Prevalence and profile of non-responder alopecia areata patients: a multicenter retrospective and prospective analysis from hospital-based aa clinics

Alopecia areata (AA) is a common non-scarring hair loss with a wide spectrum of clinical manifestations. AA clinical course and response to treatment show considerable variability, suggesting that individual differences may play a key role in promoting disease progression. Despite the advances in AA treatment, many patients still face a long-term chronic disease course, with frequent relapses and/or poor treatment response. This frequently results in mood changes, psychological comorbidities, isolation and reduced social functioning. Currently, accurate investigations on the prevalence and characteristics of non-responder AA patients are lacking, and predicting factors are poorly defined. Main goals of the present project will be: Identify, through a retrospective and prospective study, the prevalence of AA patients that do not respond to at least 2 conventional first-line treatments; investigate the demographic, anamnestic and clinical features of these subjects in order to define relevant prognostic factors; evaluate the Quality of Life (QoL) and Cumulative Life Course Impairment (CLCI) in the prospectively enrolled patients. The project is a multicenter retrospective and prospective observational study that will build upon an ongoing collaborative project between the Dermatology Clinics of the University of Catania and Bologna, Italy. The retrospective evaluation will include the last 500 non-responder AA patients from registry-based samples, while the prospective one will include 300 non-responder AA patients accessing the 2 Dermatology Clinics in the 2 years following the beginning of the project. Major domains and variables will be identified and collected, including, but not limited to, demographics, patients past personal and medical history, disease characteristics including familiarity, severity, clinical type, age and clinical subtype at onset, disease duration, and treatment history. For those patients recruited in the prospective arm, laboratory tests and a face-to-face interview including questionnaires for the evaluation of quality of life will also be performed. Finally, data obtained from the retrospective and prospective evaluations of the 2 centers will be merged and a statistical analysis will be performed. The strength of the present study is represented by the high number (800) of the enrolled patients and the well-established reputation of the 2 study sites. We believe that the obtained results will be helpful to provide novel insight into the role of risk factors for treatment failure and will be crucial to better define the AA population at risk for poor or absent treatment response. In addition, it will be useful for the design and implementation of future trials which selectively target non-responder AA patients. Such results may possibly contribute to build an efficient prevention program for such patients through a proactive approach.