Title: The Impact of Socioeconomic and Demographic Disparities on Time from Symptom Onset to Diagnosis in Scarring Alopecia

Author: Thomas Issa, BS1; Carolyn Goh, MD1;

1Division of Dermatology, University of California, Los Angeles, Los Angeles, California, USA

Area of Concentration (Petal): Research

Specialty: Dermatology

Keywords: Scarring Alopecia, Time to Diagnosis, Health Disparities

Background:

Scarring alopecia (SA) refers to a group of hair loss conditions characterized by permanent follicular destruction and replacement with scar tissue. While treatment data are limited, early diagnosis and intervention are critical to slow disease progression.

Objective:

To examine whether socioeconomic factors (race, income, insurance type) and SA subtype are associated with time from symptom onset to diagnosis.

Methods:

We conducted a secondary analysis of the Cicatricial Alopecia Patient Assessment & Impact Report (CAPAIR) survey, evaluating individuals diagnosed with SA. Time to diagnosis was calculated as the difference between age at symptom onset and age at diagnosis. Descriptive statistics summarized demographic and clinical variables. One-way and two-way ANOVA assessed the effects and interactions of demographic factors on time to diagnosis.

Results:

Among 1,034 individuals, the most reported SA subtypes were frontal fibrosing alopecia/lichen planopilaris (FFA/LPP) [731 (70.7%)] and central centrifugal cicatricial alopecia (CCCA) [234 (22.6%)]. Black/African American patients had significantly longer time to diagnosis (5.47 ± 6.67 years) than white patients (2.87 ± 5.10, P<0.001). Individuals earning $80,000–$100,000 experienced longer time to diagnosis (5.62 ± 8.48) compared to higher-income groups (3.00 ± 4.80, P=0.001). Patients with non-Medicare government insurance faced significant longer time to diagnosis (5.48 ± 7.01) than those with Medicare (3.31 ± 5.83, P=0.042) or private insurance (3.46 ± 5.59, P=0.049). CCCA presented earlier (38.90 ± 13.99 years) and was associated with longer time to diagnosis (5.67 ± 7.16) than FFA/LPP (51.29 ± 12.45, 2.88 ± 5.04; P<0.0001). CCCA was more common in Black patients [195 (84.0%)] than white patients [29 (12.5%)], while FFA/LPP predominated among white patients [670 (92.0%)] vs Black patients [26 (3.6%)], χ²(4, N=total)=664.0, p<0.0001. Two-way ANOVA revealed SA subtype had the strongest influence on time to diagnosis, with Black patients and those with CCCA experiencing longer time to diagnosis across income and insurance groups.

Conclusions and Relevance:

Race, income, insurance type, and alopecia subtype are associated with time from symptoms onset to diagnosis  in SA. Targeted awareness, access to care, and research are essential to reduce disparities and promote timely diagnosis and treatment.