Determining Alopecia Areata Severity

Determining alopecia areata severity is one of the challenges dermatologists face in treating the disease. Is the disease mild, moderate, or severe? The distinction is important because it affects treatment choices.

Not all doctors use the same criteria to determine the scale of their patients’ hair loss. This can cause confusion. Without a consistent measurement, a mild case of alopecia areata to one dermatologist may be a moderate case to another. Since 2004, some doctors have used the Severity of Alopecia Tool (SALT) to describe the disease. This scale was developed so researchers in clinical trials have a common tool for measuring hair regrowth with treatment.

The SALT score describes the percentage of scalp hair loss and ranges from 0 to 100.  A SALT score of 100 means there is complete (or 100%) scalp hair loss. A SALT score of 0 means there is no scalp hair loss. A SALT score of 50 or greater is generally considered severe disease.

Salt score for determining alopecia areata severity

This is a useful tool, but the SALT score only looks at scalp hair loss when determining alopecia areata severity, not the rest of the body. Nor does it take into account the eyebrows and eyelashes. It also doesn’t consider the emotional and psychological aspects of living with the disease.

Alopecia Areata Severity Scale

In 2022, researchers published the Alopecia Areata Scale, which they felt more accurately captured hair loss severity.

First, they looked for mild, moderate, or severe scalp hair loss.

Alopecia areata severity score

The researchers then considered other criteria including body hair loss and the psychological impact of the disease.

  • Has the hair loss negatively impacted the patient’s psychosocial functioning? For example, does the hair loss prevent the patient from going out? Is the patient depressed because of it?
  • Is there noticeable hair loss from the eyebrows or eyelashes?
  • Has the patient had treatment for at least six months without positive effect?
  • Is the hair pull test positive? To perform a hair pull test, the dermatologist takes a small section of hair (from 40 to 60 strands) from different parts of the scalp and tugs gently.

By considering measures that go beyond scalp hair loss, the new Alopecia Areata Scale will allow dermatologists to be as accurate as possible in describing the severity of the disease in each patient, which will help determine the appropriate course of treatment.

Learn what to expect when you visit your dermatologist on the Symptoms and Diagnosis page.