Patients with AGA are significantly affected with self-image satisfaction, with potentially adverse psychosocial factors and with negative impact on a patient's QoL11
. Alopecia has many known psychosocial complications, including depression, low self-esteem, an altered self-image, and less frequent social engagement7,11
. Therefore, it has been suggested that physicians should address these psychosocial and QoL issues when treating patients with alopecia12
. Although the Hairdex index was designed by Fischer et al.13
, it is in limited use and is hard to utilize when comparing QoL of alopecia patients with patients that have other skin diseases. Therefore, we modified some terminology of the Skindex-29 to 'alopecia' or 'scalp', and then renamed it as the Hair Specific Skindex-29. For atopic dermatitis, psoriasis and acne, the Skindex scale is a validated, reliable, sensitive, and specific measure of how bothered patients are by their dermatologic conditions14
However, a Skindex score has not been validated for use in AGA. Despite the widely reported psychosocial consequences of alopecia, each researcher used different kinds of tools, such as the Skindex-16, the Skindex-29, and the Dermatology Life Quality index and the brief COPE. Among those tools, the Skindex scale was recently used to measure the QoL of patients with hair loss7
. Reid et al.7
demonstrated a relationship between hair loss and QoL, using the Skindex protocol. Also, the terms 'skin' and 'skin condition', used on the Skindex-29 scale, seemed to be confusing to patients who showed hair loss only on the scalp. Therefore, we suggest and hope that the Hair Specific Skindex-29 is used as a variant tool of the Skindex-29, and to be used to evaluate the QoL of patients with alopecia.
According to Kim et al.15
, Korean patients with AGA receive incorrect information on the alopecia treatment. Furthermore, 60.9 percent of them use inappropriate, non-medical hair care products, and rarely get satisfaction; the current study was consistent with the previous findings16
. AGA may have a marked psychosocial impact, in which the patients may seek inappropriate and unproven therapies that are available in nonmedical settings, often at great expense to the consumer17
. Therefore, it is necessary to provide patients with correct information that is medically approved.
In regards to QoL in patients with AGA, experience in previous non-medical hair care, hospital visits for AGA treatment, young age, longer duration of AGA, and severe AGA were determined to be strongly correlated with poorer QoL. Patients with previous experiences in nonmedical hair care and hospital visits for AGA treatment tend to perceive their hair loss as worse. Furthermore, these findings demonstrate that patients' QoL are strongly and reliably correlated with the patient's perception of AGA. These results are in accordance with the findings by Cash16
in that persons seeking AGA treatment experienced more psychosocial impairment and substantial distress than the male controls.
Not surprisingly, patients of younger age and longer durations of AGA had a decreased QoL. Physical appearance is extremely important to most young men, and early onset of hair loss can have a definite negative effect on self-image and self-esteem. Low self-esteem makes life difficult when finding life partners and employment18
. This result suggests that a longer duration of AGA may result in more severe hair loss, but tolerance of alopecia does not occur.
In conclusion, the strong relation found between patients' perception about their condition and the severity of AGA and patients' QoL in the current study suggests that patients with AGA have significantly decreased QoL. However, few studies have investigated therapeutic or supportive treatments that might improve their QoL. It is important that physicians consider the psychosocial impact of AGA on diverse areas of patient's lives. Physicians need to offer relevant treatment not just for hair loss, but for their emotional distress to AGA and functional consequences on their everyday lives. Our findings have implications for the treatment of patients diagnosed with AGA. Upon initial visit, the Hair Specific Skindex-29 questionnaire was given to each patient. Patients, with a low score of QoL were medically treated, but patients with higher scores of QoL might need both medical treatment and psychotherapy, as well. Further research is needed to better understand the effects of AGA and to improve treatment on self-image, psychological functioning and QoL.