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

Brett A. King, Maryanne M. Senna, Manabu Ohyama, Antonella Tosti, Rodney D. Sinclair, Susan Ball, Justin M. Ko, Marc Glashofer, Rodrigo Pirmez, Jerry Shapiro

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)825-834
Number of pages10
JournalDermatology and Therapy
Issue number4
StatePublished - Apr 2022
Externally publishedYes


  • Alopecia areata
  • Alopecia totalis
  • Alopecia universalis
  • Classification
  • Disease severity

ASJC Scopus subject areas

  • Dermatology


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