New Scale to Describe Alopecia Areata Severity

September 14th, 2022

Alopecia areata is an autoimmune disease with an unpredictable course – chronic for some people, but coming and going for others, sometimes on different areas of the body. It affects people living with it in a wide range of ways beyond hair loss, often causing anxiety and depression and negatively impacting relationships and other aspects of life.

Even with this wide range of impacts, the clinical terms doctors have to classify the types of alopecia areata (AA) are largely based on a narrow description of patchy or complete scalp or body hair loss: alopecia areata, alopecia totalis or alopecia universalis.

Two leading dermatologists treating alopecia areata patients, Brett King, MD, PhD from Yale School of Medicine and Maryanne Senna, MD from Massachusetts General Hospital, are lead authors for a working group convened to change the conventional approach to the classification of alopecia areata. The group looked at a broader picture of alopecia areata to classify the condition with greater detail and accuracy that reflects how the diseases is affecting each patient and their clinical condition. This academic-industry collaborative effort, by more than 20 clinicians and alopecia areata experts from academia and industry (including Concert Pharmaceuticals), resulted in the development of a new alopecia areata disease severity scale for use in clinical practice.

publication in the Journal of the American Academy of Dermatology (JAAD) highlights the new severity scale:

The new severity scale, called the Alopecia Areata Scale (AASc) is not just based on the amount of scalp hair loss but it also captures additional key features that are commonly used by AA experts in clinical practice and will better aid clinicians in appropriately assessing severity of AA in patients.

Alopecia Areata Scale

Scalp Hair Loss

Mild AA 20% or less scalp hair loss
Moderate AA 21-49% scalp hair loss
Severe AA 50-100% scalp hair loss

If mild or moderate, the AA severity rating is increased by 1 level if 1 or more of the following is present:

  • Negative impact on psychosocial functioning resulting from AA
  • Noticeable involvement of eyebrows or eyelashes
  • Inadequate response after at least 6 months of treatment
  • Diffuse (multifocal) positive hair pull test consistent with rapidly progressive AA

With the AASc scale, physicians will now have a simple tool for the comprehensive assessment of AA severity, accounting for the multiple important clinical features of the disease.

In this exciting time of advancement of our understanding of alopecia areata and new treatments, physicians also need better patient assessment tools such as the AASc scale. This marks another step forward in the journey toward effective treatment for those suffering from alopecia areata.



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