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

December 2025 in “ Chinese Medical Journal ”

Cheng Zhou, Xufeng Du, Weixin Fan, Hong Fang, Yiqun Jiang, Ji Li, Ying Luo, Zhongfa Lyu, Longquan Pi, Yongjun Piao, Yan Ru Tan, X F Wang, Aihua Wei, Jinjin Wu, Xuegang Xu, Dingquan Yang, Qinping Yang, Shuxia Yang, Xingqi Zhang, Hengguang Zhao, Fenglin Zhuo, Xiangqian Li, Wenyu Wu, Jianzhong Zhang, Chinese Society of Dermatology; on behalf of Working group for hair diseases, Chinese Association of Rehabilitation Dermatology; Working group for hair diseases

alopecia areata SALT ophiasis diffuse alopecia areata systemic treatment psychosocial distress

TLDR Experts recommend starting systemic treatment for alopecia areata when the condition is severe or causes significant distress.

The study establishes a consensus on a multidimensional assessment scale for alopecia areata (AA) in China, addressing the need for a more comprehensive evaluation beyond the traditional Severity of Alopecia Tool (SALT). Through the Delphi method, involving 23 experts, consensus was reached on 54 items relevant to AA assessment and management, including 8 key definitions and classifications. The study recommends systemic treatment initiation for patients with a SALT score ≥50 or those with specific clinical factors, such as ophiasis or diffuse AA, inadequate response to previous treatments, or significant psychosocial distress. This approach aims to provide personalized care and improve patient outcomes, contributing valuable data to global AA research.

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

Research cited in this study

research SALT II: A New Take on the Severity of Alopecia Tool for Determining Percentage Scalp Hair Loss

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community Study: There is 70x Higher Unconjugated DHT in Feces Compared To Blood Levels in Young Adults - Gut Microbiota Manages DHT Recycling and Metabolism

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