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

February 2026 in “ Journal of the American Academy of Dermatology ”

Fanshu Li, Wenhan Zhang, Chen Wang, Jianzhong Zhang, Xiangqian Li, Cheng Zhou

ophiasis alopecia areata trichoscopic analysis histopathologic analysis vellus hair yellow dots telogen follicles typical ophiasis ophiasis with patchy AA diffuse ophiasis hair loss scalp involvement hair regrowth chronic hair loss

Studysummary In this study, researchers characterized the clinical features of ophiasis, an uncommon type of alopecia areata, and proposed a new subtype classification that may help predict treatment response and guide management, noting that ophiasis generally has a chronic and refractory nature.

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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.

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