Facial hair involvement and the presence of nail disease should be incorporated into alopecia areata severity assessments rather than considered separately, according to an Australian-led panel of dermatologists.

The doctors also said patients who had failed to respond to at least two topical or intralesional agents or who had rapidly progressive disease could be prescribed systemic therapy.

In a consensus statement published in JAMA Dermatology, the team identified criteria to indicate potentially worsening disease severity, independent of the percentage of scalp hair loss, as well as thresholds for initiating systemic treatment.

“These findings are anticipated to provide a crucial foundation for the development of a multidimensional tool to adequately assess [alopecia areata] severity, ensuring a comprehensive understanding of the disease burden,” they wrote.