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Effect of hairpieces on perceived quality of life in female pattern hair loss patients: Questionnaire based study

Dear Editor, Because hair plays important roles in self body image, hair loss remarkably affects patients’ quality of life (QOL). For hair camouflage, a wig/hairpiece is most effective and indeed we have recently reported significant preferential effect of a wig/hairpiece on perceived QOL of patients with alopecia areata (AA) and male androgenetic alopecia (AGA) using the Psychological Impact of Assistive Device Scale (PIADS). Here, we quantitatively evaluate the impact of hairpieces for patients with female pattern hair loss (FPHL) using the PIADS. This scoring is a 26-item, self-rating questionnaire, addressing three QOL indicators: (i) competence; (ii) adaptability; and (iii) self-esteem. The scores range from 3 to +3, with a 0 indicating no change and a positive score QOL improvement. Twenty females with FPHL, who were using a hairpiece, were enrolled in this study from July 2012 to February 2013 at the wig salon of Aderans (Aderans Osaka Salon, Kita-ku, Osaka, Japan) after informed consent had been obtained. Their ages ranged 46–83 years (median, 70.5 years). Psychosocial QOL was measured using the Japanese version of PIADS (JPAIDS) and degree of satisfaction with their own appearance with the hairpiece was measured using a 0–10-cm visual analog scale (VAS). The severity of FPHL was evaluated using Tajima’s rating from 1–6 by comparing with the standard photographs of hair loss severity. As a result, two patients were evaluated as 2, three patients as 3, three patients as 4, seven patients as 5 and five patients as 6. This study was conducted in accordance with the ethical principles originating from the Declaration of Helsinki, reviewed and approved by an institutional review board. For statistics, the change from zero (baseline in PIADS) was examined by Mann–Whitney U-test as described in our recent studies. The correlation between various scores was evaluated by Spearman’s rank correlation coefficient. P < 0.05 was considered significant. The mean standard deviation of the VAS was 8.02 1.43, showing sufficient satisfaction with hairpieces. The PIADS consists of 26 items measured on 7-point scales. The 12 items comprise the competence scale, six on adaptability and eight on self-esteem. In Table 1, the total PIADS score and mean of each scales are shown. The total PIADS score and the QOL indicators such as competence, adaptability and self-esteem significantly increase from 0 (P < 0.001, Table 1). Although our recent reports showed that the total PIADS score and the indicators of competence, adaptability and self-esteem positively correlated with VAS for satisfaction with the patients’ appearance in AA and male AGA, there was no significant correlation between them (P > 0.05). Further, while the total PIADS score and indicators of competence and adaptability positively correlated with baldness severity of male AGA, there was no significant correlation between these parameters and Tajima’s score of FPHL. These results indicate that hairpieces have significant preferential effect on perceived QOL of FPHL patients but their mental distress is intricately affected by factors other than hair loss severity. Alternatively, the no significant correlations may be ascribed to the old age of the enrolled patients.