King et al reported a clinical scale for evaluating a patient with alopecia areata. The authors are from multiple institutions in the United States.
Patient selection: alopecia areata
(1) percent scalp hair loss
(2) impact of alopecia areata on psychosocial functioning
(3) involvement of eyebrows or eyelashes
(4) response to >= 6 months of treatment
(5) hair pull test
Scalp Hair Loss
21 to 49%
In addition, there are stage modifiers that can increase mild or moderate grades by 1 level:
none or minor
eyebrows or eyelashes
response to therapy
hair pull test
negative or patchy
• Positivity of the hair pull test in a diffuse pattern is consistent with rapidly progressive alopecia areata.
number of stage modifiers present =
= SUM(points for all of the parameters)
If the patient has mild alopecia and if >= 1 stage modifiers are present, then restage to moderate.
If the patient has moderate alopecia and if >= 1 stage modifiers are present, then restage to severe.
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