Treatment of Alopecia Areata in the Symptom-Fixed Chronic Phase When 25% or More of the Scalp Is Affected

This protocol addresses alopecia areata that has entered the symptom-fixed (chronic) phase, with hair loss covering 25% or more of the scalp (severity grade S2 or higher). The protocol applies across multiple alopecia areata patches, alopecia totalis, and alopecia universalis, and is applicable regardless of patient age.

• Disease phase: symptom-fixed (chronic, stable)
• Alopecia extent: S2 or higher — scalp hair loss of 25% or more
• Pattern: multiple alopecia areata, alopecia totalis, or alopecia universalis
• Age: applicable regardless of age

The structured protocol for this scenario is based on contact immunotherapy — a topical intervention in which sensitizing agents are applied directly to the affected scalp according to a defined schedule. The complete agent selection, concentration protocol, and maintenance regimen are specified in the structured evidence-based protocol.

Concentration titration, application intervals, and response-based adjustments are detailed in the full protocol.