Clinical Characteristics, Subtype Classification, and Prognostic Factors of Ophiasis: A Retrospective Study of 150 Patients with Therapeutic Implications

This study retrospectively analyzed 150 patients with ophiasis, a challenging form of alopecia areata, to propose a novel three-subtype classification based on scalp involvement patterns. The study found that ophiasis predominantly affects females, has a prolonged disease duration, and exhibits lower activity and regrowth rates compared to other alopecia areata subtypes. Trichoscopic and histopathologic analyses indicated significant vellus hair involvement, abundant yellow dots, minimal inflammation, and increased telogen follicles, suggesting chronicity. The proposed subtypes—typical ophiasis, ophiasis with patchy AA, and diffuse ophiasis—showed different prognoses, with ophiasis with patchy AA having a more favorable regrowth. This classification system can predict treatment response and guide early intervention and stratified treatment, despite limitations such as sample size and retrospective design.