Clinical characteristics, subtype classification, and prognostic factors of ophiasis: A retrospective study of 150 patients with therapeutic implications - 23/03/26

Doi : 10.1016/j.jaad.2026.02.068

Fanshu Li, MD ^a, Wenhan Zhang, MD ^a, Chen Wang, MD ^b, Jianzhong Zhang, MD ^a, Xiangqian Li, MD ^a,^⁎ , Cheng Zhou, MD ^a,^⁎

^a Department of Dermatology, Peking University People's Hospital, Beijing, China

^b Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

^∗ Correspondence to: Cheng Zhou, MD and Xiangqian Li, MD, Department of Dermatology, Peking University People's Hospital, No 11 Xizhimen S St, Beijing 100044, China. Department of Dermatology Peking University People's Hospital No 11 Xizhimen S St Beijing 100044 China

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 23 March 2026

Abstract

Background

Ophiasis is an uncommon, clinical heterogeneous, and therapeutically challenging presentation of alopecia areata (AA). Evidence guiding meaningful subtyping and its implications for management remains limited.

Objective

To characterize the clinical, trichoscopic, and histopathologic features of ophiasis and evaluate a novel subtype classification for prognostic and management relevance.

Methods

A retrospective study of 150 patients with ophiasis was performed. Clinical, trichoscopic, and histopathologic data were collected and compared with patchy AA, acute diffuse and total alopecia, and alopecia universalis/alopecia totalis cohorts. A novel three-subtype classification of ophiasis based on scalp involvement patterns was proposed and evaluated its prognostic value.

Results

Ophiasis showed a female predominance, prolonged disease duration, and lower activity and regrowth rates than other AA subtypes. Trichoscopy demonstrated significant vellus hair involvement, abundant yellow dots, and minimal activity signs, while histopathology revealed minimal inflammation and increased telogen follicles, supporting chronicity. The 3 subtypes—typical ophiasis, ophiasis with patchy AA, and diffuse ophiasis—exhibited markedly different prognoses. Ophiasis with patchy AA showed comparatively favorable regrowth. Subtype classification independently predicted treatment response.

Limitations

Sample size, retrospective design.

Conclusion

Ophiasis is chronic and refractory. Our proposed classification system can accurately identify patients with poorer prognosis, guiding early intervention and stratified treatment.

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Key words : alopecia areata, classification, ophiasis with mono-hairline, ophiasis with patchy AA, ophiasis with diffuse scalp hair loss or sparse, ophiasis

Abbreviations used : AA, ACE, ADTA, DLE, FFA, SALT, SD, UVFD

Plan

Introduction

Methods

Patients

Classification of ophiasis

Statistical analysis

Results

Clinical characteristics of ophiasis and comparative analysis with AT, AU, and ADTA

Trichoscopic features of ophiasis compared with AT, AU, and ADTA

Histopathologic characteristics and chronicity indicators of ophiasis

Clinical and trichoscopic differentiation among 3 newly proposed subtypes of ophiasis

Prognostic outcomes and treatment response according to ophiasis subtypes

Discussion

Conclusion

	Funding sources: This work was supported by grants from the National Natural Science Foundation of China (No. 82373504 ) and the Natural Science Foundation of Beijing (No. 7254439 ).
	Patient consent: All participants provided written informed consent for participation in this study.
	IRB approval status: The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by Institutional Medical Ethics Review Board of Peking University People's Hospital (2024PHB234-001).
	Data availability statement: Data are available from the corresponding author upon reasonable request.