Alopecia areata, an autoimmune condition causing unpredictable hair loss, can be difficult to track objectively. While many sufferers and doctors assess severity by sight, the Severity of Alopecia Tool (SALT) score provides a standardized way to measure scalp hair loss. This article breaks down what the SALT score is, how it’s used, its limitations, and why it’s becoming increasingly important for both treatment decisions and insurance coverage.
How the SALT Score Works
The SALT test, performed by a dermatologist, assigns a number between 0 and 100 to represent the percentage of hair loss on the scalp. A score of 0 means no hair loss, while 100 indicates complete baldness. The process involves visually dividing the scalp into four quadrants (front, back, left, and right) and estimating hair loss in each. These estimates are then averaged to produce a total SALT score.
According to Dr. Brendan Camp, a dermatologist at MDCS Dermatology, the test is quick – taking only a few minutes to complete. This efficiency makes it a practical tool for routine assessments.
Interpreting Your SALT Score
The higher the number, the more severe the alopecia. The National Alopecia Areata Foundation categorizes scores as follows:
- 0–20: Mild alopecia areata (inactive disease)
- 21–49: Moderate alopecia areata
- 50–100: Severe alopecia areata
A SALT score of 20 or higher often indicates the need for systemic treatments, rather than just topical solutions, to stimulate hair regrowth. For patients already in treatment, the SALT score serves as an objective benchmark for progress: a reduction of at least 50% in the score suggests the medication is effective.
Why Knowing Your Score Is Important
The SALT score isn’t just about measurement; it’s about access to care. Increasingly, insurance companies require it to justify coverage for alopecia treatments. By providing concrete evidence of disease severity, the SALT score strengthens medical necessity claims.
Moreover, tracking changes in your score over time helps refine treatment strategies. Dermatologists can reassess after three to five months on therapy and adjust the approach if the score hasn’t improved sufficiently.
Limitations of the SALT Score
Despite its utility, the SALT score has drawbacks. It focuses solely on scalp hair loss, ignoring other affected areas such as eyebrows, eyelashes, or body hair. Crucially, it doesn’t account for the psychological impact of alopecia – the anxiety, embarrassment, or depression that often accompany the condition.
Recognizing these limitations, researchers have developed alternative assessment tools. The Alopecia Areata Scale, for example, includes body hair loss and psychosocial effects in its evaluation. Dermatologists also use photographic documentation and qualitative descriptions (mild, moderate, severe) to gain a more holistic picture of a patient’s condition.
“The SALT score provides a useful, but incomplete, snapshot of alopecia severity. A comprehensive evaluation requires considering both the physical and emotional aspects of the disease,” says Dr. Oyetewa Asempa, a dermatologist specializing in hair loss at Baylor College of Medicine.
Conclusion
The SALT score is a valuable tool for objectively measuring scalp hair loss in alopecia areata. It aids in treatment decisions, helps patients track progress, and may be necessary for insurance coverage. However, it’s essential to remember that the score is just one piece of the puzzle. A comprehensive assessment considers the full spectrum of the disease, including psychological impact and overall health.
