In more recent years, disease severity in AA has been anchored in the extent of total scalp hair loss. Although their recommendation was to combine the AA prehypertensive type with the AA common type, they recognized that the overall validity of the groupings was poor, given that patients presented with overlapping features or that the groupings excluded consideration of other potentially relevant prognostic factors, such as family history. through analyses of 356 patients who were grouped according to age and chronicity. Īn attempt to replicate these groupings was undertaken by Sharma et al. Comparing these groupings, she then observed differences in comorbidities to develop a four-category system: AA common (single patches that spontaneously regrow), AA prehypertensive (recurrent small patches and predisposition for hypertension), AA autoimmune (persistent alopecia with associated autoimmune conditions), and AA atopic (persistent alopecia with atopic comorbidity). Using the course (pattern and persistence over time) as the external criterion, she based groupings primarily on duration of episode and onset of the disease. Subsequently, she reviewed the clinical history and course of 1989 patients who were treated within the skin clinic at Kyoto University over an 18-year period. However, Ikeda (1965) proposed that this system was inadequate because it did not account for the course of the illness. In 1902, Besnier classified AA into three types based on pattern of hair loss and inflammation: AA vulgaris, AA decalvans, and AA ophiasis.
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