Assessment of clinician-reported outcome measures for alopecia areata: a systematic scoping review.

Abstract

Background: Clinician-reported outcome measures (ClinROMs) are an important part of disease assessment in daily practice and clinical trials. There is a broad disagreement on the most appropriate ClinROM for a comprehensive assessment of alopecia areata (AA) severity.

Objectives: To identify the currently available ClinROMs for AA through a systematic literature search, address their practical strengths and weaknesses, and identify the road ahead for future research.

Methods: A search was conducted of the published, peer-reviewed literature via PubMed (MEDLINE) and Embase (via Ovid) databases. Articles published in English within the past 23 years (post-2000) that objectively measured AA severity were included. We did not select scoring systems that were solely based on patient-reported outcomes.

Results: The literature search identified 1376 articles, of which 27 were chosen for full-text review. Based on our eligibility criteria, 14 articles were identified, describing 16 different ClinROMs. Five ClinROMs solely measured scalp hair loss [Severity of Alopecia Tool (SALT), SALT II, Alopecia Density and Extent (ALODEX), pediatric SALT (pSALT) and Alopecia Areata Investigator Global Assessment Scale (AA-IGA)]. Three trichoscopy-based ClinROMs assessed disease activity [Alopecia Areata Progression Index (AAPI), Alopecia Areata Predictive Score (AAPS) and the coudability hair score]. Six ClinROMs exclusively assessed nonscalp areas [Brigham Eyebrow Tool for Alopecia Areata (BETA), Brigham Eyelash Tool for Alopecia Areata (BELA), Alopecia Barbae Severity (ALBAS), ClinRO Measure for Eyebrow Hair Loss™, ClinRO Measure for Eyelash Hair Loss™ and ClinRO Measure for Nail Appearance™]. Two ClinROMs assessed both scalp and nonscalp domains [Alopecia Areata Severity Index (AASI) and Alopecia Areata Scale (AASc)]. The practical strengths and weaknesses of each assessment tool are described.

Conclusions: Various practical limitations associated with their established tools have impeded the universal implementation in routine clinical practice. There is a significant need for a composite clinical severity scoring system to capture all the key severity identifiers beyond the involvement of the scalp.