The hidden burden of visibility: Social appearance anxiety in patients with alopecia areata – A comparative cross-sectional study

This cross-sectional study investigated social appearance anxiety in individuals with Alopecia Areata (AA), a chronic autoimmune condition causing visible, non-scarring hair loss. A total of 129 AA patients and 142 age- and sex-matched healthy controls (18-65 years) completed the Social Appearance Anxiety Scale (SAAS) and the Hospital Anxiety and Depression Scale (HADS); the AA group additionally completed the Dermatology Life Quality Index (DLQI) and a Visual Analog Scale (VAS). SAAS scores were markedly higher in AA than controls (65.32 ± 8.45 vs 21.45 ± 9.32, <i>p</i> < 0.001). Within AA, SAAS showed a moderate positive association with perceived severity (VAS; <i>r</i> = 0.304, <i>p</i> < 0.05). HADS-Anxiety/Depression did not differ significantly between groups. In the AA cohort, DLQI averaged 12.3 ± 5.4 (median 12, IQR 9-16), with 62.8% ⩾ 10 and 10.9% ⩾ 20. DLQI correlated most strongly with perceived severity (VAS; <i>r</i> = 0.45, <i>p</i> < 0.001) and clinical visibility (<i>r</i> = 0.37, <i>p</i> = 0.002), with comparatively smaller associations with lesion count/area (<i>r</i> = 0.26/0.34). Taken together, these findings indicate that AA's psychosocial burden is driven primarily by appearance- and visibility-related factors rather than generalized anxiety/depression or sheer disease extent. Routine dermatologic care should incorporate targeted psychosocial assessment-particularly for patients with visible-site involvement-to facilitate timely support.