Darchini-Maragheh Emadodin, Moussa Anthony, Rees Huw, Jones Leslie, Bokhari Laita, Sinclair Rodney
Department of Medicine, The University of Melbourne, VIC, Australia.
Sinclair Dermatology, Melbourne, VIC, Australia.
Clin Exp Dermatol. 2025 Jan 27;50(2):267-278. doi: 10.1093/ced/llae320.
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.
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.
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.
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.
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.
临床医生报告的结局指标（ClinROMs）是日常实践和临床试验中疾病评估的重要组成部分。对于全面评估斑秃（AA）严重程度的最合适ClinROMs，存在广泛的分歧。
通过系统的文献检索，确定目前可用于AA的ClinROMs，阐述其实际的优点和缺点，并确定未来研究的方向。
通过PubMed（MEDLINE）和Embase（通过Ovid）数据库对已发表的、经过同行评审的文献进行检索。纳入过去23年（2000年后）以英文发表的客观测量AA严重程度的文章。我们未选择仅基于患者报告结局的评分系统。
文献检索共识别出1376篇文章，其中27篇被选作全文评审。根据我们的纳入标准，识别出14篇文章，描述了16种不同的ClinROMs。五种ClinROMs仅测量头皮脱发情况[脱发严重程度工具（SALT）、SALT II、脱发密度和范围（ALODEX）、儿童SALT（pSALT）和斑秃研究者整体评估量表（AA - IGA）]。三种基于皮肤镜检查的ClinROMs评估疾病活动度[斑秃进展指数（AAPI）、斑秃预测评分（AAPS）和可信赖毛发评分]。六种ClinROMs专门评估非头皮区域[斑秃的布莱根眉毛工具（BETA）、斑秃的布莱根睫毛工具（BELA）、须部斑秃严重程度（ALBAS）、眉毛脱发的ClinRO测量工具™、睫毛脱发的ClinRO测量工具™和指甲外观的ClinRO测量工具™]。两种ClinROMs评估头皮和非头皮区域[斑秃严重程度指数（AASI）和斑秃量表（AASc）]。描述了每种评估工具的实际优点和缺点。
与其现有工具相关的各种实际限制阻碍了其在常规临床实践中的普遍应用。迫切需要一种综合临床严重程度评分系统，以涵盖头皮受累之外的所有关键严重程度指标。
