Alopecia areata
ICD-10 L63 · ICD-11 ED70.2

Chronic-Phase Alopecia Areata with 25% or More Scalp Involvement: Treatment Approach

This protocol addresses patients in the symptom-fixed (chronic) phase of alopecia areata presenting with an alopecia area of 25% or more of the scalp (S2 severity or higher), encompassing multiple alopecia areata, alopecia totalis, and alopecia universalis.

Clinical scenario
The affected population includes individuals with established, persistent hair loss at S2 grade or above — meaning at least 25%–49% of scalp surface affected — as well as those with complete scalp loss (alopecia totalis) or total body hair loss (alopecia universalis). The chronic, non-progressing nature of the disease in these patients distinguishes this scenario and informs the treatment selection.
Chronic (symptom-fixed) phase S2+ (≥25% scalp) Alopecia totalis Alopecia universalis
Treatment approach
The structured protocol for this scenario centres on a photochemotherapy-based intervention — specifically relevant for adult patients with the most extensive forms of the condition. The full regimen involves a defined combination strategy; the complete sequence, options, and clinical decision points are available in the protocol. Full regimen details, including therapy selection and combination strategy → see protocol.
Instant Access to Structured Evidence-Based Regimens
References

DOI: 10.14924/dermatol.134.2491

  • Contact immunotherapy may be performed in symptom-fixed-phase patients with S2 or higher multiple AA, AT, or AU regardless of age.
  • S2: 25%–49% hair loss of the scalp.
  • PUVA therapy may be primarily performed in adults with AT/AU.
  • As the advantage of PUVA therapy has not been sufficiently demonstrated, it may be performed as a regimen of combination therapy for AT/AU for which contact immunotherapy is ineffective.
View source ↗