Efficacy, Insurance Coverage Drive Alopecia Areata Treatment Preferences

People with alopecia areata (AA) value hair regrowth efficacy, insurance coverage, and flare-up prevention the most when considering possible treatments, according to a new report.

Those findings are based on a cross-sectional questionnaire sent to patients recruited by the National Alopecia Areata Foundation. The results were published in a letter to the editor published in JAAD International.¹

The authors noted that previous research has suggested that people with severe AA have low rates of treatment satisfaction. For example, a study published in 2022 found that just 17% of patients with severe disease reported that they were satisfied with their therapy.² The study also found that therapy switching was common among people with AA.

While previous research has evaluated treatment satisfaction among people with AA, the new study aimed to see if treatment preferences varied significantly based upon disease severity.¹

The questionnaire was sent to patients between November 2022 and January 2023. Five hundred people responded, which translated into a 58% response rate. All of the participants were adults who had previously experienced hair loss and who had seen a provider in the 12 months prior to the survey.

Most of the participants (80%) were White, 86.2% were female, and approximately two-thirds (66.2%) had severe AA. All but 20 of the respondents were insured.

Patients were asked to rate the importance of several factors on a scale of 1 to 7, with 7 representing a factor that had a high impact on their likelihood of using a potential treatment.

The survey found that hair growth efficacy was the top priority across all severity levels, with a mean score of 6.51 (standard deviation 1.28). After that, though, treatment preferences differed slightly. Among patients with severe AA, the next priorities were insurance coverage, followed by efficacy at flare-up prevention. In patients with moderate AA, insurance coverage, followed by side effects and flare-up prevention, were the next-highest priorities. Patients with mild AA listed flare-up prevention, followed by insurance coverage, as their next priorities.

Price and contraindications were ranked fifth and sixth in terms of importance in the overall sample. Other factors were less important, the authors said.

“If treatments are affordable and effective, individuals with AA are flexible with treatment length, frequency, and route of administration,” they said.

The investigators also ran logistic regression analyses to see if patient characteristics other than disease severity—such as age, sex, education level, and health insurance status—affected responses. However, the only significant intergroup difference that analysis identified was that patients who had health insurance placed a higher value on insurance mitigating treatment costs compared to people without insurance.

The authors said the study had low sample diversity, so they said its findings may not be generalizable to underrepresented groups, such as men and people outside the United States. They also said their respondents likely had high baseline AA-related health literacy since patients needed to have seen a physician recently in order to be included in the study.

Future research should attempt to connect AA therapy experiences and preferences to quality of life and psychological impacts, the authors explained. They also said that studies with a larger sample size might better elucidate the experiences of patients with AA.

“Until then, continued focus on overall efficacy and financial accessibility is key for promoting patient-centered treatments,” they said.

References

1. Biba U, Sanchez K, Gregoire S, et al. Treatment preferences by disease severity in alopecia areata: A cross-sectional survey study. JAAD Int. 2025;24:303-305. Published 2025 Dec 12. doi:10.1016/j.jdin.2025.11.023

2. Fridman M, Ray M, Gandhi K, Shy ME, Mostaghimi A. Treatment Patterns and Treatment Satisfaction Among Adults with Alopecia Areata in the United States. Adv Ther. 2022;39(12):5504-5513. doi:10.1007/s12325-022-02338-4