Treatment of Alopecia Areata with Moderate-to-Severe Scalp Hair Loss (21–100% Scalp Involvement)
Clinical Scenario
This protocol applies to alopecia areata (AA) with significant scalp involvement. Moderate AA is defined as 21–49% scalp hair loss; severe AA as 50–100% scalp hair loss. The extent of scalp involvement is the primary basis for severity classification and drives treatment selection.
Treatment Approach
First-line management for scalp hair loss in moderate-to-severe AA includes topical corticosteroid therapy, with additional options available for more severe presentations — the complete sequencing and eligibility criteria are set out in the full protocol.
Treatment Goals
The aim is improvement in hair regrowth from baseline, with the ultimate goal of complete terminal hair regrowth. Treatment is continued for at least 6 months before response is assessed.
References
DOI: 10.1093/bjd/ljae385- The AA severity definitions used in this living guideline are based primarily on the extent of scalp hair loss, with limited (mild) hair loss representing 1–20% scalp involvement, moderate hair loss representing 21–49% scalp involvement and severe hair loss representing 50–100% scalp involvement.
- Offer a potent or very potent topical corticosteroid once daily for 3–6 months to people with AA who have scalp hair loss, as the first-line treatment in primary or secondary care.
- Ultimately, the aim of treatment is complete terminal hair regrowth on the scalp and any other body site affected.
- Conventionally, treatments in AA are continued for ≥ 6 months, but are stopped if there is an insufficient response.