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A group of 22 US board-certified dermatologists have endorsed the alopecia areata (AA) disease severity scale. The scale assesses the extent of hair loss on the scalp, hair loss in the special hair-bearing sites, previous treatment response, psychological impact, and diffuse and rapid hair loss to evaluate the severity of AA.

Alopecia areata (AA) is a chronic autoimmune disorder involving hair loss on the body, face, and scalp. It is the second most prevalent cause of non-scarring alopecia, which has different clinical presentations in children and adults. The development of AA involves the interaction between autoimmune mechanisms and genetic factors. The severity of AA is categorized on the basis of the amount of hair loss on the scalp. This is measured using the Severity of Alopecia Tool (SALT). This study, published in the Journal of the American Academy of Dermatology, aimed to develop a disease severity scale for AA.
The study employed an advisory panel comprising 22 board-certified dermatologists. Online surveys were developed for the establishment of criteria. The AA scale was developed on the basis of responses and consensus of board-certified dermatologists from the United States. The diagnosis of mild AA was designated as ≤ 20% scalp hair loss. A 21-49% hair loss on the scalp was designated as moderate AA. A 50-100% hair loss on the scalp was indicative of severe AA. Clinicians can assess patients for the psychological impact of hair loss by asking them to rate the effect of AA on quality of life on a scale of 0–10. Scores ≥ 6 represent a significant psychological impact. The disease severity scale also assessed the involvement of hair-bearing sites other than the scalp, diffuse and rapid hair loss, the extent of hair loss on the scalp, and the patient’s initial response to treatment.
The AA scale developed for this study provides a detailed rating of the severity of the disease with multiple aspects of the disease as well as for its implementation in clinical practice. With the primary focus on the extent of hair loss on the scalp, this AA disease severity scale facilitates a reasonable assessment of the severity of disease in AA patients.
King, B. A., Mesinkovska, N. A., Craiglow, B., Kindred, C., Ko, J., McMichael, A., . . . Senna, M. M. (2022). Development of the alopecia areata scale for clinical use: Results of an academic-industry collaborative effort. J Am Acad Dermatol, 86(2), 359-364. https://doi.org/10.1016/j.jaad.2021.08.043

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