This protocol addresses alopecia areata that has entered a symptom-fixed, chronic phase with scalp hair loss affecting 25% or more of the scalp (S2 grade or higher). It covers presentations ranging from multiple alopecia areata patches through alopecia totalis and alopecia universalis.
Patients in this category have extensive, stable involvement — from 25–49% scalp loss (S2) up to complete scalp or total body hair loss — in a prolonged, chronic course.
For alopecia totalis or universalis following a prolonged course, the structured approach includes patient-centered, flexible supportive management. The full regimen — including the complete sequence of interventions and decision points — is available in the protocol.
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.
For the treatment of AT or AU with a prolonged course, flexible management, such as the confirmation of a will to continue treatment and a proposal for the use of a wig, is necessary.
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