Expert Consensus on Systemic Treatment Activation and Grading Evaluation for Alopecia Areata

The expert consensus on systemic treatment activation and grading evaluation for alopecia areata (AA) in China aims to standardize assessment and management practices. Developed with input from 23 senior dermatology experts using the Delphi method, the consensus introduces a framework with 7 severity grading items and 6 systemic treatment initiation criteria. Key recommendations include using the Severity of Alopecia Tool (SALT) to classify AA severity, with systemic treatment advised for severe cases (SALT ≥50) or specific subtypes like ophiasis and diffuse AA. The consensus highlights the importance of patient self-reported outcomes and personalized treatment decisions. A simplified multidimensional assessment scale was developed, recommending systemic treatment for SALT scores ≥50 or between 20 and 50 if additional criteria are met, such as a positive hair-pull test or psychosocial impairment. This approach supports personalized care and contributes to global AA research.