Alopecia Areata Beyond the SALT Score: Patient Selection, Monitoring, and Long-Term Management

Alopecia areata (AA) may be measured by the percentage of scalp hair loss, but the numbers don’t tell a full story. A patient with limited visible involvement may still be experiencing profound changes in confidence, relationships, identity, and daily life.

In this episode of The Spot Check, Jamie Restivo, PA-C, is joined by Matthew Brunner, PA-C, for a walk through the alopecia areata patient journey, from initial assessment and treatment selection to baseline testing, follow-up, and long-term management with deuruxolitinib (Leqselvi).

Brunner begins with the SALT score, explaining how it gives clinicians an objective way to quantify scalp hair loss and track response over time. But severity should also account for rapid progression, eyebrow or eyelash involvement, previous treatment response, and psychosocial burden. Alopecia areata is not cosmetic. It’s a chronic autoimmune disease that can disrupt a patient’s fundamental sense of self.

When considering a JAK inhibitor, Brunner recommends moving beyond a rigid treatment ladder. Patient goals, medical history, comorbidities, reproductive plans, previous therapies, and tolerance for risk all belong in the discussion. Counseling should be deliberate, not rushed. “This isn’t a conversation you have standing with your patient,” he says.

The episode also gets into the practical details of starting deuruxolitinib, including baseline labs, tuberculosis and viral hepatitis screening, vaccination status, pregnancy considerations, lipid monitoring, and the CYP2C9 genotype testing required before treatment. Brunner then outlines his approach to follow-up, using SALT scores, photography, adherence checks, and subtle signs of improvement such as fine vellus hairs, reduced shedding, or early eyebrow and eyelash regrowth.

Just as important is preparing patients for the pace of treatment. “This is a marathon, it’s not a sprint,” Brunner says. Meaningful regrowth may take months, and improvement doesn’t mean the disease has been cured.

From patient selection and safety counseling to the first signs of response, this episode provides a grounded framework for treating alopecia areata earlier, monitoring it thoughtfully, and helping patients stay the course.

Disclaimer: This episode of The Spot Check is supported by an industry sponsor. Topic areas and guest participation may be informed by sponsor interest. The sponsor may have had the opportunity to review the content for medical accuracy; however, the clinical discussion and opinions expressed are those of the host and guests.

This program is intended for health care professionals and is provided for educational purposes only. It should not be interpreted as medical advice. Clinicians are responsible for reviewing prescribing information and applying independent clinical judgment within their scope of practice.