Alopecia Areata Scale (AASc)

DESCRIPTION:
The Alopecia Areata Scale (AASc) is a multidimensional assessment tool designed to evaluate the severity of alopecia areata (AA) in clinical practice. Disease severity is assessed by combining the primary criteria, or clinical features of scalp hair loss, with secondary criteria. The secondary criteria act as a severity modifier, potentially increasing total disease severity in individual patients.¹

DISEASE STATES: 
Alopecia areata

VALIDATED USES: 
Severity assessment

ADMINISTRATION METHOD:
Clinician

COMMONLY USED IN:
Clinical practice

DETAILED DESCRIPTION:
The AASc is an easy-to-use, standardized scale that captures the broader clinical spectrum of disease severity of AA. It was designed to incorporate multiple important features of AA, including clinical exams and patient history, to provide a descriptive severity rating that is easy to remember and apply in clinical practice. It is a static assessment to be used in clinical practice to measure disease severity at a single point in time. It is specifically not intended for clinical trials.¹

The AASc scale items and score can be documented in electronic medical records and may improve patient access to novel therapeutics over time. The scale involves two parts, primary and secondary criteria consisting of 5 items in total. The first part, or primary criteria, consists of a physician or qualified HCP assessing the extent of a patient’s scalp hair loss. Once scalp hair loss is assessed, and a severity level assigned, secondary criteria are examined. These include psychosocial impact, special site involvement, refractory disease, and rapid progression. If secondary clinical features are present, overall disease severity is increased one level in mild to moderate patients.¹

AASC PRIMARY CRITERIA¹

AASC SECONDARY CRITERIA¹

• Negative impact on psychosocial functioning resulting from AA
• Noticeable involvement of eyebrows or eyelashes
• Inadequate response after ≥6 months of treatment
• Diffuse (multifocal) positive hair pull test consistent with rapidly progressive AA

For mild or moderate ratings, if any secondary criteria are present, increase severity rating by one level.¹

VALIDITY:
The qualitative review of the scale is consensus-based, relying on the expertise and agreement of a panel of 22 expert dermatologists in the US using a modified Delphi approach.¹ There are ongoing studies designed to provide quantitative, psychometric-based data to validate the AASc tool.

LIMITATIONS:
No formal statistical testing, prospective or real-world patient data used to validate the scale. Not for use in tracking dynamic changes or treatment responses over time. Psychosocial assessments may introduce subjectivity. Outside of a negative impact on psychosocial functioning, nail, beard, and body hair involvement are not severity modifiers, potentially overlooking some patient subgroups.¹

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.

References: 1. King BA, Mesinkovska NA, Craiglow B, et al. Development of the alopecia areata scale for clinical use: Results of an academic-industry collaborative effort. J Am Acad Dermatol. 2022;86(2):359-364. doi:10.1016/j.jaad.2021.08.043