INTRODUCTION
Alopecia areata (AA) was once considered a mere cosmetic condition. Now, we know that AA is a disease that profoundly impacts patients' lives.1 Alopecia areata not only causes psychosocial distress but may also lead to depression and anxiety.2 All too often, we hear patients with AA say, "I am ashamed to go out in public; I have no eyebrows or eyelashes!" or "People stare at my bald patches; it is humiliating!" How can we alleviate the distress and better care for our patients with AA?
This article began as two separate surveys: one survey for patients with AA and one survey for physicians developed by Antonella Tosti MD, a world-renowned dermatologist known for originating trichoscopy, which is a noninvasive method for diagnosing and assessing the severity of hair disorders.3 Gathering responses from nearly 2500 physicians, primarily dermatologists and primary care physicians in community practices, the physician survey captured physicians' attitudes, knowledge, and beliefs around practice patterns for AA. Most respondents were actively managing patients with AA, 21% saw 16 or more patients with AA in a month, 37% saw 6 to 15 patients, and 35% saw 1 to 5 patients. The 40-patient survey, including responses from patients and caregivers, captured the impact of AA on patients' lives as well as patients' medical care and barriers to care. For patients surveyed, the extent of hair loss varied from mild (30%) to moderate (32%) to severe (38%), and two-thirds of patients reported hair loss often or all the time.
In this interview, Antonella Tosti MD reflects on the survey data, as well as her personal experiences, and highlights unmet needs in AA management and care.
DISCUSSION
There are several types of hair loss, but how do you define alopecia areata?
Alopecia areata is an autoimmune disorder of the hair follicles, characterized by sudden-onset, remitting-relapsing, nonscarring hair loss at any hair-bearing site (ie, scalp, eyebrows, eyelashes, beard, body hair).4 Hair loss is variable from discrete bald patches to diffuse thinning to total hair loss involving the scalp (alopecia totalis) or total body (alopecia universalis) in severe cases. The patchy type localized to the scalp is the most common4 and initially presents as a single patch in most cases.5 Alopecia areata can also present with nail abnormalities, usually nail pitting. Nail involvement occurs in 10% to 15% of dermatology referral cases and is usually associated with severe forms of AA.4
As the second most common nonscarring alopecia,4 AA can occur at any age, with the highest prevalence in patients between 30 and 49 years.6 Men and women were thought to be equally affected, but recent data suggest that women have a 30% higher prevalence. Similarly, historical data suggested no ethnic differences in susceptibility, but newer data suggest a higher prevalence in Asian patients followed by Black and Hispanic patients compared with White patients.6
