Publish in this journal
Journal Information
Vol. 109. Num. 5.June 2018
Pages e33-e36Pages 385-464
Download PDF
More article options
Vol. 109. Num. 5.June 2018
Pages e33-e36Pages 385-464
Original Article
DOI: 10.1016/j.adengl.2018.04.013
Validation of a Cross-cultural Adaptation of the Hair Specific Skindex-29 Scale to Spanish
Validación de una adaptación transcultural al idioma español de la escala Hair Specific Skindex-29
A. Guerra-Tapiaa,
Corresponding author

Corresponding author.
, A. Buendía-Eismanb, J. Ferrandoc, on behalf of the Hair Specific Skindex-29 validation group 1
a Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Facultad de Medicina, Universidad Complutense, Madrid, España
b Facultad de Medicina, Universidad de Granada, Granada, España
c Servicio de Dermatología, Hospital Clínico, Barcelona, Facultad de Medicina, Universidad de Barcelona, Barcelona, España
Related content
Actas Dermosifiliogr 2018;109:388-910.1016/j.adengl.2018.03.016
E. Martínez-García
This item has received
Article information
Full Text
Download PDF
Figures (2)
Tables (5)
Table 1. Items on the Hair Specific Skindex-29 Scale.
Table 2. Grade of Alopecia According to the Ebling/Sinclair Scale (Cases).
Table 3. Difference in Scores Between Cases and Controls in the Spanish Version of the Hair Specific Skindex-29 Questionnaire.
Table 4. Results for the Score on the Hair Specific Skindex-29 Questionnaire by Age Group (Cases Only).
Table 5. Matrix of Varimax-Rotated Components in the Factor Model of the Hair Specific Skindex-29 (Cases Only).
Show moreShow less
Background and objective

Female androgenetic alopecia (FAA) has considerable impact on quality of life. Our analysis of the clinical scales available in the literature to measure the impact of FAA led us to choose the Hair Specific Skindex 29 (HSS29) as the most appropriate for adaptation to Spanish as a tool for following patients in treatment for FAA. This tool assesses disease impact on quality of life over time so that treatments can be tailored to patients’ needs. The HSS29 score reflects impact in 3 domains (emotions, symptoms, and functioning) on a scale of 0 (no effect) to 100 (maximum effect). The scale is useful in routine clinical practice, and patients can respond to all items in 5minutes.

Materials and methods

We followed recommended procedures to produce a cross-cultural adaptation of the scale. The process involved forward translation of the questionnaire to Spanish followed by back translation by 2 native speakers of the original language (English) and revision as needed after discussion and consensus by a committee of 3 expert dermatologists. The comprehensibility of the resulting translation was assessed in a test–retest step. Next, the psychometric properties, reliability, and construct validity were assessed. Sensitivity and specificity were evaluated with the area under the receiver operating characteristic (ROC) curve, reliability with Cronbach's α, and construct validity by factor analysis using a Varimax rotation. Face validity was also assessed during the process. The intraclass correlation coefficient (ICC) was calculated in the test–retest step.


A total of 170 women with FAA and 30 control subjects completed the cross-culturally adapted Spanish questionnaire. A subgroup of 15 subjects responded a second time between 1 and 2 days after their first session (test–retest). Sensitivity and specificity were excellent according to the area under the ROC curve (0.98; 95% CI, 0.97–0.99), and high reliability was reflected by a Cronbach's α of 0.96. Factor analysis showed that the items were grouped in the same 3 domains (functioning, emotions, and symptoms) as in the original version of the scale. There were no significant differences in the mean (SD) scores on the test and the retest (23.05 [16.42] vs 22.01 [17.72], respectively). The ICC of over 0.9 indicated excellent correlation between responses to the adapted Spanish version.


The psychometric properties of the Spanish version of the HSS29 are similar to those of the original scale. The Spanish HSS29 is a useful tool for assessing quality of life in FAA.

Quality of life
Female androgenetic alopecia
Validation and cross-cultural adaptation
Introducción y objetivo

La alopecia femenina tiene un impacto importante sobre la calidad de vida. Analizadas las escalas publicadas para medir este impacto, hemos considerado que la escala Hair Specific Skindex 29 (HSS29) es la más adecuada para el objetivo del proyecto: obtener una herramienta en español para el seguimiento en el tratamiento de la alopecia androgenética femenina, que permita medir la evolución del impacto en la calidad de vida y adaptar e individualizar el tratamiento a las necesidades de la mujer. La escala HSS29 puntúa entre 0 (nula afectación) y 100 (total afectación) y discrimina 3dominios (emociones, síntomas y función), siendo una escala útil en la práctica clínica diaria, autocumplimentada en menos de 5 min.

Materiales y métodos

Se realizó el proceso metodológico establecido para la validación transcultural de una escala, a través de la traducción y retrotraducción por 2traductores nativos en la lengua original de la escala (inglés), con el consenso de un comité de 3dermatólogos expertos cuando fuera necesario. La versión consensuada se sometió a un pretest con pacientes para comprobar la correcta comprensión. Posteriormente, se determinaron las características psicométricas de la escala, la fiabilidad y su validez de constructo (sensibilidad y especificidad mediante curva ROC, fiabilidad por alfa de Cronbach, constructo por análisis factorial con rotación Varimax), de apariencia y la validez test-retest (correlación intraclase).


Ciento setenta mujeres con alopecia y 30 controles respondieron a la escala. Un subgrupo de 15 pacientes realizó el test-retest y respondieron a la escala tras 1-2 días de la valoración inicial. La escala presentó una excelente sensibilidad y especificidad medida por la curva ROC 0,98 (intervalo de confianza del 95%, 0,97-0,99) y una muy elevada fiabilidad con alfa de Cronbach de 0,96. El análisis factorial mostró que los ítems se distribuyeron en las 3dimensiones (funcional, emociones y síntomas) como en la escala original. No se encontraron diferencias significativas entre los valores del test y del retest (23,05 ± 16,42 vs 22,01 ± 17,72, p = ns) y el coeficiente de correlación intraclase fue excelente (superior a 0,9).


La versión española de la escala HSS29 presenta unas características psicométricas similares a la escala original y es una herramienta útil para la evaluación de la calidad de vida en alopecia femenina.

Palabras clave:
Calidad de vida
Alopecia androgenética femenina
Validación y adaptación transcultural


These are the options to access the full texts of the publication Actas Dermo-Sifiliográficas (English Edition)

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe to

Actas Dermo-Sifiliográficas (English Edition)

From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
902 88 87 40
Calls from outside Spain
+34 932 418 800
Actas Dermo-Sifiliográficas (English Edition)

Subscribe to our Newsletter

Article options
es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?