A real-world analysis presented at AAD 2025 shows that patients with alopecia areata (AA) with eyebrow or eyelash hair loss have greater health-related quality of life (HRQoL) burden than those without eyebrow and eyelash involvement.

“Patients with AA may experience eyebrow and eyelash involvement in addition to scalp hair loss … [In our study,] 27.1 percent and 17.3 percent of [participants] had eyebrow and eyelash hair loss, respectively,” said the researchers.

The researchers evaluated data from 2,026 individuals (mean age 35.7 years, 52.3 percent men) in five European countries (France, Germany, Italy, Spain, and the UK) who had a confirmed diagnosis of AA. Two-thirds of the overall population had moderate (36.5 percent) to very severe (10.6 percent) scalp hair loss as per the AA-IGA*. [AAD 2025, abstract 63532]

Compared with participants without eyebrow involvement, those with eyebrow hair loss scored significantly higher on the Skindex-16 AA total (adjusted difference [ß], 13.4; p<0.001) and emotion (ß, 15.6; p<0.001), symptom (ß, 8.2; p=0.003), and functioning domains (ß, 16.9; p<0.001). A similar pattern was seen for those with vs without eyelash hair loss across the total (ß, 9.7; p=0.003) and three domains (ß, 9.8; p=0.016, ß, 9.4; p=0.005, and ß, 9.6; p=0.017, respectively).

Similarly, the Hospital Anxiety and Depression Scale (HADS) ? Depression scores were higher among those with vs without eyebrow (ß, 1.9; p<0.001) or eyelash involvement (ß, 1.4; p=0.035), as was the HADS ? Anxiety score for those with eyebrow hair loss (ß, 2.6; p<0.001).

According to the researchers, higher Skindex-16 AA scores denote worse HRQoL, while higher HADS scores indicate worse depression and anxiety levels.

Conversely, EQ?5D** scores were lower among those with eyebrow or eyelash involvement as opposed to those without, as reflected by the EQ-5D Visual Analogue Scale (VAS; ß, ?6.35; p=0.001 [eyebrow] and ß, ?5.74; p=0.012 [eyelash]) scores. For this parameter, lower scores reflect worse QoL.

No significant differences were observed in the absenteeism and activity impairment metrics for patients with vs without eyelash hair loss. For presenteeism, those with eyelash involvement had a significantly lower WPAI:AA*** score than those without (ß, ?9.3; p=0.012), which could have factored in the lower overall work impairment score among those with eyelash involvement (ß, ?7.7; p=0.07).

There were no significant differences across all metrics of WPAI:AA for eyebrow hair loss.

All the differences across the parameters evaluated were adjusted for age, sex, and AA-IGA on the multivariable linear regression model.

HRQoL crucial for assessment of Tx responses

Eyebrow and eyelash hair loss may be physically and psychologically bothersome for patients and may trigger eye irritation, social stigma, and emotional distress. [Am J Clin Dermatol 2020;21:725-732; J Eur Acad Dermatol Venereol 2023;37:1490-1520; J Patient Rep Outcomes 2020;4:76]

“[Taken together, the findings demonstrate that] patients with eyebrow or eyelash hair loss reported significantly greater HRQoL burden as measured by Skindex-16 AA, HADS, and EQ?5D VAS, but not by WPAI:AA; this finding underscores the importance of using HRQoL measures that are sensitive and specific for AA,” said the researchers.

“Clinical assessment of eyebrow and eyelash hair loss and the use of HRQoL measures are critical to determine AA severity and assess treatment responses following treatment initiation,” they concluded.