Skip to main content

The Alopecia Areata Severity and Morbidity Index (ASAMI) Study: Results From a Global Expert Consensus Exercise on Determinants of Alopecia Areata Severity.

JAMA dermatology

Authors: Anthony Moussa, Michaela Bennett, Dmitri Wall, Nekma Meah, Katherine York, Laita Bokhari, Leila Asfour, Huw Rees, Leonardo Spagnol Abraham, Daniel Asz-Sigall, Fitnat Buket Basmanav, Wilma Bergfeld, Regina C Betz, Bevin Bhoyrul, Ulrike Blume-Peytavi, Valerie Callender, Vijaya Chitreddy, Andrea Combalia, George Cotsarelis, Brittany Craiglow, Rachita Dhurat, Jeff Donovan, Andrei Doroshkevich, Samantha Eisman, Paul Farrant, Juan Ferrando, Aida Gadzhigoroeva, Jack Green, Ramon Grimalt, Matthew Harries, Maria Hordinsky, Alan Irvine, Victoria Jolliffe, Spartak Kaiumov, Brett King, Joyce Lee, Won-Soo Lee, Jane Li, Nino Lortkipanidze, Amy McMichael, Natasha Atanaskova Mesinkovska, Andrew Messenger, Paradi Mirmirani, Elise Olsen, Seth J Orlow, Yuliya Ovcharenko, Bianca Maria Piraccini, Rodrigo Pirmez, Adriana Rakowska, Pascal Reygagne, Lidia Rudnicka, David Saceda Corralo, Maryanne Senna, Jerry Shapiro, Pooja Sharma, Tatiana Siliuk, Michela Starace, Poonkiat Suchonwanit, Anita Takwale, Antonella Tosti, Sergio Vañó-Galván, Willem I Visser, Annika Vogt, Martin Wade, Leona Yip, Cheng Zhou, Rodney Sinclair

IMPORTANCE: Current measures of alopecia areata (AA) severity, such as the Severity of Alopecia Tool score, do not adequately capture overall disease impact.

OBJECTIVE: To explore factors associated with AA severity beyond scalp hair loss, and to support the development of the Alopecia Areata Severity and Morbidity Index (ASAMI).

EVIDENCE REVIEW: A total of 74 hair and scalp disorder specialists from multiple continents were invited to participate in an eDelphi project consisting of 3 survey rounds. The first 2 sessions took place via a text-based web application following the Delphi study design. The final round took place virtually among participants via video conferencing software on April 30, 2022.

FINDINGS: Of all invited experts, 64 completed the first survey round (global representation: Africa [4.7%], Asia [9.4%], Australia [14.1%], Europe [43.8%], North America [23.4%], and South America [4.7%]; health care setting: public [20.3%], private [28.1%], and both [51.6%]). A total of 58 specialists completed the second round, and 42 participated in the final video conference meeting. Overall, consensus was achieved in 96 of 107 questions. Several factors, independent of the Severity of Alopecia Tool score, were identified as potentially worsening AA severity outcomes. These factors included a disease duration of 12 months or more, 3 or more relapses, inadequate response to topical or systemic treatments, rapid disease progression, difficulty in cosmetically concealing hair loss, facial hair involvement (eyebrows, eyelashes, and/or beard), nail involvement, impaired quality of life, and a history of anxiety, depression, or suicidal ideation due to or exacerbated by AA. Consensus was reached that the Alopecia Areata Investigator Global Assessment scale adequately classified the severity of scalp hair loss.

CONCLUSIONS AND RELEVANCE: This eDelphi survey study, with consensus among global experts, identified various determinants of AA severity, encompassing not only scalp hair loss but also other outcomes. These findings are expected to facilitate the development of a multicomponent severity tool that endeavors to competently measure various disease impact. The findings are also anticipated to aid in identifying candidates for current and emerging systemic treatments. Future research must incorporate the perspectives of patients and the public to assign weight to the domains recognized in this project as associated with AA severity.

PMID: 38324292

Participating cluster members