Skin disease is a significant problem in developing countries but its effect on quality of life has rarely been investigated. Multiethnic developing countries provide valuable opportunities to assess the influences of socio-demographic factors like social class, age and gender on the impact of skin diseases on quality of life. Lagos, Nigeria provides an ideal setting for such a study. The present study is aimed at determining the pattern of alopecia and the effect of alopecia on the quality of life of patients. This would increase awareness about possible underlying psychopathologic disorders in dermatological patients with a view to facilitating early recognition, treatment and optimizing patient management. The study population consisted of 100 consecutive adult patients who presented with alopecia to the dermatology outpatient clinic of the Lagos University Teaching Hospital. An age and sex matched control group consisting of 100 persons with no dermatologic or chronic medical disorders were also recruited from patient relatives, colleagues, friends and medical students. Structured pretested questionnaires incorporating the Dermatology Life Quality Index, modified to meet the language and cultural needs of the population were administered to both the cases and controls, followed by a dermatological examination and laboratory investigations where relevant. xii Results One hundred patients were studied who were aged between 16-61 years. The mean age was 33.65 + 10.82 years. There were 60 (60%) and 40 (40%) females. The controls also consisted of 100 patients who were age and sex matched for the patients. Most of the patients seen (68%) were aged between 21 and 40 years. Generally, all patients presented with alopecia of the scalp with just a few having involvement of other body sites (ninety seven patients had only their scalp affected, two (2%) had both scalp and eye brow alopecia and only 1 patient had involvement of all body sites). The most frequent symptoms associated with hair loss were pruritus and pain, though 30% of patients reported no symptoms at all. The most frequent causes of alopecia were keloid folliculitis (acne keloidalis nuchae and acne folliculitis nuchae) (28%), followed by alopecia areata (15%), CCLE (14%), folliculitis decalvans (9%), lichen planopilaris (6%) and dissecting folliculitis (5%).Mostly male patients presented with keloid folliculitis. Twenty one (21%) patients were observed to have sought the services of a dermatologist only after having been elsewhere for treatment. The mean score of the DLQI was 7.3 + 7.16. The total DLQI scores were significantly higher for patients (median 4, range, 0-30), than for controls (median 0, range 0-1). (P< 0.0001).The Highest DLQI scores were obtained for keloid folliculitis, alopecia areata, Chronic Cutaneous Lupus Erythematosus and lichen planopilaris. xiii There was no significant increase of DLQI scores with increasing severity of alopecia. Majority of patients (54%) had a moderate to extremely large impairment of their quality of life. Female patients had more impairment in their quality of life than the male patients. Patients had their greatest impairment in the symptoms and feelings subscale of the DLQI. Females had the highest scores here and they were also more affected in the daily activities domain. Conclusion A wholistic approach has become increasingly relevant in the management of patients with alopecia as this condition can have a severe psychological impact on an individual’s well being. This study has shown that Alopecia negatively affects the quality of life of affected patients and those with the most cosmetic disfigurements have the greatest impairment in their life quality