Defining Severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework

Abstract

Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. As a clinically heterogeneous disease, various classification systems have evolved for defining its severity. In this high-level review of the literature, we discuss the traditional classification systems for AA severity and their strengths and weaknesses. Most recent classifications have focused on the extent of scalp hair loss as a defining feature, but additional clinical aspects of the disease, including location, pattern, and duration of hair loss as well as impact on the patient's quality of life, are also relevant. These various components have typically been used unidimensionally to classify patients. We propose a multidimensional framework to define AA severity that incorporates multiple patient- and illness-related domains. Using such a framework, dermatologists may better assess the severity of the disease for the individual patient beyond the extent of hair loss.

Keywords: Alopecia areata; Alopecia totalis; Alopecia universalis; Classification; Disease severity.

Fig. 1

Components for assessing disease severity, including signs and symptoms of AA, impact on quality of life, and treatment history for qualitative evaluation in classification of severity. Questions under each component are attributes for consideration with potential greater implications of severity from top to bottom. AA-IGA Alopecia Areata Investigator Global Assessment, mo months, SALT Severity of Alopecia Tool