Beyond the SALT Score: Evaluating Alopecia Areata More Holistically

In 'Beyond the SALT Score: Evaluating Alopecia Areata More Holistically,' the expert dermatologist examined the following critical questions:

Can you give background on the Scalp Area and Hair Loss Tool (SALT) score which is used in alopecia areata (AA)?

A novel scoring system for alopecia areata was developed in 2022. What are the key components of this scoring system and why might it be more applicable to clinical practice?

The panelist discussed the SALT scoring system, which divides the scalp into four regions — the frontal parietal scalp, bilateral preauricular and postauricular scalp, and posterior scalp — and evaluates the percentage of hair loss in each area to produce a composite score ranging from 0 to 100, with a score below 20 serving as the primary efficacy benchmark in JAK inhibitor clinical trials. Dr. McMichael outlined the key limitations of the SALT score, noting that it does not capture eyebrow or eyelash involvement, psychosocial impact, disease activity, or response to prior treatments — all of which are clinically meaningful dimensions of disease burden. She then described the novel scoring system published in the Journal of the American Academy of Dermatology (JAAD), developed collaboratively by dermatologists, the National Alopecia Areata Foundation, and pharmaceutical partners, which augments the SALT score by incorporating eyebrow and eyelash involvement, psychosocial burden, disease activity as measured by pull test, and inadequate response to prior therapies — allowing patients to be reclassified at a higher severity level to support access to systemic treatment.

Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, 'From Specialist Roles to Unmet Needs: Advancing Alopecia Areata Care,' further explores alopecia areata, highlighting the multidisciplinary team involved in diagnosis and management and the unmet needs with prior treatments that drove the development of novel therapeutics including FDA-approved JAK inhibitors.