Development of the alopecia areata symptom impact scale

The existing literature on alopecia areata (AA) clearly demonstrates patients' concerns related to physical symptoms, emotional well-being, mental health, social functioning, and other dimensions of daily functioning. Although questionnaires such as the Skindex-16 and the Dermatology Life Quality Index have been used, these questionnaires were validated for skin conditions other than AA as a chronic condition. The goals of this study are to develop a measure of quality of life, symptoms, and their impact for patients with AA called the Alopecia Areata Symptom Impact Scale (AASIS) and to provide psychometric evidence for its use. We used data from 1,400 patients from the National Alopecia Areata Registry together with clinical experts' reviews and quantitative approaches. The preliminary version of the AASIS with 13 items was administered to about 210 patients with AA. Results indicated that the AASIS measures three underlying constructs related to AA. These dimensions were impact of AA, hair loss, and physical skin symptoms. The internal consistency reliabilities of these subscales are 0.93, 0.86, and 0.81, respectively. Cognitive debriefing results showed that patients find the AASIS items easy to understand, clear, and concise. Preliminary evidence suggests that the AASIS is a reliable and valid measure of the symptoms and their impact in patients with AA.