Table 3.

Coping related evidence for cumulative life course impairment

Reference	Study type	Patients	Assessment tool	Evidence
Coping
Firooz et al. (2005)[42]	Survey of patients attending a skin clinic	80 patients with AA	Illness Perception Questionnaire	76.9% of the patients believed that the role of stress was the cause of disease >50% of patients believed that their illness had major consequences on their lives 40% of patients believed that their illness would likely be permanent 58% of patients considered treatments to be effective
Montgomery et al. (2017)[49]	Cross-sectional email survey to Alopecia UK mailing list	279 patients with alopecia areata >13 year/old	Validated measures of social anxiety, depression, anxiety and questions on wig usage	87% of participants reported wearing a wig to socialize66% of respondents reported they would not feelconfident leaving the house without a wig 43% of participants reported that wearing a wig could negatively impact confidence during social situations
Matzer et al. (2011)[50]	Questionnaire survey and qualitative study	45 patients with AA	Interview with 5 standardized topics combined with stress and coping process questionnaire	Patients with first onset of AA felt less burdened when they had an attitude of waiting for regrowth (P=0.038)The coping competencecorrelated with the number of coping behaviors (P=0.033) and acceptance (P=0.030)
Inui et al. (2013)[51]	Prospective exploratory study	49 females with AA using a wig or hairpiece	Psychosocial Impact of Assistive Device Scale questionnaire	QoL indicators such as competence, adaptability and self‐esteem were significantly improved from zero (P<0.001) as the result of using a wig or hairpiece
Hussain et al. (2017)[52]	Electronic survey study	1083 patients with AA	13-item electronic survey distributed to NAAF database	31% pursued mental health therapy29% sought out support groups50% used yoga or relaxation techniques as an alternative treatment
Willemse et al. (2019)[53]	Online survey on QoL	243 patients with AA	Dermatology life quality index, brief-illness perception questionnaire, brief-coping orientation to problems experienced	QoL impairment was reported by 84% of participants, with 31% reporting very to extremely large impairmentMore QoL impairment was related to a stronger illness identity (P<0.001), more concern about AA (P<0.001), and experiencing less personal control (P=0.003)

QOL – Quality of life; NAAF – National Alopecia Areata Foundation; AA – Alopecia areata