Clinical Assessment of Alopecia Areata Severity and Validating the Patient Experience: A Vodcast.

Alopecia areata (AA) is an autoimmune disease that is characterized by nonscarring hair loss of the scalp, face, and/or body. Three therapies have been approved for the treatment of severe AA; however, there are several different approaches for defining disease severity. Therefore, severity assessment tools are helpful in determining the appropriate treatment approach and evaluating treatment response in patients with AA. This vodcast discusses tools for assessing AA severity, including the Severity of Alopecia Tool, AA Scale, and AA Severity and Morbidity Index. It is suggested that severity assessments should include factors beyond just scalp hair loss, with the AA Scale including secondary clinical features, such as involvement of eyebrows and eyelashes. Moreover, AA can significantly impact patient's quality of life; therefore, measuring the psychosocial impacts of AA is as important as measuring the physical effects. Some of the measures to assess the negative impact on the quality of life of patients with AA include the Dermatology Life Quality Index, Alopecia Areata Symptom Impact Scale, and Children's Dermatology Life Quality Index. Behavioral changes due to AA could also be considered when assessing psychosocial impacts, particularly for adolescents, who may experience bullying, which can lead to school avoidance, anxiety, and depression. In summary, when assessing severity of AA to inform treatment decisions, clinicians should be guided by evidence-based tools, with additional consideration of factors beyond scalp hair loss, such as impairment in activity, mental health, and wellbeing. Supplementary file1 (MP4 383174 KB).