Standardizing the Management of Alopecia Areata: Results from a Delphi Panel of Italian Experts

Alopecia areata (AA), a chronic autoimmune condition with variable severity of clinical presentation, affects patients' quality of life (QoL). In Italy, a lack of awareness and standardized practices contributes to inconsistent patient care.

This study aimed to develop a consensus on the diagnosis, management, and treatment of AA among Italian dermatologists, using the Delphi technique. Twenty dermatologists participated in the tailored Delphi. The questionnaire covering diagnosis, management, and treatment approach, was developed by a steering committee and validated by five validators before administration. Statements were evaluated on a 5-point Likert scale, with consensus defined as ≥70% agreement.

All statements achieved the agreement threshold in the first round. Key practices were the need for comprehensive diagnostic evaluation, trichoscopy use, and assessment of autoimmune comorbidities. Management approaches emphasized empathetic communication, QoL assessment, and multidisciplinary collaboration. Treatment strategies prioritized individualized approaches based on the Severity of Alopecia Tool score, disease activity, and patient-specific factors. Systemic therapies were recommended with SALT ≥50 and active/worsening disease.

The study proposes a framework for standardizing AA care in Italy, with attention to patient-centered and personalized approaches. This work provides practical guidance for improving diagnostic and management of AA, while addressing its psychosocial impact.