Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the Society of Dermatology Physician Associates.

Appropriate Serological Testing for the Chief Complaint of Alopecia

Society of Dermatology Physician Associates

Publication Date: Aug 1, 2025

Page Last Updated: May 6, 2026

The GRADE system: grading recommendations

Grade	Description	Benefit vs. risk and burdens	Quality of supporting evidence	Implications
1A	Strong recommendation, High-quality evidence	Benefits clearly outweigh risk and burdens or vice versa	RCTs without important limitations or overwhelming evidence from observational studies	Strong recommendation, can apply to most patients in most circumstances without reservation
1B	Strong recommendation, Moderate-quality evidence	Benefits clearly outweigh risk and burdens or vice versa	RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or exceptionally strong evidence from observational studies	Strong recommendation, can apply to most patients in most circumstances without reservation
1C	Strong recommendation, Low- or very-low quality evidence	Benefits clearly outweigh risk and burdens or vice versa	Observational studies or case series	Strong recommendation but may change when higherquality evidence becomes available
2A	Weak recommendation, High-quality evidence	Benefits closely balanced with risks and burdens	RCTs without important limitations or overwhelming evidence from observational studies	Weak recommendation, best action may differ depending on circumstances or patients’ or societal values
2B	Weak recommendations, Moderate-quality evidence	Benefits closely balanced with risks and burdens	RCTs with important limitations (inconsistent results, methodologic flaws, indirect or imprecise) or exceptionally strong evidence from observational studies	Weak recommendation, best action may differ depending on circumstances or patients’ or societal values
2C	Weak recommendation, Low- or very-low quality evidence	Uncertainty in the estimates of benefits, risks and burden; benefits, risk, and burden may be closely balanced	Observational studies or case series	Very weak recommendations; other alternatives may be equally reasonable

Document Overview

Document Title: Appropriate Serological Testing for the Chief Complaint of Alopecia

Authoring Society: Society of Dermatology Physician Associates

Document Publication Date: Aug 1, 2025

Page Last Reviewed/Updated: May 6, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: journals.lww.com/jdpa/fulltext/2025/01930/expert_consensus_recommendations_on_appropriate.2.aspx

Source Citation: Middleton, Hayden T. DMSc, PA-Ca,b,*; Monahan, Erin DMSc, PA-C, CAQ-Dermatologyc; James, Garland MMS, PA-Cd; Grippe, Kristen MPAS, PA-Ce,f; Link, Jenny MDg; Chavez, Magdalena MPAS, PA-Ch; Damodaran, Sindhuja Sominidi MDg; Pham, Van DNP, APRN, FNP-Ci; Franley, Brittney MSHS, PA-Ce,f; Griffith, Cynthia F. MPAS, PA-Cj; O’Brien, Jack MDj; Whinery, Sarah Jane MPAS, PA-Cj. Expert consensus recommendations on appropriate serological testing for the chief complaint of alopecia. Journal of Dermatology for Physician Assistants 19(3):p 6-13, Summer 2025. | DOI: 10.1097/jdpa.0000000000000067

Document Scope, Criteria, and Use Cases

Document Objectives: Our objective, as a panel, was to formulate a clear set of guidelines in the workup of various forms of hair loss by a systematic review of clinical data and literature on the matter. The panel’s review revealed that the diagnostic laboratories and/or scalp biopsy should be considered to varying degrees depending on the type of hair loss at presentation. If there is concern for a scarring process, a biopsy should be strongly considered, while serum laboratory work may be of little benefit. In nonscarring alopecias including alopecia areata, telogen effluvium, and androgenetic alopecia, the literature supports ordering certain serologic tests based on the type of hair loss at presentation.

Scope: Assessment and Screening, Diagnosis

Diseases/Conditions (MeSH)

D000506 - Alopecia Areata

D000505 - Alopecia

D000506 - Alopecia Areata

D000505 - Alopecia

Keywords: Alopecia

Inclusion Criteria: Male, Female, Adolescent, Adult, Child

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Appropriate Serological Testing for the Chief Complaint of Alopecia

Summary of Recommendations

Figure 1. Recommended serological testing for non-scarring and scarring alopecia subtypes

Figure 2. Recommended diagnostic approach for alopecia

Scarring (cicatricial) alopecia

Nonscarring alopecia

The GRADE system: grading recommendations

Document Overview

Document Scope, Criteria, and Use Cases