King et al reported a clinical scale for evaluating a patient with alopecia areata. The authors are from multiple institutions in the United States.
Patient selection: alopecia areata
Parameters:
(1) percent scalp hair loss
(2) impact of alopecia areata on psychosocial functioning
(3) involvement of eyebrows or eyelashes
(4) response to >= 6 months of treatment
(5) hair pull test
|
Scalp Hair Loss
|
Severity Grade
|
|
<= 20%
|
mild
|
|
21 to 49%
|
moderate
|
|
>= 50%
|
severe
|
In addition, there are stage modifiers that can increase mild or moderate grades by 1 level:
|
Stage Modifier
|
Finding
|
Points
|
|
psychosocial impact
|
none or minor
|
0
|
|
|
negative impact
|
1
|
|
eyebrows or eyelashes
|
not affected
|
0
|
|
|
noticeable involvement
|
1
|
|
response to therapy
|
adequate
|
0
|
|
|
inadequate
|
1
|
|
hair pull test
|
negative or patchy
|
0
|
|
|
diffuse (multifocal)
|
1
|
where:
• Positivity of the hair pull test in a diffuse pattern is consistent with rapidly progressive alopecia areata.
number of stage modifiers present =
= SUM(points for all of the parameters)
If the patient has mild alopecia and if >= 1 stage modifiers are present, then restage to moderate.
If the patient has moderate alopecia and if >= 1 stage modifiers are present, then restage to severe.
