fig7

Figure 7. Self-estimated severity scores by patients complaining of hair loss versus clinician’s estimates of pattern and severity. Female and male patients appear, respectively, in the left and right panels. All patients received the questionnaires and cartoons on their first visit to the clinic. They were not given any assistance during the reporting to be returned at the second visit. This prevents undue interferences between observer and patient evaluations. From the initial 304 females, we retrieved 294 duly completed files. From the initial 110 males, self-scoring documents were lacking for four subjects, thus 106 were retained. The other questionnaires were considered as lost to follow-up. The dermatologist’s classification appears as “DermPattern” in the shaded areas (blue) while the “self minus derm” (red bars) reflect the differences between patient’s self-estimated classification and the clinical severity attributed by the dermatologist. Positive bars indicate overestimation while negative bars indicate underestimation by patients as compared with the dermatologist’s evaluation. In the pool of 294 females who completed the self-administered questionnaire, there is no apparent surface when dermatologist found no pattern (cases on the left side of the vertical bar; no pattern (NoP) scored as 0). The cases on the right side of the vertical bar appear as positive shaded areas (light blue) reaching up to 1, 2 or 3 (scale from -3 to +3; y-axis) for females with a Ludwig pattern rated as LI, LII or LIII, respectively. Only 5% of the pool of 294 females (14 occurrences in total; eight in NoP and six in LI) overestimated their condition and attributed a more severe score. Complete agreement between subjective estimates by females and clinician was recorded in 38% of females while underestimation occurred in 57% of the female patients (167 cases; one grade for 140 subjects and two grades for 27 subjects). Similarly, in males (all pattern hair loss; scale from -5 to +5), only 2.5% overestimated the severity (one HII by two grades and one HIII by one grade), while 85% and 72% of HIV and HV, respectively, underestimated the clinical class attributed by the investigator.