 Lately, emphasis has shifted to the psychosocial ramifications of the disorder. 2 Studies have suggested a small, but significant, influence of psychological factors in the development and evolution of From the Department of Dermatology, a Department of Preventive Medicine, b and Hair Loss Disorders Clinic, c Northwestern Uni- versity Feinberg School of Medicine. Funding sources: None. Conflicts of interest: None declared. Accepted for publication November 8, 2010. Presented as: Reid E, Haley AC, Borovicka J, West DP, Wickless H. Quality of life correlates more closely with patient-rated versus physician-rated hair loss severity in women with nonscarring alopecia. JID 2010. Reprints not available from the authors. Correspondence to: Ann Cameron Haley, BA, Department of Dermatology, Northwestern University, 676 N St Clair, Suite 1600, Chicago, IL 60611. E-mail: a-haley@northwestern.edu. Published online May 23, 2011. 0190-9622/$36.00 Ó 2010 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2010.11.042 Abbreviations used: AA: alopecia areata AGA: androgenic alopecia HLS: hair loss severity QoL: quality of life SALT: Severity of Alopecia Tool TE: telogen effluvium e97